Midwifery Today Community

Can anyone explain to me the legal status of midwives in IL, and why the Direct entry Midwives are not certified by the state of IL?

I also found on my insurance policy that home births are not covered, but practicing midwives in an approved facility are. How do I go about talking to my insurance company about the possibility of having a home birth? Do I even need to go through my insurance, as I've heard that sometimes a home birth is way less expensive and other times a midwife will help you by cutting costs for working w/ you uncovered. 

I'm just a little confused about the whole process. I've placed some of the recommended reading on hold at my local library and I'll be reading up. I've already done some reading and A LOT of searching on the internet. I've found some great blogs and an awesome community. I'm just sorry that I wasn't aware that in some states it was such a problem. 

I'm not currently pregnant, but I'm looking into my options for when I do. I want to be prepared and have as much information as possible.

Thank you.

 Hi there.

The only "legal" midwives in Illinois are CNMs. There is a "Big Push" to legalize CPMs too but we're not there yet.

There are many underground options available but obviously- your insurance won't cover those.

What type of insurance do you have? The only "approved facilities" currently in Illinois are hospitals. We got birth centers passed but it will be some time before they exist in practice.

I think that you can contest the coverage but often times- it's not the insurance company that is restricting the coverage- it's your employer! I found that out while trying to get a breastpump covered by my BCBS insurance.

Home birth is quite affordable out of pocket as well and that is always an option.

What books are you reading?

My dad lives in Cary so I'm out there quite a bit. Feel free to PM me if you want to get more info. What community are you involved in?

I'm in Berwyn

I have BCBS, it's a PPO through my employer. I've been trying to figure out if going to a hospital is worth my time, b/c I'm a little aprehensive of the stigma attached to them. If I did go to a hospital, I'd want a midwife and doula, no drugs, no intervention unless absolutely nessecary, no cutting, etc. I have a regular GYN. I'm going to her for my yearly appt. in a week. I don't believe that she practices out where I am, b/c currently she's located in Arlington Heights, which would mean finding someone that would attend near my house and I don't even know if that's what I would want. 

I'm fairly certain that I would like a home birth. But, I'm not interested in fighting w/ the insurance company, or my employer. I believe it will be a lost cause and undo stress. Though, I'm not unwilling to step up to bat for this particular issue.

I've read, Ina May's Guide to Childbirth, Pushed by Jennifer Block, Active Birth by Janet Balaskas and part of Baby Catcher by Peggy Vincent. I have a few more on hold at my local library, more so about the pregnancy apsect this time. My husband and I are looking to start trying at the end of the summer and I'd like to treat my body with the upmost care before hand. I also grabbed a pre publication book from where I work that's supposed to be out in May called "Getting Ready to Get Pregnant" by Michael C. Lu. It's all about preconception and is very interesting.

I've not officially "joined" any communities, though I've reached out in IL and just started coresponding with them. I've been following Citizens for Midwifery and Illinois Families for Midwifery. I've contacted my state reps and tried to keep on top of things since finding out the situation in IL, hoping that I can help. 

I'm glad you responded to me and I hope to keep a dialogue going. Thanks!

Erin

Hi Erin,

Welcome to the forums.

I felt the same way as you are regarding fighting for insurance when I was looking into having a homebirth.  That was one of the things that made me look for a homebirth midwife that had an insurance biller to help out with that.  They really took a huge load off me, so I didn't have to fight with our insurance company.  I never even spoke to them once during the whole process (though I know my midwife called them a few times).  I also have a PPO (not BCBS)  My midwives charge 5000 for everything, but they bill with the global insurance code for prenatal/birth/postpartum which comes out to about 6,500 (that included care of the newborn as well).  Insurance paid 3000 and I ended up paying 2000 which stinks, but its better than nothing.  I did appeal this after the birth (in writing) because some of what they did in their system of determining my eligible benefits seemed really unfair.  In reality, if they hadn't played their nasty insurance games, they should have paid 1000 more than that.  They would not budge on it, saying that what was billed was well over the reasonable and customary charges for my geographical area.  (BS, IN THE HOSPITAL, even with a midwife, they would have been paying at least 2 TIMES the amount my midwives were asking for).  That really got me going, so when I have my next homebirth, I actually think I wouldn't mind being a bit more involved in the process of bothering my insurance company to get payment more fully.  Check out this article.  Its pretty specific to NY, but I wonder if many insurance companies across the nation use Ingenix to determine (or rather lowball) the reasonable and customary charges for out of network:

http://attorneypages.com/hot/ny-attorney-general-accuse-insurers-of-fraud.htm

BCBS has also received a subpoena along with 15 other insurance companies.

Having said that, homebirth midwives often negotiate with you and work out barters and payment plans, etc. 

As with many things, uncharted territory can seem a bit scary and overwhelming, but picking a homebirth midwife and getting them paid by insurance is not as bad as it seems.  I personally think the hastle was well worth it.

Good luck!!!

Thanks so much for your encouragement and relating your homebirth/insurance experience. It helps to know that there is a possibility to have insurance involved with some of the payment. However, it explicitly says that "homebirths are not covered" in my insurance plan. Bummer, I know. I intend to at least inquire with them when the time comes, but I'm not getting my hopes up. It's unfair the way that the insurance companies skew things within the system. 
I plan on asking my regular GYN/OB some specific questions to get her stance on the subject, only b/c I'm still not sure what to do. Like I said, I'm aprehensive of the whole hospital birthing situation. (Which is weird b/c my mom is a nurse...)

Anyway. 

I'm on a mission to make the right descision for myself and eventual babies, and again, I thank you for your reply.

Erin

Hey Erin,

You're welcome.  That is a bummer.  Is that clause in writing in your insurance plan or was that a statement made by someone over the phone (could it have been a misinterpretation of the person because they're unfamiliar with homebirth)?  It sounds like you've also been in contact with your local people to see about the legal status.  I know in NY, at least, insurance companies are obligated to pay for services provided by licensed midwives regardless of the place of service, but I don't know about other states.  Also, I wonder if there's a sneaky way of sort of omitting the place of birth.  :-) 

One good way to find out about the local culture/feel of local hospitals and caregivers is talking to Bradley childbirth educators and/or LaLeche league leaders.  They often know about the local gems.

This is the exact wording in my insurance packet - "NOTE: Home births are not covered, even if attended by a mid-wife."

We'll see. I suppose I should start looking for a midwife soon, if I intend on having a homebirth. And maybe look more into what insurance companies are legally obligated to cover in IL.

Thank you for the advice on talking to the Bradley childbirth educator and LLL leaders. That's an excellent idea.

  I do not many clients who have insurance, so am no authority on the subject, but here is what I do know.

Sometimes its a semantics game. If one is planning a hospital birth, there are provider charges & facility charges. Of course for a homebirth there are no facility charges, so in one sense it makes perfect sense that "homebirths are not covered"  The provider charges are a separate matter, many of the people working at the ins co's are not familiar with homebirths, so won't know that.

 For the last two or three years now all HCP's nationwide must have an NPI (National Provider Identifier) number in order to be paid by ins co's. So, if your midwife doesn't have one, tell her to get one. Its just a registry, no special qualifications needed. If she has one, they should cover her charges.

One of my clients was originally denied coverage for her homebirth, but she persisted in arguing with them untill they did. I believe what she got them on was, since none of their in-network providers within 100 miles offered homebirth services, they would cover me at in-network rates no less!

Others with insurance have seen that the fee for my services are less than their co-pay would be for a hospital birth, so are willing to pay out of pocket, and not hassle with their insurance providers, but have submitted my reciepts for their flex accounts.

Marlene