Who pays the midwife, and when

A midwife's payment comes from one of three places: your health insurance, you directly out of pocket, or a combination of both. The route depends on whether your midwife is in-network with your plan, whether you have insurance at all, and what type of birth setting you choose — hospital, birth center, or home. Most of the time, your insurance company pays the midwife's practice directly, and you pay your copay or coinsurance at the visit. Sometimes you pay upfront and submit a claim yourself later.

The timing matters. Insurance companies typically pay within 30 to 60 days of receiving a claim from the midwife's office. If you are paying out of pocket, many practices ask for payment at each prenatal visit, at delivery, or in installments over several months. Some practices offer payment plans with no interest if you ask.

Key Takeaways

  • Insurance coverage for midwife care depends on whether the midwife is in-network with your plan and whether your plan covers birth centers or home births at all.
  • In-network midwives bill your insurance directly, and you typically pay only your copay or coinsurance at each visit.
  • Out-of-network midwives require you to pay upfront and then submit a claim to your insurance for reimbursement, which may be partial or none.
  • Out-of-pocket midwife care costs vary widely by region and setting, from $2,000 to $5,000 or more for the full pregnancy and birth package.
  • Medicaid covers midwife care in most states, though coverage rules and payment amounts differ by state.

In-network midwives and what your insurance covers

An in-network midwife has a contract with your insurance company. When you see an in-network midwife, the practice submits the bill to your insurance, and your insurance pays them directly. You pay your share — usually a copay per visit or coinsurance (a percentage of the cost) — at the time of the visit or shortly after.

What your insurance covers depends on your specific plan. Most plans that cover midwife care cover prenatal visits, delivery, and postpartum care. Some plans cover midwife-attended births only in hospitals. Others cover birth centers or home births with a certified nurse midwife. A few plans do not cover midwives at all, or cover them only under certain conditions. You can find out by calling the customer service number on your insurance card and asking: "Does my plan cover midwife-attended births? In what settings — hospital, birth center, home? Do I need a referral?"

In-network midwives typically charge less out of pocket than out-of-network ones, because the insurance company has already negotiated a rate with them. Your copay or coinsurance is usually lower than the full cost of care.

Out-of-network midwives and reimbursement

An out-of-network midwife does not have a contract with your insurance. You pay the midwife directly, and then you submit a claim to your insurance for reimbursement. Your insurance may reimburse you in full, in part, or not at all — it depends on your plan and whether your plan covers midwife care at all.

Before you commit to an out-of-network midwife, contact your insurance and ask: "If I see an out-of-network midwife, what percentage of the cost will you reimburse?" Some plans reimburse 70 to 80 percent of what they would have paid an in-network provider. Others reimburse based on what they call "usual and customary" charges in your area, which may be less than what your midwife actually charges. Some plans do not reimburse midwife care at all if the midwife is out of network.

The reimbursement process takes time. You will need to submit an itemized receipt or invoice from your midwife, along with a claim form from your insurance. Processing typically takes 30 to 60 days. If your insurance denies the claim, you can appeal, but you will need documentation from your midwife showing that the care was medically necessary.

Medicaid coverage for midwife care

Medicaid covers midwife-attended births in all 50 states, but the details vary by state. Some states cover only hospital births with a certified nurse midwife. Others cover birth centers or home births. Some states pay midwives a flat fee for the entire pregnancy and birth package; others pay per visit. Payment amounts range widely — from around $1,500 to $4,000 or more for the full package, depending on the state and setting.

To find out what your state's Medicaid program covers, contact your state Medicaid office or visit your state's Medicaid website. You can also ask your midwife directly — they work with Medicaid regularly and can tell you whether they are enrolled as a Medicaid provider and what your state covers. If your midwife is a Medicaid provider, they will bill Medicaid directly, and you will not owe anything out of pocket (unless your state has a small copay for certain services).

Some states have expanded Medicaid postpartum coverage to 12 months after birth. If you are on Medicaid, ask whether your state covers postpartum midwife visits beyond the standard six-week checkup.

Out-of-pocket costs and payment plans

If you do not have insurance or your insurance does not cover midwife care, you will pay the midwife directly. Out-of-pocket costs for midwife-attended care vary by region, setting, and the midwife's experience. A full package — prenatal care, delivery, and postpartum visits — typically costs between $2,000 and $5,000 for a hospital or birth center birth, and between $2,500 and $6,000 for a home birth. Some midwives charge more; some charge less.

Many midwives offer payment plans so you do not have to pay the full amount upfront. A common arrangement is to pay a deposit when you book (often $500 to $1,000), then monthly installments during pregnancy, and the remainder at delivery or shortly after. Some practices offer payment plans with no interest; others charge a small fee. Ask your midwife about their payment plan options before you commit.

If cost is a barrier, ask your midwife whether they offer a sliding scale based on income, or whether they know of community organizations or funds that help pay for midwife care. Some areas have nonprofit organizations that subsidize midwife care for low-income families.

What happens if your midwife is not in your insurance network

If you want to see a midwife who is not in your insurance network, you have a few options. First, ask your insurance whether they will make an exception and cover the out-of-network midwife at the in-network rate. Some plans do this if there are no in-network midwives in your area. Second, you can pay out of pocket and then submit a claim for reimbursement, knowing that you may not get back what you paid. Third, you can ask your midwife whether they are willing to become in-network with your insurance — some midwives will do this if you are a patient, though it requires paperwork and credentialing.

Before you choose an out-of-network midwife, get a clear answer from your insurance about reimbursement. Ask for the answer in writing if possible. Then ask your midwife for an itemized estimate of costs so you know exactly what you will owe upfront and what you might get back from insurance.

Billing codes and what appears on your bill

Midwife care is billed using specific medical codes that tell your insurance what service was provided. Prenatal visits are billed differently from delivery, which is billed differently from postpartum care. Your midwife's office uses these codes when they submit a claim to your insurance. You do not need to memorize the codes, but you should understand that your bill will likely show separate charges for different services — not one lump sum for "midwife care."

When you receive a bill or an explanation of benefits from your insurance, you may see charges for "office visit," "delivery," "global obstetric care," or "postpartum visit." These are standard billing categories. If you do not understand a charge, ask your midwife's billing office or your insurance company to explain it. You have the right to an itemized bill that breaks down what you are being charged for.

Frequently Asked Questions

Does my insurance cover a midwife if I give birth in a hospital?

Most insurance plans that cover midwives do cover hospital births with a certified nurse midwife. Call your insurance company and ask specifically: "Does my plan cover a certified nurse midwife for a hospital birth?" Some plans cover midwives only in certain hospitals or only if a physician is also present, so get the details before you book.

What if I pay out of pocket and then my insurance denies my reimbursement claim?

You can appeal the denial. Ask your insurance in writing why they denied it, then ask your midwife for documentation showing the care was medically necessary. Resubmit the claim with the additional documentation. If the appeal is denied again, you can file a complaint with your state's insurance commissioner, though this does not may provide reimbursement.

Can I use a health savings account or flexible spending account to pay a midwife?

Yes. Midwife care is a may have access to medical expense, so you can pay with funds from an HSA or FSA. This reduces the amount you pay in taxes. Ask your midwife's office whether they accept HSA or FSA cards, or whether you need to pay out of pocket and then submit a receipt for reimbursement from your account.

What if I switch insurance during pregnancy?

Notify your midwife's office when ready. They will need to update your insurance information and may need to resubmit claims to your new insurance. Your new insurance may have different coverage rules, so confirm with them that they cover your midwife and the birth setting you have chosen. Some plans have waiting periods for maternity care, so check your new plan's rules.

Do I have to pay my midwife's full fee even if insurance reimburses me?

If your midwife is in-network, you pay only your copay or coinsurance — the insurance pays the rest directly to the midwife. If your midwife is out-of-network, you typically pay the full fee upfront and then submit a claim for reimbursement. Ask your midwife's office about their payment policy before you book.