The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Insurance Coverage for Homebirth

Here are some ideas about letter writing to insurance companies to cover midiwery and homebirth:

• Have the insurance policy holder call the company themselves to state they want their homebirth to be covered
• Have the insurance policy holder contact their human resources department if the insurance is through their employer
• Have the insurance policy holder write a letter stating that they pay the insurance premium and would like their homebirth covered

HMO’s, Medi-Cal, and Champus (Military insurance) are the main reason claims are not paid.  I feel that until we can change these types of policies, there will be problems in getting claims paid.  To help make this change, bill every claim and insurance policy (even if you know they will deny the claim).  Claims that are billed need to be regularly followed up on - calls to the insurance companies (at least once a week), faxing letters of explanation for the services, etc.  Eventually, insurance companies will see that there is a demand for homebirth; it is not going away!  Once you receive a denied claim a letter and appeal should be submitted.  Having a billing service will provide all this for you.  My billing clerk only charges me a fee for paid/approved claims, that means I don’t have to pay for billing services on denied claims to HMO’s.

The main reason HMO’s don’t pay is that they only pay providers in their group (they have a list of providers).  There is usually a group of medical doctors and nurses who decide on paying or denying claims for HMO’s.  In general, if a provider is not part of their group they don’t pay.  Becoming part of their group for LM’s usually involves having malpractice insurance (amounts are around 1 million/3 million that most require) and having a “supervising” physician.  This is one policy that must change for homebirth to be covered with most HMO’s.  HMO’s need to start offering coverage for more midwives.

Medi-Cal and Champus need to have a policy change as well.  This will take some time to accomplish (they are government controlled).  We must all be diligent in our current billing and appealing processes to bring about changes in the insurance industry.  Susan recently wrote the following as part of a  letter to an HMO: “The current health care trend is that more people are becoming involved with natural health care.  As this happens more homebirths are being performed.  In my business, I have seen that more women want homebirth (with a provider of their choice, licensed midwife) to be offered as part of the covered insurance choices.  Many insurance companies have already started to offer other natural health care choices such as chiropractic, physical therapy, and acupuncture.”  Homebirth with midwives is the next area in the list of allied health care to be added as covered service with insurance companies.  With persistence change will happen.

To inquire about using a billing service, call:

Susan Weckter of S & W Medical Billing
         791 B Street ? Lincoln, CA  95648
        Phone:  916-645-0861
E-mail:  weckter@jps.net