Understanding Insurance for Maternity Care

Are you thinking you’d be better off financially if you use your insurance at the hospital?  While sometimes that is the case, most of the time it’s not. The world of insurance and hospital charges is a strange and convoluted one.  The most frustrating aspect is that you don’t know how much it’s going to cost you until it’s too late.

There are several key pieces of information you need to know about your insurance to estimate your costs:

Do you have maternity coverage?

It is common to have medical insurance, but not maternity coverage.  If this is the case for you, none of the expenses related to the pregnancy or birth will be covered.

Is it a personal or family policy?

Medical insurance is very specific about who is covered.  If you have a family policy, the baby should be covered as long as you add the baby within 30 days of birth.  BEWARE, if you miss this window, the baby’s expenses will NOT be covered, and you will not be able to add the baby to the policy until the next open enrollment period or for a full year, depending on the policy.  Be sure to check with your insurer about the time lines and process for adding the baby to the policy.  If you have an individual policy, you may not be able to add the baby, and the baby’s expenses will not be covered.

Deductible

The deductible is the amount you must pay per year before the insurance will pay anything.  It is quite common to have a $5000 or higher deductible.  This means if your birth costs $8000, you will pay the first $5000 before the insurance will pay anything.  Keep in mind, deductibles are often calculated per person covered under the policy.  That means there may be a separate deductible for the mother and the baby.  If the deductible is $5000 per person, you’ll pay the first $5000 of the mother’s expenses, and the first $5000 of the baby’s expenses.

Sometimes the maternity deductible is separate from the regular deductible, which means any deductible satisfied by other medical expenses are not applied to the maternity deductible, and you have to start over for the pregnancy.  Deductibles are calculated annually, starting over on the renewal date of the policy (usually, but not always, January 1 of each year).  If you are due mid-year, some maternity expenses may be incurred in one policy year and some in another.  In this case, you will have to satisfy two deductibles for the mother.

What is maternity co-pay or coinsurance?

The co-pay or coinsurance is the percentage of the expenses you will pay after the deductible is satisfied.  A common co-pay amount is 20%, although it might as easily be 50%.  Check this with your insurer.

What are your out-of-pocket maximums?

Some policies have an out-of-pocket maximum (the one ray of good news in all this).  That means that once you pay a certain amount out-of-pocket, the insurance picks up 100% of the rest.  Often there are both individual and family out-of-pocket maximums, and sometimes there is a separate maternity out-of-pocket maximum.  Consult your insurer to find out how this will be handled under your policy.

It’s Like This

Here is an example of the out-of-pocket costs for a natural (no epidural) delivery at a hospital with insurance that has a $1500 deductible and and 80/20 co-pay (meaning the insurance pays 80% of costs after the deductible is satisfied):

(These charges do not include the cost of an epidural.)

Hospital Delivery
Facility Charge $37,049*
Doctor or Midwife Charge $6,711*
Newborn Facility Charge $6,870*
Newborn Provider Charge $370*
Total $44,287* UVA will give a cash discount for non-insurance of $11,477* equaling a total of $32,810* for non-insurance paying normal natural vaginal deliveries
With Insurance
Deductible for Mother $2,500
Deductible for Baby $2,500
20% of remaining balance $1,940*
Total Out of Pocket $6,940* – $12,496 is the average out of pocket cost for families choosing hospital birth with the best insurance coverage available. 

*These figures are estimates only (but based on actual hospital reported charges), because unfortunately, when you birth in-hospital there will be many fees you cannot predict.

Does Insurance Cover My Care With a Midwife?

Home birth deliveries are being covered with increasing frequency! A $500 deposit paid to retain our services is required.  Reimbursement and refunds will be settled after insurance claim payments are finalized. Though we are not covered as an in-network provider for any insurance companies, our billing service may be able to help you get reimbursement from your health insurance company. 

Midwifery care even without insurance can be affordable because it can be similar to the deductible that some parents pay for maternity care in the hospital since a normal, uncomplicated vaginal delivery can cost thousands which doesn’t include doctor’s fees, prenatal or newborn care. Studies show that no matter where you give birth, if a woman has had quality, midwifery care during pregnancy, she greatly increases her likelihood of a healthy, positive birthing experience. And we believe this is invaluable.

Some financial options for you to consider:

  • HSA and FSA are accepted
  • Insurance billing is provided by SLB Billing if you are interested in seeking reimbursement from your health insurance company.​ To determine and estimate your insurance coverage for maternity care, you can use the link below to initiate a Verification of Benefits by filling out the Client Information Form here.
  • Another option to be aware of are Medical Cost Sharing companies (similar to an insurance companies). For example: Samaritan Ministries is happy when their clients choose a home birth and fully support that choice. www.samaritanministries.org Other Medical Cost Sharing Companies that will reimburse families for midwifery care are: Christian Healthcare Ministries www.chministries.org and Liberty Health Share www.libertyhealthshare.org
  • MedLoan is also available to help with financing your homebirth www.medloanfinance.com

For families with a high deductible or who are without insurance, an out of hospital birth can also provide tremendous savings! All fees must be paid in full to the midwife by 37 weeks. If you choose to utilize either SLB billing or a Medical Sharing Company your fees will be reimbursed to you directly after your care with Birth & Biodynamic Midwifery is complete. Cash payment plans will be made available to you. All credit card transactions include an additional 3.5% convenience charge. Birth & Biodynamic Midwifery offers a unique sliding scale fee system that allows out-of-hospital birth to be more accessible for those dedicated to the Midwifery Model of Care.