Talking to Your Insurance Company about Midwifery Coverage

Contact your insurance company as early in your pregnancy as is feasible. When you call, have your insurance card in front of you so you know policy numbers, etc. Write down the date and the name of the person you talk with, in case you have to retrace your path later. Even if your midwifeís billing company will be calling your insurance company for information on services and charges your insurance policy will cover, it is a good idea for you to contact them as well. This way you can compare notes and be sure you understand what is covered. What if My Insurance Says They Donít Cover Midwives? Occasionally CPMís (Certified Professional Midwife) are covered as nurse practitioners or CNMís rather than simply midwives. If the person you are talking to can’t find a listing for midwife or CPM, ask them to check for coverage under Licensed Midwife, Certified Nurse Midwife (CNM), Nurse Practitioner, or Registered Nurse. In Virginia my designation for licensing is “certified professional midwife “or CPM. This is a newly recognized credential and they may not be familiar with it yet. Sometimes they donít have CPMís in the listing, but do cover CNMís and that may be important to distinguish, if they do cover CNMís they might or might not cover CPMís. Questions About Birth and Maternity Coverage

1. Does my policy have maternity coverage?
2. When does this coverage become effective?
3. Does this insurance cover the services of a Midwife for maternity care? Which midwifery licenses are covered?
• Certified Professional Midwife (CPM)
• Licensed Midwife (LM)
• Certified Nurse Midwife (CNM)
• Nurse Practitioner (NP)
4. Does this insurance cover the services of a Midwife for women’s health care and annual exams?
• Certified Professional Midwife (CPM)
• Licensed Midwife (LM)
• Certified Nurse Midwife (CNM)
• Nurse Practitioner (NP)
• Registered Nurse (RN)
5. Is homebirth with a Midwife a covered service?
• Certified Professional Midwife (CPM)
• Licensed Midwife (LM)
• Certified Nurse Midwife (CNM)
• Nurse Practitioner (NP)
• Registered Nurse (RN)
6. Will this insurance pay a CPM who is in private practice?
7. How much is my deductible per year?
8. Is that for the whole family, or will I have to start over with another deductible for a newborn?
9. What percentage does my insurance pay after the deductible is met?
10. What is the calendar year for this policy (e.g. Jan. to Dec. or Oct to Sept.)?
11. How much of my deductible is already met for this calendar year?
12. What happens if we go into another year during maternity care? Do we have to start over and pay another deductible?
13. What is the most that I could be required to pay out-of-pocket as an individual?
14. Does the maternity care included in this policy pay for prenatal care, birth services, and postpartum care?
15. Are these services to be billed “globally”, or as individual visits?
16. Do I have to pay part of the cost of each visit (co-pay)? How much?
17. There are supplies necessary for a homebirth, which are billed separately. Are these supplies covered by my policy? Note: Supplies vary for each birth. Homebirth is an enormous cost saver for the insurer, so supplies need to be recognized as an important part of coverage, just as the insurer covers supplies used in a hospital birth. This cost is beyond what the insurer pays for the provider services. (Negotiate with them for payment if they state they do not pay. State that you can provide a list of necessary supplies.)
18. My chosen provider for homebirth bills a percent of a facility fee in addition to the provider fee, with CPT code 59899 for bundled services at a home birth, including the assistant and the hours the midwife works as a labor RN. The PKU test for the newborn is also captured in this bundled charge. Will this be recognized by my insurance?
19. If pre-authorization is necessary, how do I go about that?
20. Please verify the exact address the claims should be sent to.

Questions About Newborn Coverage

1. Does my insurance cover a newborn exam at the time of birth?
2. Is there any stipulation as to who can provide this newborn care?
3. Does my insurance cover newborn care when it is provided in any location?
4. How soon must I call to add the baby to my policy?
5. How many well baby visits are allowed, and within what kind of time frame?
6. Is there a co-pay for well baby visits?
7. Do I have to call you to verify my choice of providers?
8. How are lab fees covered?
9. Is a referral from a primary care provider required?
10. Can this referral be retroactive?
11. Do you require any special forms or documentation?

Thanks to Peggy Franklin, who shared this advice and these questions with us!