Did you know insurance plans often do not reimburse midwives at the same level as doctors?
This issue has been ongoing and is a constant battle for birth centers and midwives across the country.
That’s IF insurance plans even choose to cover midwifery care at all, because many plans simply choose to exempt midwives entirely. Contracting with a freestanding birth center is another issue in and of itself as well. Instead of viewing physicians and midwives as different, but equal, plans put physicians as superior.
This is despite the fact that midwives go through YEARS of schooling, countless hours of hands-on training, and licensing. Becoming a midwife takes a high level of education and is a highly regulated and specialized process. Being a midwife is different, not lesser, than being a physician. It’s simply a different job. Physicians and midwives do a lot of the same things when they provide care, so why would they be paid differently? Why should a physician be paid more than a midwife when they complete the same exact task? Unfortunately this is what often happens, even though midwives have excellent outcomes.
So as a result, midwives and facilities are left with the dilemma of choosing to contract at wildly inequitable reduced rates they know are unfair and close to infeasible, or not accept certain insurances, which unfortunately directly affects accessibility of care for clients. Sometimes the rates that insurance companies agree to reimburse midwives at make it financially straining on the facility to accept the insurance at all. There are (obviously) costs involved with providing care from the time to the tangible supplies and these costs have to be recouped through some type of payment.
Inequitable reimbursement affects far more than the bottom line of a birth center. At the end of the day, it affects clients. It affects access and affordability of giving birth outside of the hospital. This is especially egregious at a time where maternal deaths are at an all time high in our country, as we face what’s been dubbed the “maternal mortality crisis.”
Furthermore, plans don’t always make it obvious if midwives are covered. Insurance generated directories often show countless physicians, but don’t display midwives, even if covered. Even when midwives and birth centers are covered, it’s often not “advertised” so to speak. This makes it so people have to spend the time finding out. Calling their insurance, getting a hold of the right person, and hopefully getting an accurate answer. That’s if they even get that far.
Even when people have a plan that DOES cover birth center care, it’s not uncommon to assume it’s not even an option, and not even investigate further. At Best Start, we have had countless clients that were (pleasantly) surprised to hear that their insurance will cover costs.
On a more conceptual level, this problem of inequitable reimbursement also further perpetuates the idea that giving birth in the hospital setting with a physician should be the norm. It’s hard not to view birth as a medical event when your insurance plan tells you your only option is to see a physician and give birth at the hospital. How can the narrative of birth being a pathological event be changed when the midwifery model of care isn’t even being presented as a viable option to people giving birth?
At Best Start, one of our fundamental values is access for all. We want everyone, regardless of financial background, to be able to have the birth they want. No one should ever have to compromise on how they want to give birth due to cost. Because of this, we do our best to contract with a vast variety of plans. Sometimes this means going to bat so to speak, to negotiate contracts that allow us to be adequately reimbursed to continue to provide quality care we stand by.
We will always stand by our commitment to making midwifery care an option for anyone who wants it. Tell your friends that may not know birth centers are an option to see what their coverage allows. Speak up to your insurance companies and tell them you desire and value midwifery as a fully covered option. And if you’re considering getting care at Best Start and don’t know what your coverage is, please don’t hesitate to reach out for help navigating.