Berkeley Parents Network: Midwives and Insurance

Berkeley Parents Network

Midwives and Insurance

Berkeley Parents Network > Reviews > Health & Medical > Midwives > Midwives and Insurance

Midwife and HealthNet HMO
Finding a Midwife with BlueShield HMO
Midwives and medi-Cal
Does Alta Bates Medical Group cover midwives?
More advice about HMOs and midwives
See also:
Midwives and Kaiser
Midwife Recommendations

Midwife and HealthNet HMO

Aug 2008

Hi, I am 28 weeks pregnant and recently decided I wanted to switch from an OBGYN to a midwife. I have Health Net HMO and need to switch to Hills Physicians for the midwife to be covered. I am wondering if anybody recently switched to Hills Physicians for the same reason and what the procedure was like. HP's Customer Service was not very helpful in explaining all the rules etc.. Thanks! Olga

I did this very same thing 4-5 years ago and it was pretty simple. There are two annoying things about it though. One is that you have to find a new primary doc in Hill Physicians, even if it's temporary. The second is that your baby will have your medical group for the first month of its life, so even though our pediatrician is part of Alta Bates MG, our baby had to go see someone in Hill Physicians for the first month (as well as at the hospital). Annoying, but not necessarily a dealbreaker... anon

Finding a Midwife with BlueShield HMO

Nov 2007

I know there are lots of reviews of midwives in the archives, but I need help navigating new insurance waters. I am switching to a BlueShield HMO in January when I will be at 24 weeks, and I need to find a midwife. Blue Shield told me I need to find a primary care doctor first, but I'm hoping I can work backwards and find a midwife first and then find the med group with which she is affiliated. I'm frustrated with the ins and outs of insurance, so if anyone can give me advice on how to find a doctor and midwife, or on which midwives are covered through this insurance, I would be grateful. Emelie

i did the same thing with switching physician groups in my first pregnancy so that i could have a midwife with blue shield HMO. i found that i chose a midwife--jeri zukoski--and then picked a primary care doc--julie nickelsen--who are both affiliated with hill physicians group in the berkeley area. both of them are fantastic and i haven't looked back since! i highly recommend either of them. jeri can also recommend midwives with whom she works or others that also deliver at alta bates and other PCPs that she knows in that MD group. good luck! sv

I had Jeri Zukoski (Certified Nurse Midwife) deliver both my children (2005 and 2007) at Alta Bates. She's great! Call her at 510-530-3374 and see which medical group she's in. I was with PacifiCare and AB Med Group when #2 was born. Good luck! happy Jeri mama

Midwives and medi-Cal

Feb 2005

We are looking for an excellent ob/gyn in the east bay, preferably in Berkeley, who accepts Medi-Cal and works with a midwife. I lost my excellent PPO coverage at the start of '05, and although this is our third child, it is our first time working within the Medi-Cal system. I wish a midwife assisted home-delivery were an option, but since it is not covered I would appreciate any recommendations, advice, or resources anyone has to offer. I am already well into the second trimester and would feel good finding a health care provider soon. Thanks to all! BRAREN FAMILY

Jeri Zukoski takes Medi-Cal. her office in on downtown Berkeley- Dwight & Shattuck. she has privileges at Alta Bates. her number is 530.3374 good luck, Virginia Duplessis

West Berkeley Family Practice takes medi-cal and has midwives 5 days a week. They also have 2 Community health workers whose sole job is to work with our pregnant families and help with things like medi-cal sign up and and insurance issues down the road, WIC, BIH, hospital tours and registration. West Berkeley also has the program Centering Pregnancy, which is prenatal care in a group setting (you can check out the Centering program at www.centeringpregnancy.org) You can call 981-4269 and talk to Anya (one of the CHW's)for sign up info or for informations about the Centering program call Cris at 981-4200 x.4245 good luck!

I went to Hsiu-Li Cheng when I was on Medi-cal, and she was totally amazing (see other reviews in BPN archives). It's a bit of a drive from Berkeley, though, if her office is still in the same place, next to Summit hospital. Consider her, though -- she is really, really skilled and experienced, and I felt complete confidence in her during my whole pregnancy and birth. She also works closely with O.B.s, if you end up with any medical needs she can't handle/prescribe for. anon

Back in 1998 I had Medi-Cal, and depite misinformation from 2 different Medi-Cal staffmembers they DO cover CNMs,(unless it has since changed.) The practioner we used is Jeri Zukosky CNM at Alta Bates who has an MD back-up, but we never met with nor used the MD. It was 100% covered. I believe Medi-Cal covers any of the CNMs, check with Waddle and Swaddle in Berkeley for a full list of choices. Jeri also does homebirths (most do one or the other) and you'd have to call her to check, but I'm nearly certain this actually would have been covered by Medi-Cal as well (with a CNM, but unfortunately not a homebirth-only midwife.) happy we had MediCal and a supported natural birth

Does Alta Bates Medical Group cover midwives?

May 2004

Hi, I've looked on the site for this information, but the latest advice seems to be from 2001. I am wondering if Alta Bates Medical Group still does not cover prenatal and delivery by midwives. I just had my first appointment with Dr. John Girard, and while he was personable, I feel I'd be more comfortable with a midwife. My insurance is Blue Shield. Thanks in advance for any advice! Genevieve

Last fall I switched from AB Medical Group to Hills Physicians so I could be covered by a midwife for my pregnancy. I also have Blue Shield. It seems unlikely that ABMG would have changed their policy in such a short time period, but you can always call them and ask. The problem I have now is that the pediatrician we've chosen isn't covered by HPMG (and newborns are in the same med group as their mothers for the first month) so I've got to find out how to deal with that. Just another aspect to be aware of (a minor one, I'm hoping). anon

I would highly recommend Lindy Johnson as a midwife. I have only heard very positive things about her. I am currently receiving pre-natal care from her and have yet to experience the actual birthing experience. Thus far she has been very warm, caring, supportive and knowledgable. She also has hospital privliges at Alta Bates. I have Bluesheild PPO, which does cover her (not full-coverage, but I think around 70%). I would recommend calling Blueshield to see how your specific plan covers her or other midwives at Altabates. Viviana

When I had a baby 1 year ago, there were no midwives in Alta Bates Medical Group. Hill Physicians, however, had a bunch to choose from. I easily switched medical groups and used a midwife. I have Healthnet, but you may want to see how easy it is to switch groups on your plan. You can always switch back after you have the baby, and many doctors take both (i.e. my primary care physician does) so there may not even be a need to switch back. milli

More advice about HMOs and midwives

2001

You asked if Blue Cross or Kaiser cover midwives. Although I use healthnet, this info may yet be of use to you. Under Healthnet I found that I had to switch from the Alta Bates Physicians group to the Hill Physicians group in order to access a midwife. Can you believe that a Berkeley group won't cover midwives!!! I delivered at Alta Bates with midwife Lindy Johnson. You should speak with a midwife as they really know the current status of health care coverage for pregnancies.

I recommend that you speak to some midwives about what insurance companies cover them and what doctors groups are under those insurance companies. Perhaps they will tell you which they find to be the easiest to deal with.

My daughter was delivered in June by Hsui-Li Cheng (highly praised -- and for good reason -- on the website) and there were no problems with PacifiCare billing. I don't remember the details of the PCP/OB referral process, only that it was unproblematic.

As for choosing a pediatrician, we chose someone with Alta Bates Medical group because we wanted both kids to have the same doctor. The process is a little bit more involved, but PacifiCare explained it clearly and then didn't mess up the billing. We filled out a form with all the info beforehand, then notified them as soon as the baby was born so that the baby had its own account immediately rather than remaining on my insurance for the usual 30 days. The only hitch was that Hsui-Li only delivers at Summit, and our pediatrician doesn't have privileges there, so our daughter was seen by the on-call pediatrician in the hospital and then by her regular pedi a few days later. (this wasn't an insurance issue) I can't compare PacifiCare with any of the other plans you mention, but I have no complaints about them. Jennifer

I just had my daughter a few months ago and stayed with UC Care throughout. My midwife, Hsiu-Li (Sho-Lee) Cheng, was fabulous. She delivers at Summit where I had a great experience. Hsiu-Li, referred me to Primary Pediatrics. While I had to change my medical group from Alta Bates to Hills, I was able to keep my PCP because he is in both, as many doctors are. Also, an added bonus, Summit has a free home nurse visit program and so I got 4 home visits postpartum from a nurse through that program plus another visit through UC Care which made all the difference in the world since by baby was a slow-weight gainer. Roxanne

1998

I am recently pregnant with my second child. I would like to work with a midwife this time, but I have PacifiCare insurance through Alta Bates and it looks like they don't pay for midwives (how crazy!). Does anyone know of a way around this or have any advice. I know I have the option to choose a duola if it turns out I can't get a midwife, but I would prefer to go midwife all the way.

So, my questions to all of you are: is there any way to get a midwife with PacifiCare insurance through Alta Bates Medical Group, if not, I would love OB GYN recommendations (I used Debra Levinsky for my first child who is now 5 years old and have not been thrilled), and finally, any doula suggestions. I know a short time ago there was a wonderful discussion about duolas, but, not knowing I was pregnant at the time, I purged them all from my email! I look forward to hearing from you. Thanks in advance for the help!

From: Tahani

I'm fairly sure the only East Bay physician's group which includes independent midwives is Hill Physicians. I saw Lindy Johnson (there's also her partner, Robin Hale) when I had my 2YO, and my friend just had a baby with her. She's very good, I think. I've also heard about some OB who has a midwife in his office who you can use in a similar way -- who is not just part of a big call group -- let me know if you want me to dredge up more details on this.

Have you considered switching phys. groups just for the pregnancy? I've done it several times, for that reason and others. Unfortunately Pacificare won't do it instantly -- if you call before the 15th of the month it'll be effective the 1st of the next month. I don't think there's any limit on how often you switch groups -- you just have to pick a primary care person in the group. I recently wanted to see a specialist at UCSF and picked a primary care person completely blindly, who I've never seen and probably will never see...

Congratulations, and good luck with the pregnancy.

From: Jerry

With regards to HMOs, midwives, and Alta Bates, we found that instead of billing you directly, several midwives could bill indirectly through their backup physician's practices and that that would be covered (I am not sure why, I think it may have been because then it was deemed "better" or prescribed or some such thing (obscurity?).)

We didn't need to go that route, Blue Cross's California Care (and the UC Berkeley Student Health Plan covered midwifery at Alta Bates.) Jerry

From: Dawn
Date: Jan 21, 1998

A couple people have asked me for my story on how I got PacifiCare to pay for my Midwife. The full story is somewhat personal, so I'll just send that privately to those who've asked (I haven't forgotton; I just haven't had time!).

For the public record, though, let me say that how I did it was PERSISTANCE. I began investigating midwife care as soon as I knew I was pregant (about 3 weeks). I set my sights on a midwife-attended hospital birth, figuring that should be possible (I didn't think they'd ever consent to paying for a Home Birth). After I found that PacifiCare would not pay for a midwife through ABMG, I went on a campaign to change their minds. I didn't want to use the solution suggested by someone else on this forum--change groups to Hill Physicians--because I also have allergies, and that would require my changing Allergists as well (something I thought was pure stupidity during Pregnancy). It took 5 months, many letters and innumerable phone calls. What finally did it, I think, was a letter my husband wrote, complaining about the treatment we'd been given. We sent it to everyone we could think of: 2 people at PacifiCare, the head honcho at ABMG, all the doctors who'd ever been on this case, my midwife, the person in charge of Health Benefits at UC, and KCBS Call for Action! They caved in, I got my midwife coverage, and I switched at the beginning of my 7th month of pregnancy!

The message, in my opinion, is *never give up*. Everyone told me it couldn't be done, but I did it. I heard later that someone else right after me was approved with no argument whatsoever.

Be bold, ask for what you want, and be persistent. If you annoy them enough, they may give you what you want just to shut you up!

to the mother wanting advice about HMO & midwives

i was in your exact position nearly two years ago: i was pregnant (but w/ my first) and i had Pacificare insurance through UC and i wanted to deliver with a midwife at Alta Bates. and, i did! it was tricky then and i don't know if things have changed, but if you want to know how i did it contact me directly. Fatimah

Thanks to everyone who responded to my request for help finding a midwife and figuring out how to get Pacificare (through Alta Bates) to pay for it. I contacted several midwives and learned that PacifiCare through Hills Physicians will pay for midwives, so I simply switched to the Hills Physician's Group by calling PacifiCare directly. I can always switch back after the baby is born. I also chose Audrey Heffel as my primary care physician. She was recommended highly by many of you and also by a friend of mine. I met with one midwife yesterday and have another meeting scheduled for next week. By the way, both midwives, and a third I plan to contact, all deliver at Alta Bates. I am delighted to have figured this out. My first birth was very difficult, and I am determined to have a positive experience this (my last) time around. After all, this time it has to be positive for all 3 of us... Thanks to all of you who responded!

I would suggest that the person who found a midwife that PacifiCare would pay for check with her OB/Gyn's office to be sure that Hill Physicians will pay for a birth at Alta Bates if that is really where she wants to go. My own OB/Gyn has been grumbling that Hill Physicians makes him do all his surgeries and deliveries on Hill patients at Summit. This is a fairly recent change--when he told me about it last July, it had just gone into effect. When I asked him about Hill Physicians last week, he said it was effective in May. I wasn't sure if he meant last May or this coming May but didn't ask because it wasn't relevant to me.

Note that many doctors belong to more than one IPA (for example, Hill Physicians and Alta Bates Medical Group), and each IPA has its own rules about where its patients can be sent for lab tests, surgery, etc. Fran

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