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I've just started reaching out to a midwives in the Berkeley/Oakland area that delivers at Alta Bates, and it seems that getting insurance coverage for midwives ends up being quite an expensive proposition. I just exchanged voicemails with Lindy Johnson who said my insurance (United Healthcare) doesn't consider any midwife in this area to be an in-network provider. She also mentioned getting something called a GAP exception...?
Does anyone have advice about how to get insurance coverage for midwives without having to pay huge amounts out of pocket? I had called Pacifica Maternity, and aside from being totally full, I think the out of pocket expense would have been $2.5k+ which is a bit prohibitive for us considering we have so many of the usual expenses of a new baby.
Or perhaps going with an MD is not a bad way to go...? A friend mentioned that they ended up counting more on the nurses anyway due to a long labor and complications. Thank you SO much in advance for your insights. Overwhelmed in Berkeley
(To the previous respondent: midwives and women who choose to deliver with them (generally instead of, not in addition to an OB) have the outlook that birth is a natural process, not a medical problem requiring a doctor. An OB would only be called in in the case of a serious medical complication.) - Midwife family
Re: Midwives at Alta Bates and East Bay Perinatal
As of a year ago Hsiu-Li billed through East Bay Perinatal and accepted my insurance (HealthNet HMO, Hills Physician medical group). I moved to the bay area when I was 7 months pregnant and after reading the BPN posts chose Hsiu-Li in the hopes of having a midwife attend my child's birth at Alta Bates. I ended up with a c-section because my baby flipped to breech at 38 weeks but I did have a chance to interact with her a few times at my appointments. She seemed really great and has a fantastic reputation. The instructor of the childbirth class I attended has worked with her many times as a doula and had nothing but positive things to say about her. She explained on our first visit that there are several other midwives in the practice and one of them will attend the birth if she cannot. She does not attend births in the middle of the night. I met one of the other midwives when she was away at a conference (don't remember her name) and she seemed nice enough.
Hi BPN! We are expecting our first child in late July and have been searching (and searching) for an in-network CNM willing to deliver at Alta Bates. We met recently with Jeri Zubowski, a lovely Independent CNM working with East Bay Perinatal Group. My only concern is that Blue Shield will not cover any of her bill since she is out-of-network. My in-network deductible plus out of pocket maximum is only $6000 combined, but my out-of-network out-of-pocket maximum plus deductible is a whopping $12,000 combined. Frightening, no? I'd like to avoid any possibility of paying up to $18,000 out of pocket for both in + out of network providers. (We're going to need to save that moola up for the little sprout's school tuition, no?) C'est la vie...
So, all of that being said, I would LOVE to hear your advice regarding:
- CNM recommendations
- Your Blue Shield insurance experiences w/ out of network providers like CNMs
- Cost of Labor & Delivery at a Birthing Center
- Cost of L&D at Alta Bates (as of 2012)
- General Advice or CNM/ Doula referrals
I'd greatly appreciate your up-to-date information. Thanks so much for your time and consideration! Best, SB new mama at 30
I also am using Dolphin Doulas. They are awesome as well. I have Susan and Cindy, and they make you feel so safe and have given us so many helpful tips and pointers for everything- from sleeping at night, to exercises to get ready for birth, to relaxation tools, etc. They are based in the peninsula but take clients in east bay as well. They are a bit pricey but in my opinion worth it. Obviously insurance doesn't cover them. I wish. Anyway, good luck!! I really hope you find a midwife you like. anon
We are new to Berkeley (and California) and my husband switched jobs in November. We are now eligible for insurance and I have the choice between Kaiser and Blue Shield of CA (both HMO). I have a daughter who is unvaccinated, so I am looking for a pediatrician who is respectful of that choice. We are also thinking of trying to have another baby eventually and I want a midwife and a natural childbirth, if possible. As far as I can tell from the website, blue shield does not have midwives in network, and I can't tell anything about Kaiser covering midwives from their website. Can anyone recommend a pediatrician and or midwife and hospital/ birth center where you had a good experience in network for either of these insurance companies? Thank you in advance. Joy
Kaiser Walnut Creek has nurse-midwives on staff; Kaiser Oakland has OB residents. With Kaiser, you have prenatal practitioner (a Nurse Practitioner, mdwife, or OB, depending on the circumstances or where you're planning to deliver) and then you get whomever is on call when you are ready to deliver - - some practitioners do deliveries, some do not.
Alta Bates is the only non-Kaiser hospital in the area where mamas have babies (BS/BC contracts with Alta Bates). Most of the nurses are great and many have had natural childbirths and/or homebirths so they can be really supportive. If you want a midwife to attend a hospital birth, I recommend Hsiu-Li Cheng, CNM.
For our non-Kaiser clients, we usually recommend Janet Perlman and Katya Gerwein at Bayside Pediatrics (www.baysidemedical.com) or Gary Bean (www.glenviewpeds.com). They are usually pretty flexible about vaccination schedules or non-vaccination altogether. Unfortunately I do not know of non- vax friendly Kaiser pediatricians (doesn't mean there aren't any!). Hope this helps! Feel free to contact me if you have more questions. Warmly, Laurel
Hey there, I'm the pregnant half of a gay couple expecting our first, and am having a difficult time finding a midwife and doula rec. (OB-GYN recs would be great too.)
Ideally, I'd like a midwife that bills via an OB-GYN or hospital so that I'm not paying $4000 out of pocket. I have an Aetna PPO, but it doesn't cover independent midwives or doulas (our rockin' healthcare system at work again - sigh). The only Aetna midwife apparently covered by Alta Bates is someone named Jeri Zukowski, who on a search of this board would seem to be... er, experienced with very mixed reviews.
I'd prefer a birthing center within a hospital (even if I have to travel to Orinda or something), though I am researching home births as well. Recs (and advice) welcome! expectant mom
Many midwives bill differently (sometimes they use a billing service, sometimes they ask the client to submit the claim to their insurance company). It depends on their needs as well as the clients' needs. I can tell you that my group uses a billing service and has had pretty good success with Aetna PPO. I urge you to call her to talk about the possibility of homebirth and to ask her how she handles billing.
Editor note: additional responses to this question are posted on the Midwives page.
I'm wondering if you all could help me identify what insurance companies cover homebirth. I currently have Kaiser, but am thinking I'll need to change that as I'd like to have another child within the next couple of years and just can't imagine doing it anywhere but at home. (I realize that one can have a wonderful experience at a hospital, but this is one of my personal desires and priorities for birth.) Advice on what insurance companies to look at? Thanks so much! homebirth loving mama
At the time I was with Pacificare on an individual HMO plan, paying about $300 a month, for the plan for my age group, to find out they didn't cover homebirth. I was with Hills Physician's Medical Group for my primary care. Pacificare would cover my prenatal coverage, and birth if I had the baby at the hospital with an in network OBGYN or midwife CNM. Pacificare covered a prior birth in 2006. I had Lindy Johnson, CNM as my midwife. They covered my visits. Out of pocket I paid Lindy about $400, the rest the insurance covered. My bill at Alta Bates for a half hour birth and 1 day stay cost, $11,500. Pacificare covered $1500 of that, and Alta Bates had to write off the rest. Due to how Pacifcare and Alta Bates are contracted with each other.
With that I decided to look into other plans. There are only 5 medical insurance companies in California. None cover homebirth. Blue Shield said it WOULD cover homebirth if I was on a group plan, not individual plan. If I was trying to have covered on a group health insurance plan, I cannot change plans whilst pregnant. It has to be 10 months before you get pregnant. Hopefully your employment offer's a Blue Shield group health insurance plan. BUT please call to double check as this might have changed.
With that I decided to be responsible for the entire cost of my care. I chose Judy Luce has my midwife. She was great! And worth every penny! As I was having my third child and I was not a high risk pregnancy, Judy and I kept extra costs to a minimum; blood work, testing etc. I was able to cover 1 procedure with the help of Lindy on my plan. One procedure was a lost for Judy, as it was too much work to fight Pacificare to cover the cost. I paid Pacificare more over the last 4 years than what my homebirth cost. I was very disappointed at how much money I have given them only to find out they don't cover homebirth's. Disgrace on their part, because homebirth's are cheaper than a vaginal birth at the hospital or C- Section.
I have since changed my plan. I no longer have maternity coverage. I have decided that if I have a baby again, it would be at home, and I will find a way to financially make it happen.
I did recently found out that Doula's are now covered under health insurance. Companies will cover a doula but not a homebirth midwife.
I hope this information helps. I'm interested to see other replies on this issue/topic. hb
I'm about 12 weeks pregnant with my first baby and considering going the homebirth route. I am currently seeing Dr. Amy Huibonhoa in Berkeley for prenatal care and I like her a lot, but think I would feel more comfortable laboring in a home environment if I remain low-risk. We are right around the corner from Alta Bates so I'm confident that we'd be able to get to the hospital quickly should anything go wrong.
I'm wondering if anyone has done this recently and if so how your insurance handled it. We have Anthem Blue Cross HMO which covers 100% of hospital/doctor costs but I haven't been able to figure out if they'll reimburse homebirth/midwife costs. There do not seem to be any midwives in our medical group (Alta Bates Medical Group) but the woman I spoke with at Blue Cross seemed to think I might be able to get a referral. I also still have SHIP insurance coverage so it is possible that I can get a referral through that plan instead. I haven't really started looking at midwives so any recommendations (preferably in Berkeley or East Oakland) would be welcome. Thanks! J
When we had our homebirth, our insurance language was unclear (they did not exclude homebirth but didn't specifically state that they'd cover a LM) and we had to fight to get it covered. We are planning for #2 and assuming that we won't be able to get it covered again and that we'll pay out of pocket for the whole thing. I know that sometimes midwives will try to bill for the prenatal care and you can pay out of pocket for the birth itself. You should ask about it when you're interviewing.
We used Judy Luce, and loved her. She is an encyclopedia of knowledge, supportive, calm, and has a great sense of humor. We loved her so much that we're not going to look for a CNM for our next birth, we'd rather pay for her despite that it will be financially difficult for us. But, I think Beah Haber is a CNM and we have friends who had wonderful experiences with her. Congrats and good luck! jisun
I'm seeking recommendations/advice on how to have a home birth covered by insurance (at least partially!) Speacifically, do you have any experience with billing using a Health Net PPO for a midwife attended home birth? How did you receive coverage? After speaking with a Health Net rep on the phone I'm left feeling disappointed and frustrated. I was told on the phone that no home births were covered at all, but I'm hoping there might be a way to work around this. Most midwives I've spoken to say they will bill me at the end in a flat rate and it is my responsibility to seek reimbursement. If you've had experience with Health Net PPO I'd really love to hear from you. Thank you!! Laura
Thanks everyone for being such a great resource! I have a couple of queries for the group. Any experiences or advice on how to get maximally reimbursed for a home birth while on SHIP at Berkeley? My husband and I are both graduate students and hoping to have a home birth. We've got a great team of midwives already and would like to know how to best navigate the bureaucracy that is SHIP. Also, any advice on whether grad students are eligible for disability or paid parental leave? Any other suggestions for financial post-partum resources? Thanks! expectant grad student
As for leave, I had my baby before the new policy took place. I just had an understanding with my adviser that I would come back when I could, and stayed on my GSR-ship ''working at home'' for three months--but didn't fill in any time sheets. My school fees were paid, but no salary. Now, i think you are entitled to 6 weeks paid leave.
My heart goes out to the previous poster who lost her baby. I can't imagine feeling I could have prevented my baby's death if I had only been in a hospital. When I planned my second child's birth, though, I looked at the data and decided that I would feel equally horrible if I lost my baby to a hospital-acquired infection or a complication of an intervention that would not have occurred outside a hospital as if I lost a baby at home. So, knowing that, horribly, some babies die at home and that some babies die in the hospital, I decided that with an experienced midwife, the risks for me and my baby were actually lower at home while the benefits were greater. In no way to I want to minimize what the poster went through; it's absolutely awful. But looking at the literature and the data as a whole, i came to a different conclusion. Good luck, and all the best.
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
Hi! Just curious if any other moms have succesfully filed a claim with Blue Shield HMO through John Muir Medical Group for a homebirth with a midwife? I was told John Muir does not ''recommend'' midwives- although Blue Shield will cover the costs. Any advice for an expectant mom?
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
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
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.
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 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!
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.
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
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
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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