Help me decide on my care provider, please! (long, sorry)

[Anonymous]

I just found out I am expecting again, and I am looking forward to another homebirth. My last two babies were born at home, 2 hours of active labor, absolutely marvelous and delightful experiences. All of my births have been short, healthy, vaginal deliveries with no complications, no tears, after healthy pregnancies. I am confident in my body's ability to birth, I love giving birth, and I really just want my husband when I am in labor, so I am a very low-maintenance pregnant lady and birthing mommy.

I love, respect, and admire the (CPM) midwives who cared for me the last two times, but they are not covered by my insurance, so I had to pay out of pocket for their (excellent) care, as well as for the mohel afterwards, and the doula. Both times, I sought out "parallel care" with my OB (who previously delivered my last hospital baby), because their care WAS covered by my insurance. I wanted to have a relationship with an OB in case I risked out along the way--not because I was not committed to a homebirth.

Unfortunately, my OB "fired" me as a patient after my second homebirth, stating that unless I was "committed" to a hospital birth, they were "not interested" in providing care. So that kind of "parallel care" is not an option this time.

I think I have three options right now:

#1 Stay with the CPMs who cared for me the last two homebirths, pay out of pocket, travel far to appointments

#2 Move to one of the CPMs who apprenticed with my CPMs, but who has now started her own practice, pay out of pocket, but for a somewhat reduced fee because she is getting established, and who will come to my house for all appointments

#3 Move on to the one (CNM) midwife practice that is covered by my insurance (Birthcare), only have to pay the birth assistant out of pocket, but have to travel very far to appointments. Also, note that the birth assistant can be someone of my choice, and the CPM who is starting her own practice is one of the choices.

I have been saving for another homebirth, but finances are extraordinarily tight right now, and I am afraid to wipe out our health care savings. I want experienced, caring professionals with me, but I don't really need someone to hold my hand through the process anymore. I treasure the trusting relationship I have with my CPMs from the last two births, and I worry about hurting their feelings if I use a different provider. Although I don't anticipate risking out, I am comforted by the idea of having physician backup, since my OB will no longer care for me. Lastly, Birthcare does not permit water births, and my two homebirths were both waterbirths. I am not absolutely wedded to the need for a waterbirth this time, but it makes me sad to lose that option entirely.

I know this is a lot of information, and if you are still with me, thanks for listening. I was hoping some women would be willing to share their insights about making this choice. Especially if you have a personal experience with Birthcare, because it troubles me to start all over again, building up a relationship with women who will be with me in my home at this sacred time. I need to decide rather soon, because all of these midwives are extremely in demand and fill up quickly.

Thank you, with all my heart, for any help!

[Anonymous]

I'm not sure what to tell you because it sounds like you've researched all your options, and I'm not really sure where in the metro area you are. I assume you've looked at the midwives listed on the Birth Options Alliance website and double checked about insurance and whether there are any midwives your insurance would partially cover as an out-of-network provider. Also, if you haven't joined the BOA listserv, the women there might be able to provide some advice.

You're really the only one who can determine which issues are most important to you in terms of cost, convenience and relationship.

[Anonymous]

I have A LOT of friends who have delivered with Birth Care and had very positive experiences. I am with their practice for my pregnancy, but I'm early along and only met them once.

If you're in Montgomery County, you could look into MAMAS Midwifery.

[Anonymous]

I am concerned about the lack of water birth options with Birth Care too! My first baby was born in tub and I'm thinking baby #2 might just be born in the tub "accidentally". What will the midwife do? Refuse to administer postnatal care? Ha!

[Anonymous]

Anonymous wrote:I am concerned about the lack of water birth options with Birth Care too! My first baby was born in tub and I'm thinking baby #2 might just be born in the tub "accidentally". What will the midwife do? Refuse to administer postnatal care? Ha!

OP here--yes, this is a concern for me! Both of my waterbirths just happened--I was so peaceful and quiet and comfortable, and then I was pushing. I had a very traumatic hospital birth when everyone was yelling at me to not push, and I am afraid of a similar scene in my bedroom if I am in the water as the baby crowns. How would they handle such a scene? Would they physically drag me out?!?

[Anonymous]

OP, where are you located? Is Birthcare the only CNM practice that can successfully bill your insurance? You should keep in mind that Birthcare will risk you out for a few things that other home-only CNMs and CPMs won't (like twins, breech, and some other unusual scenarios). For that reason, and for the fact that you want a very hands-off midwife, I personally would not make the effort to establish care, do the long drives, etc. with Birthcare. I do think they provide excellent out-of-hospital care, but I see them as a bit more restrictive and, as I said, they are required to risk you out for certain things and as you said, don't allow waterbirth. If I were you, I would call every CPM and homebirth CNM and see if they can bill your insurance - try MAMAS and Joey Pascarella to start with, since they are CNMs. You might also be surprised to find that certain CPMs could bill your insurance - bottom line, just do your homework on this. If you find that you truly have no other option than Birthcare to pay for this birth, then I think I would go to them. It is not worth completely depleting your insurance for this, especially since you are likely to have another very straightforward birth, and you will still have your DH and could have your same doula/birth assistant. And if you do wind up going to Birthcare, it is worth a very detailed conversation about your previous experiences and ask them specifically what they would do if your baby were "coming out" in the water. They might be able to be flexible considering the circumstances.

[Anonymous]

Anonymous wrote:OP, where are you located? Is Birthcare the only CNM practice that can successfully bill your insurance? You should keep in mind that Birthcare will risk you out for a few things that other home-only CNMs and CPMs won't (like twins, breech, and some other unusual scenarios). For that reason, and for the fact that you want a very hands-off midwife, I personally would not make the effort to establish care, do the long drives, etc. with Birthcare. I do think they provide excellent out-of-hospital care, but I see them as a bit more restrictive and, as I said, they are required to risk you out for certain things and as you said, don't allow waterbirth. If I were you, I would call every CPM and homebirth CNM and see if they can bill your insurance - try MAMAS and Joey Pascarella to start with, since they are CNMs. You might also be surprised to find that certain CPMs could bill your insurance - bottom line, just do your homework on this. If you find that you truly have no other option than Birthcare to pay for this birth, then I think I would go to them. It is not worth completely depleting your insurance for this, especially since you are likely to have another very straightforward birth, and you will still have your DH and could have your same doula/birth assistant. And if you do wind up going to Birthcare, it is worth a very detailed conversation about your previous experiences and ask them specifically what they would do if your baby were "coming out" in the water. They might be able to be flexible considering the circumstances.

.

Thank you so much for this informative post--I really appreciate it!

We have Blue Cross/Blue Shield Federal Employee, Basic. So if it is not a preferred provider, insurance pays nothing. According to their provider directory, Birthcare is it for home birth midwives.

I will only be 9 weeks at my first appointment with them, so I could probably still choose a CPM if I was not happy afterwards. Truly, I have been spoiled by the deference and respect I was shown by my CPMs--it would be hard to go back to a practice where my choices were more limited.

But as you said, IF I have another quick, straightforward birth, it is hard to imagine spending $3500-$4500 when $500 out of pocket would get almost the same birth attendants and birth experience. I need to balance my hopes with the financial needs of my whole family.

Thank you again for the food for thought!

If only more insurance companies reimbursed CPMs!

[Anonymous]

OP again--forgot to mention I live in Prince William County, right by a VRE stop.

[Anonymous]

I have BCBS FEP (standard) and have found that lots of specialists take my insurance, but aren't listed in the provider directory. I don't consider it all inclusive for any specialists anymore.

For example, it only lists 2 sleep specialists within 50 miles of DC (in Reston and Herdon, and I'm in Alexandria). I found that hard to believe and called several others not listed in their provider directory and they all were preferred providers with the BCBS Federal employee program.

Bottom line - I've found it definitely helps to ask each provider, and not trust the program's listings.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, where are you located? Is Birthcare the only CNM practice that can successfully bill your insurance? You should keep in mind that Birthcare will risk you out for a few things that other home-only CNMs and CPMs won't (like twins, breech, and some other unusual scenarios). For that reason, and for the fact that you want a very hands-off midwife, I personally would not make the effort to establish care, do the long drives, etc. with Birthcare. I do think they provide excellent out-of-hospital care, but I see them as a bit more restrictive and, as I said, they are required to risk you out for certain things and as you said, don't allow waterbirth. If I were you, I would call every CPM and homebirth CNM and see if they can bill your insurance - try MAMAS and Joey Pascarella to start with, since they are CNMs. You might also be surprised to find that certain CPMs could bill your insurance - bottom line, just do your homework on this. If you find that you truly have no other option than Birthcare to pay for this birth, then I think I would go to them. It is not worth completely depleting your insurance for this, especially since you are likely to have another very straightforward birth, and you will still have your DH and could have your same doula/birth assistant. And if you do wind up going to Birthcare, it is worth a very detailed conversation about your previous experiences and ask them specifically what they would do if your baby were "coming out" in the water. They might be able to be flexible considering the circumstances.

.

Thank you so much for this informative post--I really appreciate it!

We have Blue Cross/Blue Shield Federal Employee, Basic. So if it is not a preferred provider, insurance pays nothing. According to their provider directory, Birthcare is it for home birth midwives.

I will only be 9 weeks at my first appointment with them, so I could probably still choose a CPM if I was not happy afterwards. Truly, I have been spoiled by the deference and respect I was shown by my CPMs--it would be hard to go back to a practice where my choices were more limited.

But as you said, IF I have another quick, straightforward birth, it is hard to imagine spending $3500-$4500 when $500 out of pocket would get almost the same birth attendants and birth experience. I need to balance my hopes with the financial needs of my whole family.

Thank you again for the food for thought!

If only more insurance companies reimbursed CPMs!

Sounds like you are working it out....but you MUST call the midwife directly to find out if she can take that insurance. Do not trust what the insurance company says or what the directory says. Only the midwife will know if she can successfully bill them. Of course at the end of the day, your answer might be the same, but at least you will have double-triple-checked.

[Anonymous]

OP, can you change insurance during open season in November/December? It sounds like you have time, and you can switch back next open season if you really like BCBS Basic for everything except birth. Perhaps the standard option would work for you since they take out-of-network practitioners for a higher co-pay? I'd just ask CPM who they CAN bill and try to get on that plan - federal employees tend to have a lot of options.

[Anonymous]

If it's that important to you - then you should pay out of pocket. It's not an accident that practices that can bill insurance have standards of care they must meet - like risk requirements etc. If you violate them the insurance co will simply deny your claim anyway. You want a riskier set up then your insurance is comfortable with- then you should bear all of the financial risks for those choices.

[Anonymous]

What about the DC Birth Center? I'm not sure if they allow water births, but they do have a tub.

[Anonymous]

Anonymous wrote:
What about the DC Birth Center? I'm not sure if they allow water births, but they do have a tub.

Oh, that's right! DCBC does allow waterbirths, too. However, I wonder if OP lives far out (where is Prince William county, exactly?) then the drive in to DCBC could take her entire labor. That definitely would not be fun.