We are trying to decide between two different hospitals or two different homebirth midwifery groups.
Is there a way we can find out before we commit to one what the general costs after insurance should be for a normal delivery? I'm not finding anything on our insurance company's website.
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Are they both in your network? I think it will be harder to get information from insurance companies since they have different contracted rates with different Drs. I would call each group and ask them what their contracted rate with your insurance company is. From there you can determine your out of pocket based on your plan coverage.
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I think you'd need to find out if they are all in-network vs. out-of-network - out of network tends to have different costs. Then you'll want to look into what your out of pocket max is for in-network vs out-of-network so you know the max you'd be paying, regardless. Then, let's say your insurance will pay 80% after your deductible - you'll have to find out what the average cost at the particular hospital/birthing center is to get an idea of what you'll end up with having to pay.
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@PurplePumps: My doctor and both hospitals are in network! The midwifery group coverage is a complete mystery... I know people who've been covered 100%, and people who have gotten zero.
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@Boheme: The midwifery group might be complicated, because different providers may be in-network and others aren't and they all work at the same place! I think you'll have to get a list of the providers there and then you can search through your insurance to see if they are in-network. You probably have to call your insurance though in general and ask if homebirths in general are covered or not, provided that the midwife attending is in-network or something?
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@Adira: I might also call the billing company the midwives use, and see if they can offer any insight. I know some of them will ok it if your midwife is a CNM as opposed to a CPM, so I'd have to be picky within my practice who is on call during my birth - at my practice two are CNMs, two are CPMs!
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I was able to call my insurance and ask about different in-network drs rates in the area for a different procedure, you may be able to do that with birth, too.
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@Boheme: It's totally possible the CPMs aren't covered by insurance, while the CNMs are! Such a tricky situation and if you go with the midwife group, you'll have to be careful to make sure you're seen by providers that your insurance will cover! So complicated!! But it's great you're figuring this stuff out now ahead of time rather than waiting to get the bill and being shocked!
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@Boheme: Is MW birth something that is covered by your insurance? Your insurance should be able to tell you that part. If so, you should be able to determine if they are in/out of network as well. Either ins or the MW group should be able to tell you that as well as contracted rates, not what they bill, but I think that information is easier to get from them rather than the insurance company. Insurance hates giving up useful data IMO.
If they say they don't have that information, (which I don't believe for a second), you could try to ask them to do a test claim (I can't remember the exact term for this) to see how much would be covered. (It may not be accurate tho, I've had a test claim come back at $0 for meds, and ended up having to pay $160)
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I just went through this. I dropped my ob and am going with a midwife and birthing center. I had to call and get a an out of network referral which puts them at the in network contract price (60% covered). This means we pay about 3k instead of the 1.5k at the hospital but that was totally worth it to me.
Oh and we pick on CNm and all is billed through that name even if we see the other midwifes.
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I called the hospital, gave them my insurance info and asked for an estimate. They were really nice and, of course, gave me a warning that this was JUST an estimate for an uncomplicated vaginal delivery. Of course, I ended up with a c-section so my bill was different, but they spot on according to my friends who had also delivered there.
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I considered a practice like that one. I would ask the midwife practice (or rather their billing company). For a $20 fee, the billing company offered to contact insurance with the specifics and get an estimate. People said it was pretty accurate.
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You need to call the individual doctor/midwife clinic to find out what the standard rates are. Then see if they are in or out of network. From there you can figure out when you hit your deductible and out of pocket max to determine the max amount you would pay. Insurance company's won't have anything about the actual bill from the doctors on their site as they aren't the one setting the price the doctor charges.
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You can have each provider do a predetermination of benefits. It will not be a guarantee of payment by the insurance company, but it will give you a general idea, based on your particular plan deductible, and out of pocket expenses what you would pay for a vaginal delivery and what you'd pay for a C-section. As others have said you can also call your insurance company and ask them based on the diagnostic codes for vaginal versus C-section what the potential cost would be.
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