Frequently Asked Questions
- Do you accept insurance?
- What are my out-of-pocket costs?
- What if I transfer care in labor?
- Are some insurance companies better than others for home birth?
- What about lab work and ultrasound?
- Is routine ultrasound part of the care I will receive?
- How many women are due within a month of my due date?
- What happens if two women go into labor on the same day?
- Do you ever induce labor? Do you use pharmaceutical products to do so?
- What prenatal tests do you rountinely recommend and/or require?
- How comfortable are you with delivering babies of first-time mothers?
- What kinds of pain relief can you offer at a home birth?
- What is your experience with pregnancy loss?
Do you accept insurance?
If you have health insurance with maternity benefits, you will be reimbursed accordingly once your insurance company pays the claim. We cannot bill for any services until after the birth and it can take several months for the claim to be paid. Due to the low volume of our practice, we cannot accommodate this long delay in payment for our services. So, while we are willing to do insurance billing you should have a realistic view on how the system works and what will actually be paid back to you.
While Mountain View Midwives provides insurance billing for clients it is important to know up front that the current insurance system does not work well for our care. The main reason is that medical billing is procedure driven, not time driven. In the medical insurance system there are technical fees and facility fees that are paid along with procedure codes and ultimately the whole reimbursement system is based on volume (most providers see a lot of patients and spend very little time with you). In our model of care we don’t do any procedures, we take a very small caseload and we spend a lot of time with our clients. So no matter what we do, even if we are approved providers and you have no deductible to pay, the reimbursement for our care is very low.
WHAT ARE MY OUT-OF-POCKET COSTS?
In terms of planning, you will pay us our entire fee and after the birth has happened we will have our billing agent submit a claim to your insurance company. Depending on your coverage you may receive some money back in reimbursement. The insurance company will not reimburse you all the money you paid for our care. Even if you are covered at 100% the allowable charge for the bundled maternity care is less than the fee we charge.
If you have a private plan, you are used to making co-payments when you visit a provider’s office. Some time later you receive a letter in the mail from your insurance company explaining how they settled with the provider and if you owe more money. Usually, the provider is paid less than what was billed. In most cases the provider has agreed to be paid less in order to be listed as an approved or network provider. The advantage to the provider is that the billing is simplified and reimbursement usually happens quickly. Sometimes, the insurance company pays a portion of the bill and applies a portion to your deductible. Most private plans have some type of yearly deductible, meaning you must pay a certain amount first before the insurance pays.
Most insurance companies treat us as out-of-network providers so you will not make co-payments to our practice. You are responsible for paying our entire fee as detailed in our financial agreement. Our fee does not change based on when you enter care, the number of prenatal visits, the time we spend with you in labor, whether or not we transfer care at some point during labor or the number of postpartum visits you have. Maternity care is usually billed as a global code, meaning that all of the care is bundled together and there is one charge for everything.
For example, if you are insured by Anthem we will get pre-approval to be your providers and Anthem with reimburse at 100% of the allowable charge. While all of this sounds good Anthem’s 100% of the allowable charge for the maternity care code is $1,650. This means that the maximum you can receive in reimbursement is $1,650. If you have a deductible then it is paid first and the reimbursement is $1,650 less your deductible. If we do not get pre-approval to be your provider then we get an out-of-network rate usually about 80% of the allowable charge. So, as you can see even under the best circumstances your reimbursement is much less then what you paid out-of-pocket for care.
WHAT IF I TRANSFER CARE IN LABOR?
Another problem with the insurance comes up if we transfer care in labor to the hospital. If the baby is born in the hospital then we can no longer bill the global code for maternity care. At best, we can bill for prenatal visits and postpartum visits but the reimbursement for these visits is low. Typically, this comes to between $600-$800. The same issue with your deductible applies here too. Sometimes insurance companies will not pay for the prenatal care as a separate charge at all.
ARE SOME INSURANCE COMPANIES BETTER THAN OTHERS FOR HOME BIRTH?
At this point in time, we prefer not to do any billing for Southern or Aetna. Both of these plans exclude us a providers and have exclusion for home birth. If Anthem or Anthem Healthkeepers insures you then we will request pre-approval before the birth and will submit the claim after the birth.
If you are a subscriber to an insurance company other than Anthem we will not do any billing unless you call your insurance company to verify what benefits you have and whether or not any of our fees are covered. There is an insurance worksheet attached to this document that we highly recommend you use when you call. The worksheet has all of the questions we need answered before we can do any billing. We recommend that you make this call soon after entering care.
If you have any questions about insurance billing and what to expect for reimbursement, please talk with Deren Bader, email at firstname.lastname@example.org or call at 434-962-0148.
WHAT ABOUT LAB WORK AND ULTRASOUND?
The good news is that your insurance will cover things like lab work, ultrasound, physician consultation, and hospital birth (if needed) very well.
IS ROUTINE ULTRASOUND PART OF THE CARE I WILL RECEIVE?
Routine ultrasound has become an expected component of prenatal care that many women desire. We will discuss with you the schedule for routine ultrasound and the risks and benefits of each ultrasound exam. Though it is not a requirement, most women in our care decide to have at least one ultrasound, usually around 20 weeks.
We refer to the Prenatal Diagnosis Center at MJH or to the Fetal Care Center at UVA for ultrasound. Both of these facilities offer state-of-the-art comprehensive ultrasound screening. You will be seen by a physician who will evaluate the ultrasound findings and send a detailed report to our office. Please see our information on Ultrasound under Informed Choice for more information about these facilities and the services they provide.
Sometimes there is a medical indication for an ultrasound exam. In this situation we will describe the concern and how ultrasound could be helpful. Again, we would refer to MJH or UVA where the ultrasound will be interpreted by a physician. with special attention to the issue that necessitated the referral. The physician notes and recommendations are then sent to our office.
HOW MANY WOMEN ARE DUE WITHIN A MONTH OF MY DUE DATE?
Our practice is growing each year, but usually we have about 6 women birth each month.
WHAT HAPPENS IF TWO WOMEN GO INTO LABOR ON THE SAME DAY?
While this happens rarely, it is not a problem for our practice since there are three midwives. In the event that two women are laboring at the same time we will can easily arrange to have at least one midwife and a trained labor assistant at your birth.
DO YOU EVER INDUCE LABOR? DO YOU USE PHARMACEUTICAL PRODUCTS TO DO SO?
Induction with drugs (pitocin or cytotec) is not part of our practice. If a medical induction is needed then we would make arrangements for that to happen in hospital. Sometimes we recommend natural remedies; such as herbs, homeopathics, acupuncture or castor oil to try and stimulate labor or to make it stronger.
WHAT PRENATAL TESTS DO YOU ROUNTINELY RECOMMEND AND/OR REQUIRE?
You will be offered all prenatal tests and screening currently available to pregnant women in the United States. For each test and/or screen you will be given information on the condition or disease being screened for, information about the test and/or screen itself, information to help understand the range of results and how the results may affect your care. You will than make a decision about whether or not to do a particular test/screen. Read more about this process and the tests we offer.
HOW COMFORTABLE ARE YOU WITH DELIVERING BABIES OF FIRST-TIME MOTHERS?
We are very comfortable attending first-time mothers at home. In fact, Brynne and Deren both had our first babies at home. Typically, one third to one half of the women in our practice at any given time are first time mothers.
WHAT KINDS OF PAIN RELIEF CAN YOU OFFER AT A HOME BIRTH?
Many factors contribute to a woman's perception of pain in labor. We find that with the continual support of skilled and familiar attendants, in a relaxed environment where a woman is at ease with her surroundings, a natural birth can be accomplished, often leaving a woman in awe of the power of birth. We are able to offer a variety of methods to help women cope with the discomforts of labor including massage, hydrotherapy (including waterbirth), changes of position, bodywork and other methods all without associated risks of drug use to mother and baby.
WHAT is your experience with pregnancy loss?
Anyone who has gone through pregnancy and birth has experienced the very real fear of a bad outcome. This fear is born out of both an intellectual and emotional awareness of inherent possibility of risk in birth, no matter where we are or what decisions we make. As families who have chosen non-conventional birthing options, we are all aware of the additional questioning and scrutiny that can accompany a bad outcome at home.
In more than twenty years attending home births and more than 1,000 combined births between us we have experienced adverse outcomes. We have attended the births of babies with downs syndrome, spina bifida, anencephaly, Trisomy 13 and heart defects. For each of these families the joy of birth was tempered by the realization that their new baby had serious medical issues, some which were incompatible with life. We have also experienced newborn death at birth.
It is our desire to have complete transparency regarding our experience with birth at home. We welcome questions and discussion in order to help you decide where and with whom you would like to have your baby.