Does insurance cover midwife services? How to use your insurance for midwifery
June 9, 2023
In most cases, midwife services are covered by insurance. However, the specific details of coverage can vary depending on the insurance provider and the type of plan a person has. In some cases, midwifery services may be covered under a comprehensive maternity care package, while in others they may be considered a separate benefit.
It is important to check with your insurance provider to understand the specifics of your coverage and any potential out-of-pocket costs. Additionally, some states may have laws mandating insurance coverage for midwifery services, so it's worth checking with your state's department of insurance as well. Finding a midwife covered by insurance may take time, but the savings will make it worth it. Here are some tips and FAQs to help guide you in your search.
Are out-of-network midwife services covered by insurance?
Whether out-of-network midwife services are covered by insurance can depend on several factors, such as the type of insurance plan, the specific midwife and their credentials, and the state in which the services are provided. In general, if a person has an insurance plan that covers out-of-network providers, they will likely be able to receive some coverage for midwife services from a provider who is not in their network. However, the level of coverage may be lower than it would be for an in-network provider, and the person may have to pay more out-of-pocket costs.
It's important to note that some insurance plans may not cover out-of-network midwife services at all, or may only cover them in certain circumstances. In some cases, the insurance provider may require prior authorization or a referral from an in-network provider before covering out-of-network midwife services.
To avoid unexpected out-of-pocket costs, it's best to check with your insurance provider before receiving out-of-network midwife services to understand what your coverage will be and if any pre-authorization or referral is required. If you do decide to see an out-of-network midwife, SuperBill for insurance can help! We file out-of-network claims on your behalf, and we follow up with your insurer to make sure you get the best reimbursement possible.
Do midwives take insurance even when they are not part of any network?
Midwives may still take insurance even if they are not part of a network, but the specific details of coverage can vary depending on the insurance provider and the type of plan a person has. In some cases, a midwife who is not in-network with an insurance provider may be willing to bill the insurance company directly, and the person may receive some coverage for the services provided. However, in other cases, the person may have to pay for the services upfront and then submit a claim to their insurance company for reimbursement.
It's important to note that if a midwife is not in-network with an insurance provider, the level of coverage may be lower than it would be for an in-network provider, and the person may have to pay more out-of-pocket costs. To avoid unexpected expenses, it's important to check with both the midwife and the insurance provider before receiving any services to understand what your coverage will be and if any pre-authorization or referral is required.
Does health insurance cover midwife services differently depending on your plan?
Yes, health insurance can cover midwife services differently depending on the type of plan a person has. Some insurance plans may offer more comprehensive coverage for midwife services, while others may have more limited coverage or require a higher out-of-pocket cost.
For example, some insurance plans may have a specific maternity care package that includes midwife services as part of the overall coverage. Other plans may require a referral from an in-network provider or prior authorization before covering midwife services. In addition, some plans may have a separate deductible or coinsurance for maternity and midwifery services.
Generally speaking, PPO plans offer better coverage for out-of-network services like midwifery than HMO plans, but that is not always the case. Read our explainer on the difference between HMO and PPO plans to determine which plan type is right for your needs.
It's important to review the specific details of your insurance plan to understand what your coverage will be for midwife services or any kind of out-of-network care. This information can usually be found in the plan's Summary of Benefits and Coverage (SBC), or by contacting your insurance provider directly. Understanding your coverage before receiving midwifery services can help you avoid unexpected out-of-pocket costs and ensure that you receive the care you need within your budget.
How do I find midwife services covered by insurance?
To find midwife services covered by insurance, you can start by contacting your insurance provider directly. The insurance provider can help you understand what midwifery services are covered under your specific plan and provide you with a list of in-network midwives or midwifery practices in your area.
You can also contact the American College of Nurse-Midwives (ACNM) for a list of midwives who are members of the organization and accept insurance. Additionally, you can search online for midwives or midwifery practices in your area and check their website or contact them directly to see if they accept your insurance.
When researching midwives, it's important to verify that they are licensed and certified by a recognized credentialing organization, such as the American Midwifery Certification Board (AMCB) or the North American Registry of Midwives (NARM). It's also important to understand what specific services are covered under your insurance plan, as some plans may not cover all midwifery services, such as home births or water births. By doing your research and working with your insurance provider, you can find midwife services covered by insurance that meet your needs and preferences for care.
What to do if you can’t afford midwife services
If you are unable to afford midwife services, there are several options that may be available to you:
- Medicaid: Medicaid is a government-funded health insurance program that provides coverage for low-income individuals and families. In some states, Medicaid covers midwifery services as part of their maternity care benefits.
- Sliding scale fees: Some midwives offer sliding scale fees based on a person's income and ability to pay. You can ask the midwife if they offer this option and what the criteria are for eligibility.
- Community health clinics: Community health clinics may offer midwifery services at a lower cost or for free. You can search online for community health clinics in your area or contact your local health department for more information.
- Non-profit organizations: There are several non-profit organizations that offer financial assistance for midwifery services, such as the National Association of Free and Charitable Clinics or the Birthing Project USA. These organizations may provide grants, scholarships, or other forms of financial assistance to help cover the cost of midwifery services.
- Payment plans: Some midwives may offer payment plans or other arrangements to help make the cost of services more manageable. You can discuss these options with the midwife directly.
It's important to explore all of your options for affordable midwifery care and to communicate openly with your midwife about your financial situation. Together, you can work to find a solution that meets your needs and ensures that you receive the care you need during your pregnancy and birth.
How SuperBill helps with insurance reimbursement for midwife services
If you do have OON benefits, or you’re unsure if your insurance covers midwife services, SuperBill may be able to help! SuperBill verifies your benefits, then files and tracks your out-of-network claims. We will update you on the status of your claim at every interval, and do everything we can to get it reimbursed. We even help with medical bill negotiation!
You can jump through all the hoops to make sure you get your midwife services covered by insurance, OR you can let SuperBill for insurance handle it all for you. We have worked with countless patients to get them the reimbursement they deserve.