Jay and I are eagerly awaiting the birth of our first child, due in less than three weeks now. We have two registered midwives who have taken great care of us throughout the pregnancy, and will be at our house for the birth next month. They have provided wonderful prenatal care and advice without excessive intervention, which was exactly what we wanted. Jay and I are not at all opposed to traditional medical care if we are sick or injured. When Jay hurt his knee, we went to the best knee surgeon in the world. My parents have spent the last seven years in an out of hospitals and research programs looking for the best care possible for my father, who has Wegener’s Granulomatosis. But I’m pregnant – not sick. And my pregnancy has progressed very smoothly – due in large part to the effort our midwives and I have put into it. So I have no need for doctors or hospitals.

Jay and I have individual health insurance, and in Colorado there is no such thing as home-birth coverage on individual policies. In fact, there are only a handful of health insurance carriers in Colorado that offer maternity coverage on individual policies at all, and for most people, the coverage provided isn’t worth the extra premium dollars. So we’ve paid the $3000 fee ourselves, as do many of our midwives’ clients.

We were talking about billing and health insurance coverage with our midwives this week, and they described the process they have to go through to get reimbursed for their clients who have health insurance policies that provide out-of-network coverage for registered home birth midwives. They each have billing services that serve as an intermediary between the midwives and the health insurance carriers, but they also each spend an inordinate amount of time tracking down money from clients’ insurance companies. They have to jump through far more hoops than an obstetrician, even though they ultimately save the health insurance carriers a huge chunk of money compared with bills generated from hospital births. In some cases, the health insurance companies send the payment to the insured, instead of to the midwives, which further complicates the situation, since the midwives then have to contact their client and ask for the money – something that is highly unlikely to happen when a doctor is doing the billing.

In Colorado, home birth midwifery is a regulated industry – these are not just women who hang out a shingle and start delivering babies on a whim. They are highly skilled professionals with very good statistical outcomes for low-risk pregnancies. Given that their fee is about a third of the cost of an uncomplicated hospital birth, and that the likelihood of more expensive procedures like c-sections is far lower with planned home births, wouldn’t it make more sense for health insurance companies that cover maternity care to encourage home births and pay the midwives promptly and respectfully? These are all employer group policies, which cover maternity care just like any other medical expense on the policy. Typically the insured pays the deductible and then a coinsurance percentage, but the majority of the expenses for a pregnancy are covered by the health insurance companies. So a provider with equally good overall outcomes, fewer interventions (all of which cost the insurance company money), and a far lower fee should be generating lots of goodwill in the health insurance industry. And yet our midwives still have to struggle more than most obstetricians to get even a portion of their small fee reimbursed.