How Does Your Insurance Effect Birth Outcomes?

Does Your Insurance Effect Birth Outcomes

Introduction: Meeting Our Insurance Biller

I was recently on a call with Alicia Hanson-Glatzel of Earthside Billing. Alicia is the incredibly enthusiastic biller who handles our billing at Hatch Midwifery. And I have to say, I never thought a conversation with a professional claims’ handler would leave me feeling so excited and proud to represent midwifery.

Before I get into the meat of why our conversation was so fascinating, I will start off by saying Alicia knows her stuff. She represents eight birth centers and over 40 private practice community midwives. She painstakingly reviews how each individual’s insurance is going to be reimbursed and follows the process of each claim through to its final payment. She’s worked in insurance billing for over 15 years and was able to successfully seek reimbursement for her own home births at a rate higher than any other client her midwife had previously worked with. If insurance billing were an Olympic sport, Alicia would be in metal contention for sure.

Understanding Insurance Billing in Midwifery Care

So, where did our 90-minute gabfest take us? I will start by saying that I like to be an informed consumer. When I opened Hatch Midwifery, I took a very dense and super informative course on insurance billing. It taught me two things: (1) billing, like midwifery, is hard and the best outcomes are achieved when it’s done on an individualized basis, and (2) the current health insurance system is rigged against high-quality midwifery care.

I’m not going to spend too much more time talking about that first point. If you’ve ever had to try and get a health claim reimbursed by an insurance company (and you’re not a skilled professional, like Alicia), you know it’s hard. I can safely say that, for myself personally, I have left reimbursable monies on the table because the thought of making one more call to my insurance company would break something irreparable within me.

The Challenge of Reimbursement Rates

Okay, let’s take on that second point…I’ll say it again: The current health insurance system is rigged against high-quality midwifery care. I think I’ve always known this in my gut since I became a healthcare provider over a decade ago. But it’s one thing to feel it and an entirely different thing to be able to clearly articulate that feeling and support it with actual data.

So, here goes. I’m going to do my best to reiterate what Alicia laid down when she took the stage at our two-person protest rally:

  •  From 2017 to 2021 (that’s the most recent period we have data for so far), insurance reimbursement rates for typical OBGYN prenatal care have gone down. You read that right. While everyone else adjusts wages up for cost of living, insurance companies boldly decided to buck that trend and tell healthcare providers they deserve even less.
  • Okay, that’s probably not good if you are a hospital-based provider and you are in-network with these insurance companies and forced to accept what they are willing to pay.
  • So, what do hospitals do to compensate for this and continue to pay their staff? Squash even more visits into an already densely packed schedule. I know this first-hand. During my training at a hospital in Detroit, the clinic schedule allowed for 24 patients in an 8-hour workday (30 minutes were deducted for lunch, though most of us had to work through lunch just to keep up). That averages a little over 3 patients in an hour – 10-12 minutes for the actual visit, followed by a few minutes to chart that visit in the medical record.
  • Once even the best-intentioned provider has said a heartfelt “Hello, how are you doing?”, reviewed scheduled tests, and listened to the baby’s heart rate, those ten minutes are nearly up. What about the pregnant person’s questions or concerns?

The Impact on Quality of Care

Given all of this, is it any wonder that the U.S. ranks among the worst for infant and maternal outcomes in the developed world? If you didn’t get to tell your provider about that worsening headache, is it any wonder when we don’t catch the preeclampsia that’s developing? If you were rushed out the door before you could mention your itchy hands, is it a surprise when we don’t pick up on the ICP that’s brewing? Don’t get me wrong, headaches and itchiness are usually annoying and benign discomforts of pregnancy. But in the uncommon instance when they are not, they can only be detected when healthcare providers have time to ask questions and pregnant people have time to share their experiences.

The Importance of Time in Prenatal Visits

All of this so far feels like enough justification for more, not less time, right? The thing that makes community midwifery care so different from typical hospital-based prenatal care is that we give that time. Not only do we give that time, we insist on it. Even if the pregnancy is normal and everything is physically very healthy, we keep those visits intentionally long. Community midwifery seeks to help pregnant people and their families feel prepared for childbirth, the postpartum, and the transition to parenthood.

The Difference Midwifery Care Makes

In my life as a community birth midwife, people will often engage me in casual conversations about their own birth and postpartum experiences. It is not unusual for folks to say to me, “Wow, I definitely didn’t know that!” when I share little tidbits. I’ve even had a couple of friends who’ve had hospital-based care remark that I should write a book called “Things No One Tells You.” But of course, how could all the preparatory information for pregnancy and the postpartum be shared in a dozen or so 10–15-minute prenatal care visits? It’s an impossible task!

The Future of Medicaid and Midwifery Care

And this brings me to, perhaps, the most exciting thing that Alicia shared with me: currently Medicaid (which sets the benchmark for all healthcare reimbursement) is in year three of a five-year project that explores the possibility of developing billing codes specifically for midwifery care! That might sound like a very boring sentence, but it is actually huge. If midwives can bill for the extensive care they provide, midwifery care will become available to a greater number of pregnant people. Not only does midwifery care lead to better health outcomes for the pregnant person and their baby, but research has also shown that people receiving midwifery care experience a greater sense of respect and are at decreased risk of mistreatment. And really, aren’t good health outcomes and respect what everyone deserves from their healthcare provider?

The Reality for Community Midwives

Sadly, at present, community midwives cannot provide the high-quality care they are known for and simultaneously make a living wage through insurance reimbursement alone. If we were to subsist on insurance reimbursement alone, we’d be forced to squeeze in more families into less time, which puts us right back in the pickle hospital-based providers find themselves in (see above). But separate billing codes that acknowledge the difference in the care we provide will begin to change that.

Conclusion: Choosing Midwifery Care for Your Pregnancy

If you’re pregnant and thinking about midwifery care, I hope this gives you the final push to reach out to midwives in your area to explore your options. If you’re in the San Francisco Bay Area and you’re interested in what we offer, please contact us to learn more about what we can do together. If you’re reading this elsewhere and want to learn more about community midwifery in your area, don’t be afraid to reach out to your local midwives – even if it is just to learn more about what they do. Most midwives love sharing with folks about their work and the difference they make.

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