Costly Care: Lack of insurance options in midwifery care leaves new mothers confused

Many insurance carriers have strict rules on which type of midwives are covered
Not all midwives are covered by insurance, and some parents have received unexpected bills. Reporter Caresse Jackman and Photojournalist Michael Estrabillo.
Published: Feb. 14, 2023 at 9:53 AM CST
Email This Link
Share on Pinterest
Share on LinkedIn

InvestigateTV - Giving birth can be a costly experience, especially for mothers who prefer to have their baby at home. That costly experience, some parents say, could be fixed if insurance expanded to include all at-home births with a midwife.

California resident Vanessa Garcia Clark and her husband, Andres, know first-hand how much out-of-pocket expenses can add up following the birth of their son, Emmett.

Garcia Clark wanted a non-traditional birth, something more personal than a hospital room. She hired a midwife and delivered Emmett at home.

“Our midwife was pretty clear about it upfront, that we would pay cash for her services, in increments throughout the pregnancy, and she would provide us with a super bill at the end of the care that we could then submit to insurance. The entire amount that was asked to be reimbursed by insurance was $9,700,” Garcia Clark said.

Clark paid her midwife in full and waited on their insurance company to reimburse them.

“You have a healthy, happy satisfied customer, and you’re paying less than you would’ve if I had gone elsewhere. After the fact, once they saw the bill, I thought they’d be like, ‘Oh okay, that makes sense. We should do this more often,’ and of course that isn’t what happened,” Garcia Clark said.

Her benefits administrator, which processes claims on behalf of their family’s employer-funded insurance, denied the claim. She sent the company a request for an internal appeal, arguing that because of the Affordable Care Act prenatal, obstetrical and well-child care are all covered services under their health plan and therefore cannot be denied, regardless of the provider she chose.

But the company denied her claim again, saying Clark’s midwife “was not certified nurse midwife” and “because certified midwives are not covered” they’ll uphold the denial.

Different Types of Midwifery Care

According to the American College of Nurse Midwives, a certified nurse midwife is a registered nurse, who also has completed intensive graduate-level studies in Midwifery. 

A certified midwife also goes through a graduate-level nurse midwifery program. The main difference is they are not a registered nurse.

Then there are also certified professional midwives who go through training specific to the birthing field but may not have taken a traditional nursing or healthcare college track. That’s the type of provider Clark’s midwife is, and she’s also licensed in the state of California. Different states handle licensing and requirements differently.

All of these definitions pertaining to who qualifies for reimbursement and why are part of what has Clark so confused and outraged.

“I think the system is built to kind of demoralize and exhaust you,” Garcia Clark said.

“There should be federal laws that mandate that women have the right to choose”

Dr. Mairi Breen Rothman is the Director of M.A.M.A.S., which stands for Metro Area Midwives and Allied Services, located in Takoma Park, Maryland.

“One of the problems in this country is that we have split midwifery up into different kinds of midwives. When it comes to home births, each of those kinds is totally qualified to do that kind of work,” Rothman said.

Rothman’s work helped change a law in Maryland that made sure insurance companies covered services, like a Pap smear, which helps detect signs of cervical cancer. Rothman believes insurance reform pertaining to midwifery care is needed across the nation.

“When you go to a certified nurse midwife or a certified midwife or a certified professional midwife, no matter what kind of midwife, when you go to any of those midwives, they’re all going to do the same things that happen at any prenatal visit with an obstetrician, plus they’re going to do a whole bunch of more stuff. They’re going to do nutritional counseling and checking on the person’s mental health,” Rothman said.

It’s why Rothman feels insurance companies should expand their coverage to acknowledge all midwives, helping make the mother’s cost a little bit easier.

“There should be federal laws that mandate that women have the right to choose what kind of provider they want and where they want to have their birth,” Dr. Rothman said.

The Cost of At-Home Births

Dr. David Anderson is a Professor of Economics at Centre College in Kentucky. He collected data on at-home births and found the average cost of a home birth is around $4,650. That number is significantly below existing cost estimates if it’s a low-risk birth in a hospital setting. Research estimates the average cost for a vaginal hospital birth in the United States is $13,562.

“If 1% of women shifted from having a birth in the hospital to having a birth at home, that would be a collective savings for our country of $321 million. So, the decisions, the policies by government and the policies by insurance companies matter a lot,” Anderson said.

Since November, InvestigateTV has contacted Clark’s insurance administrator multiple times by email and phone asking for an explanation of her denial. A spokesperson responded by email stating:

“As a third-party administrator of employer self-funded health plans, Collective Health adjudicates member medical claims consistent with plan requirements and applicable law. Our policy is to respect privacy by declining to comment publicly on specific claims.”

Midwifery care and at-home births have been around for generations. According to the National Vital Statistics Reports, the interest in home births saw a small spike during the pandemic, going from 38,506 in 2019 to 45,646 in 2020, an increase of 18.5% and the highest level since at least 1990.

Consumer Advice for Parents Seeking At-Home Births

When it comes to non-traditional birth and the lack of insurance options, Dr. Elisabeth Rosenthal, a physician and Editor-In-Chief of Kaiser Health News, says don’t give up.

“I mean there are some people, some midwives who do non-traditional births in hospitals, so you may be able to work something out ahead of time,” Rosenthal said.

Rosenthal added that before you give birth, ask your insurance provider very detailed questions so that you are not caught by surprise.

“You can say, ‘Yes, I’d like a payment plan.’ Before you do that though, ask, try to negotiate. Say, ‘Wow $9,000 sounds like a lot of money for an uncomplicated birth. How about I give you $5,000?’ And the really weird thing is often they’ll say $5,000 upfront, we’ll take it. So never say, ‘I’ll just pay the first bill.’ Always say, can I give you less and will you take it?” Rosenthal said.

Garcia Clark doesn’t regret her decision. She just hopes that by speaking out about the issue, it will shed light on a topic, she feels, is rarely discussed.

“I really, really wanted this to be an option for other women too. Women who maybe don’t have the time, the energy, the financial resources, the linguistics, the understanding of the system to do this,” Garcia Clark said.