Home Birth Cost: How I Gave Birth for Free

Before I became pregnant for the first time in 2017, one of my husband's friends shared that he and his wife were having a home birth with a midwife. "A home birth?" I asked. "That sounds expensive."

"It's not too bad," said my husband's friend. "Our health insurance covers most of it." He explained that their midwife was in-network, which would cost $3,500. The money they received at their wedding would fund the cost.

I still thought that was a lot to spend out of pocket. I'd already spoken to my insurance company about my insurance plans and hospital birth costs. My co-pay for in-network office visits and maternity hospital admission would total $25. I was curious to know why my husband's friend, a nursing student, would choose to give birth at home.

Here's what you should know about negotiating with health insurance companies to cover or reimburse the cost of a midwife-assisted home birth.

But keep in mind that many government-funded, high-deductible, and health maintenance organization (HMO) plans may not provide reimbursement. So, making sure you have the right health insurance plan that will support your pregnancy and birth before becoming pregnant is key.

Birth Statistics

My husband's friend's perspective brought home the reality of being a woman—and in my case, a Black woman. We face our country's unacceptable maternal mortality rates and unnecessary Cesarean sections for births that would have been low-risk. 

In 2020, the maternal mortality rate was 23.8 per 100,000 live births. But for non-Hispanic Black women, that rate was 55.3 deaths per 100,000, which was 2.9 times higher than for non-Hispanic White women. And between 2016 and 2020, non-Hispanic Black women had more Cesarean deliveries than women of any other race and 18.8% more cesarean deliveries than non-Hispanic White women.

Those disparities are partly due to implicit bias in healthcare. Research has found that biases likely influence interactions between people and healthcare providers, which affects their health outcomes.

Considering Home Birth

Fearful of my potential birth experience in the traditional healthcare system and desperate to feel in control of my health decisions, I decided to have a preconception consultation with a home birth midwife.

"Women should be empowered to create their own birth plans and birth experiences," said the midwife. "And they should be educated to be actively involved in decision-making and self-care for all aspects of their health." 

The midwife had mentioned that birth should unfold organically and without artificially imposed timetables and milestones. And it seemed to work: Only 12% of her clients' planned home births resulted in a transfer to a hospital for any reason. And only 4% of all births were Cesarean sections.

But then the midwife let me know that, since her home birth services were out-of-network with my insurance company, I could be responsible for most of her $8,000 fee. I was torn. I wanted the freedom and support that she was selling. And I wanted no part in the fear-mongering I'd heard about regarding hospital births.

The midwife made me feel like I could trust that my mind and body could safely bring a newborn into this world in my home. And I felt at ease with her and her decades of expertise. 

By the end of our meeting, my husband and I were set on having a home birth. We had money saved, and we were comfortable taking the gamble that maybe, just maybe, insurance would cover it.

Insurance Coverage for Home Birth

Two weeks later, my husband and I discovered we were expecting. The next day, I called the midwife. After offering congratulations, she suggested I contact my insurance company to find out how much of her fee they would cover.

But the representative at my health insurance company couldn't give me a concrete number. He said that if I chose the midwife, my insurance plan's administration would let me know whether they would approve payment for her services. But only after she submitted an authorization request would I hear back.

Halfway through my pregnancy, I received a letter from my insurance stating they had approved the payment. However, I would be responsible for the in-network cost-share, which I assumed meant my $25 co-pay.

At 32 weeks pregnant, my husband and I paid the midwife. We had expected that my insurance would cover it later and the midwife would reimburse us upon receiving that payment. We wrote a check for the entire $8,000 rather than opting for a payment plan, which would incur non-reimbursable interest charges.

I delivered my son sunny-side up on my bedroom floor after a six-hour labor, including two hours of pushing, all with the gentle guidance of my midwife and her assistant. After my golden hour of bonding with my newborn, my midwife escorted me to the bathroom and stayed while I showered.

That August, I received an explanation of benefits letter from my insurance stating that my plan would only cover $4,000. My midwife suggested I write my insurance's member appeals department to request they pay the billed amount. So I did, making it clear that the service authorization approval indicated that I would not be responsible for any payments beyond my in-network co-pay.

Within three weeks, my midwife called to congratulate me: She had received the full $8,000 from insurance. She had attended hundreds of births, but mine was the first that an insurance company had paid for in full. My midwife sent my reimbursement check, and I put it back into my savings account, where it started.

Negotiating Insurance Coverage

When I started my second pregnancy, I expected a similar experience. As before, I paid the midwife, anticipating reimbursement. By then, the COVID-19 pandemic had begun. And since I had another low-risk pregnancy, I enjoyed telehealth visits from my dining room table.

I gave birth to my daughter at home after a four-hour labor. The support we received from my midwife and her assistant was invaluable. We had their support during labor, delivery, and the early weeks postpartum. I cried daily from dealing with hemorrhoids, breastfeeding problems, mom guilt, and more.

I was surprised to get a call from my midwife's billing department when I was about a month postpartum. A vendor had reached out on behalf of my insurance. The vendor had attempted to negotiate a reduced payment to the midwife who had been so essential to me.

I had to decide whether to accept the offer and be responsible for the balance or reject it in hopes of a better payout. The gambler in me wanted to reject the offer. But the billing department warned that insurance could return with a lower number if I didn't accept. My husband and I deliberated and hesitantly rejected the offer.

The billing department contacted me again with a higher figure, which I also rejected. Then, I received an explanation of benefits letter from insurance stating they'd only pay $4,073, less than either of their vendor's offers had been.

Emboldened to continue playing their game, I mailed a letter requesting an additional payment the next day. And a couple of weeks later, an insurance representative notified me that they had settled the claim and would pay.

How To Get Home Birth Covered by Insurance

My midwife received her compensation and reimbursed me. She had also asked for my advice to help other people save money. Here's how to work with your insurance to cover home birth midwife services.

Ask if Your Plan Has In-Network Home Birth Midwives

If there are none, find out if you need prior authorization for your out-of-network midwife. Also, make sure your midwife submits the authorization request. 

Don’t Be Afraid To Appeal

Ask your insurance how you can appeal the decision if they reject your request. Then, follow their instructions. 

If you get denied again, ask your insurance for the next step you can take to get the service approved. Repeat as needed if you're willing and able to spend the time.

Have Your Midwife Bill Your Insurance Post-Birth

When you get approved authorization for your midwife if your insurance company tries to negotiate payment, reject all offers you are uncomfortable with. Accepting an offer could mean forfeiting your rights for an appeal later

Yes, You Can Appeal Again

When you get your explanation of benefits letter from the insurance indicating how much they have decided to pay, take note of the amount covered. Follow their instructions to appeal the decision if it's not your requested amount.

In your appeal, include what your authorization letter said led you to believe you would not be responsible for the remaining balance. Tell the insurance that your midwife is charging you the balance if they don't pay. 

Focus on the facts of your case only. Escalate the case with your insurance and potentially with a third-party reviewer until your case is settled.

Insurance Billing

For me, I didn't view my insurance as a villain. After all, it's their job to negotiate lower payments to service providers.

My midwife explained that insurance providers aren't familiar with the billing codes when it comes to home birth. That's because the birthing facility is essentially being brought into your home. 

Midwives may see people for an hour every appointment, not the 15 minutes that an OB-GYN might. So, an insurance provider doesn't understand that a dollar amount of, say, $8,000 is fair and reasonable compensation.

Final Thoughts

While I know that home births are not for everyone, I had beautiful experiences with both pregnancies. My midwives empowered me to make my own educated decisions. Their services would have been worth the cost had I been responsible for paying $25, $4,000 per birth, or even the full amount out of pocket.

While I'm amazed that I convinced my insurance company to pay $16,000 for my home births, I am disappointed that I had to be my advocate. Moreover, most people don't bother to do themselves the same favor. 

That lack of advocacy and involvement leads far too many people to dismiss home births as inaccessible. Or, they pay for them with money they could have saved for their new lives as parents. 

A Quick Review

Every pregnant person deserves a birth that makes them feel safe, respected, and supported, without fearing for their life—or how they will pay for it.

Remember: You can fight and advocate for yourself and your newborn. Saving money and setting a standard for what's of value in the birth process can help.

To learn more about the services of midwives and home birth as a delivery option, talk to a healthcare provider or ask an insurance provider for information and resources.