River & Mountain Midwives does not participate with any health insurance plan. In New York State, midwifery services for home birth must be covered by law. The extent of coverage is determined by each individual plan.
Under the New York State Midwifery Practice Act of 1992, midwives may provide services in hospitals, clinics, medical offices, birth centers and private residences; therefore, insurance companies must pay for midwifery services according to NY insurance law. There are a few exceptions, which will be discussed later in this document.
The Midwifery Modernization Act of 2011 removed a requirement for licensed midwives to have a written collaborative agreement with a specific physician or hospital in order to practice. This grants midwives significant autonomy and means that clients seeking midwifery care are not required to see a physician or have their charts reviewed by physician. NYS licensed midwives can order diagnostic tests, ultrasounds and can prescribe medications without consultation. If the need for consultation, collaboration or referral should arise in the event of a complication outside the midwife’s scope of practice, the midwife will make arrangements according to the needs of the individual client.
Midwives in NYS may provide primary care as well as maternity and newborn care. Many offer routine physical exams and help clients manage common health concerns such as breast and gynecological cancer screening, infections and the request for contraception requiring prescription.
River & Mountain Midwives works closely with our billing staff to ascertain information about benefits and out of pocket costs so we can make a realistic payment plan. Payment for maternity and newborn services is expected during the prenatal period because we usually cannot bill for visits until after birth.
HMO & EPO Plans
Insurance plans which do not provide out of network benefits must make exceptions for home birth. At this time, several plans purchased through the marketplace established by the Affordable Care Act have not been compliant with this rule, as there is lack of clarification regarding federally mandated insurance purchased through a state marketplace. Midwifery activists and lobbyists are currently working to mend this disparity. In addition, while the insurance plans are required to pay for services, they may not pay completely. River & Mountain Midwives works with our billing staff to ascertain what out of pocket expenses may be incurred well in advance so realistic and manageable payment plans may be established.
PPO Plans
Insurance plans which do offer coverage for services provided by out of network providers will have deductibles and coinsurance applied to all claims. It is everyone’s responsibility to be clear about individual and family deductibles, out of pocket maximum costs and coinsurance before a financial agreement is made.
Medicaid
River & Mountain Midwives PLLC is not a registered Medicaid provider. clients seeking maternity care with RMM must enroll in a Medicaid Managed Care Plan. Available Medicaid MCPs vary from county to county. Medicaid recipients should discuss these options with the midwives during an initial consultation. Most plans pay the Medicaid rate for comprehensive maternity care, which at this time is $1720 for all prenatal care, labor/birth and postnatal care. Some will also pay $123 for a newborn exam. The remainder of the midwives’ fee is the family’s responsibility and must be paid in advance of the birth. The midwives will discuss special circumstances about financial hardship and payment plans with individual families, as needed.
Military Insurance
Tricare Plans all pay at the Medicaid rate, which covers roughly 1/3 of our fees. It has been our experience that there is no home birth coverage for active duty soldiers. Prenatal care and births are expected to occur on post. If, however, the client receiving care is the spouse of an active duty soldier or officer, the US Family Plan will pay a flat $5000 at this time. client may switch from Tricare to USFHP during pregnancy without penalty. We offer a discount for active duty military families.
Self-Funded Plans
Some companies and unions have self-funded insurance plans. They are regulated by the federal government, not the state. Therefore, they can decide which services are covered and which are not. It is legal for a self-funded plan to deny coverage for home birth. Sometimes these plans will pay for office visits. Each situation is unique and will be discussed on a case by case basis.
Out of State Plans
Plans which are offered by large companies with incorporation outside New York may or may not offer reasonable coverage. Each situation is unique and will be discussed on a case by case basis.