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Your Dilemma: When Insurance Does Not Cover a Birth Center

Posted By Administration, Wednesday, January 25, 2017

You have made the decision to use a birth center as it is the right fit for your family.  You have a low-risk pregnancy and are not expecting any complications.  You look forward to your extended visits with your midwife during your pregnancy and then having her by your side throughout labor and delivery.  You want the home-like atmosphere of the birth center and are ready to involve your family.  

With a push to control general medical care and hospital costs, birth centers can be a great solutions to the high costs of delivery a baby in the hospital.  The problem is that insurance companies still are struggling to cover the costs associated with having a baby in a birth center and the midwife care.  

This is odd because birth center care of the mother and baby through delivery is less expensive than more traditional hospital stays. With childbirth being the single largest hospital expense for employers the birth center should be a welcome addition to an insurance plan.  With lower overhead, lower c-section rate, and mandatory (sometimes unnecessary) medications for delivery, hospitals stays are typically very expensive.  

So, what should you do if your insurance company has denied your initial request to use a birth center or midwife?  

Call Your Insurance Company

Sometimes your request to use a birth center will be denied because of a coding issue in the system or a misunderstanding of a processing agent who does not understand your request.  The birth center should be accustomed to this happening and help you through the process.  Explore options to change and/or upgrade your insurance coverage to allow for the birth center option.  Call your insurance agent, do your research on the company website, and ask questions about others you can speak with as well as options you may have.  

Talk with your Employer

More than likely your employer has selected your health care package to provide comprehensive coverage but within a budget.  It is possible that the individuals making the selections do not think to add a midwife or birth center option because they just did not know to ask.  Allowing this option could in fact save money on the plan since using the midwife and birth center options are more cost effective than traditional routes.  Additionally, your employer may make an exception or allot certain discretionary budget to your request or help you start a flexible spending account to manage the expenses.  You are never going to know if you do not ask.

Can You Manage the Expense on Your Own?  

Your birth center will give you a very accurate picture of the costs.  Costs to vary from center to center, region to region so it is almost impossible to tell you what it “should cost.”  If you are determined to use a birth center you have options for the expense.   Make sure to have a very frank conversation about the decision with the birth center you chose and you are giventhe best rate possible for their care.  Many birth centers can offer payment plans to make the cost more affordable over time.

While we all like to think that our healthcare options are for us to make on our own, sometimes health insurance does prevent care based on the limits to the policies.  Use all available resources at your disposal to work out the best solution for you.  

Tags:  birth options  health insurance 

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