How to get your medical insurance to pay for a birth center birth

I’m reposting this with permission of Petra (who wrote it) from one of my online groups. I’ve got two reasons: one, it’s important information, and two, I’m still feeling under the weather and a guest-post is a good way to post without having to post.

The problem: many health insurance plans will pay for a hospital birth with an obstetrician but not for a birth center birth with a midwife. For many women, however, a birth center is the optimal choice. Therefore, this was how Petra got her birth center birth to be paid for. Women who want a home birth can probably follow the same procedure to get their home birth paid for.

And now for Petra’s information:

My husband said that he ended up doing nothing to get us approved at the Birth Center – he let the billing department handle it. So I called the billing lady at the birth center and she told me that it may differ depending on your flavor of BCBS, but she has been able to get approvals (including maybe mine) this way:

– Call hospital you plan to deliver at, PLUS another local area hospital and get their estimated costs as billed to insurance (this is important! don’t get rates for someone paying OOP!) to that plan for:

  • An uncomplicated, unmedicated vaginal delivery (IV hydration and other “standard” procedures will be included), plus standard hospital stay, plus whatever costs are associated with the baby’s care
  • A delivery with epidural pain medication (she said do this one because even if you would choose something else, it’s the most common method of pain relief)
  • A C-section, plus the approximate C-section rate at that hospital (they may not be forthcoming with this; you may have to do your own research)

Then have the birth center submit these quotes with a letter stating:

  • Their charges for an uncomplicated vaginal delivery
  • Which (if any) methods of pain relief are available at the birth center and what they will bill for use (if anything)
  • What costs (if any additional) are associated with baby’s care
  • Their transfer rate
  • Their C-section rate (obviously, this is a subset of the transfers)
  • The savings that they stand to see on YOUR delivery based on unmedicated birth at the hospital minus standard birth center coverage (now, this is not the real number because likely the insurance will not pay all they are billed, etc., but they can do that calculation their own self)

Also obtain from the birth center:

  • A statement of philosophy behind their standard of care
  • Information on their maternal morbidity and mortality and infant morbidity and mortality (these will probably be transfers plus in-center-births, but still)

She told me that she’s had to go ’round and ’round with a few insurance companies, but with persistence, she’s gotten all but one to agree to pay (or agree to some arrangement) for a birth center birth.