Insurance vs. Samaritan Ministries and other Christian health care cost sharing plans; what’s right for you?

Premier Birth CenterMidwives are often asked which health insurance plans have the best coverage for home births or birth center births. Everyone’s financial picture is different, and we can’t give you advice about which insurance plan you should choose. In these times of great change in health insurance, conservative plans rise to the top as a very progressive idea, especially for out-of-hospital births. Christian health care cost sharing plans like Samaritan Ministries and Christian Care Ministry (Medi-Share) are an idea we encourage families to consider when they look at options for paying for their health care expenses. Premier Birth Center supports Samaritan Ministries by not requiring any pre-payment or out-of-pocket expense for Samaritan members. 

 

Commercial Insurance

Most people have commercial insurance, such as Blue Cross/Blue Shield (Anthem, CareFirst), Aetna, Cigna, United Healthcare, etc. These plans are often subsidized by their employer or by the government (through “Obamacare”). ObamacareMonthly payments (premiums) generally vary according to the size of your deductible and co-payment. HMO plans tend to have lower premiums than PPO plans, but when you have an HMO, you are limited to using the providers within the insurance company’s plan. PPO plans usually have in-network and out-of-network benefits, although some plans do not have out-of-network benefits at all. Some plans allow for an in-network exception. Some plans will pay for all kinds of midwives, some exclude certain credentials. Some will pay for a birth center birth, but will not pay for a home birth.

With commercial insurance, you generally have a deductible, co-payments, and co-insurance. The deductible can be different for in-network vs. out-of-network claims. So, let’s say you have a $2000 out-of-network deductible with a 70/30 co-pay. You will need to pay the $2000 before your insurance will pay anything at all. Once you have met your deductible, your insurance will pay 70% of what they consider to be the “usual and customary” amount for the codes your provider submits on their claims to your insurance, and you are responsible for the other 30%. So, if there are $6000 in usual and customary expenses after the deductible, you will need to pay 30% of that $6000, or $1800, in addition to the $2000 deductible, for a grand total of $3800 out of pocket expense.

There are many variables, and even when we think a plan will pay well, we sometimes are surprised be a claim being denied after the birth. There really is no way to know for sure whether a plan will pay and how much they will pay, so we often will tell people to plan for the maximum out of pocket (no reimbursement at all), just in case there is a surprise. It is better to be prepared for that and then be pleasantly surprised if your insurance pays well, but most of the time people are very disappointed by how poorly their supposedly “awesome” commercial insurance reimburses for their home birth or birth center birth.

Doesn’t a hospital birth cost less than a birth center or home birth?

Medical CostsOften, people look at their commercial insurance and think a hospital birth will cost them less than a birth center or home birth. Sometimes, this is true. But, if they have a deductible and co-pay, they may be surprised to find that their hospital bill will end up costing about the same or even more. Using a $1500 in-network deductible and an 80/20 co-pay as an example, if you had a $15,000-$25,000 hospital birth, you could easily end up with a bill for $4000-$5000.

Christian Health Care Cost Sharing Plans

Medi-ShareThese plans are not health insurance, although they do “count” as coverage for the Affordable Care Act. As Christian Care Ministry says, they are a “healthcare sharing ministry where members share each other’s medical expenses.” Members pay a monthly “share” instead of a premium.

Samaritan MinistriesEach health care sharing plan has slight differences in the way that their programs are run. For Samaritan Ministries, if a member has a qualified medical need, that need is published to the membership. Members will send their shares directly to the person in need, often with a note of encouragement, expressing their plan to keep the family in their prayers. Members have reported feeling very uplifted and supported by the personal and spiritual connection with other Samaritan members.

The monthly share for these plans is quite low compared to commercial insurance. Samaritan Ministries‘ monthly share for a family is $405 (as of May 2016). Christian Care Ministries‘ monthly share varies according to family size, date of birth, and Annual Household Portion (out of pocket cost per year before needs are published for sharing).

The plans have guidelines for their programs available on their websites. These guidelines detail what is and is not considered to be a publishable need, as well as what the qualifications are for membership. Generally, members are required to be Christians and live a Biblical lifestyle.

Samaritan rewards families who choose midwifery care. They waive the initial unpublishable $300 need amount for homebirth and VBAC because “they lower overall maternity costs,” and they also will pay up to $500 for doula services. They will pay in advance of the birth if the maternity care provider discounts the fee for paying in advance.

The big question: What if I transfer?

Good question. We can’t answer that question fully for every person, but in our experience, Samaritan Ministries has handled this very well. The ministry will help negotiate lower fees with the hospital and the remaining hospital bills are handled like other publishable needs.

If you would like more information about Samaritan Ministries or Christian Care Ministry, we encourage you to explore their websites to see if these plans might work for you. Your midwife can also answer questions about her experience with these plans, as well. Call Premier Birth Center at 540-709-1737 for more information about health insurance and Christian healthcare sharing plans.

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How much does a home birth cost? How much does a birth center birth cost?

birth center home birth cost insurance uninsured

How much does a home birth cost? How much does a birth center birth cost?

Long story short, it depends! Compared to a hospital birth, a birth center birth can be about a third of the cost. But, your budget depends on several factors.

Do you have insurance to help pay for your birth center or home birth?
Insurance coverage varies from carrier to carrier. Doing some homework up front will help reduce the surprises and frustrations along the way. You may believe you have “great insurance,” but when it comes to an out-of-hospital birth, your “great” insurance may not be so “great” after all. Here are some tips:

  1. Get a verification of benefits through your midwife’s professional insurance billing company. You’ll need a provider PIN to start that process. For NOVA Natural Birth Center, our provider PIN is 18277. The billing company will contact your insurance provider and get answers to the most important questions. Bonus — by having the billing company do this, you’re not the one playing phone tag and being on hold waiting to speak to someone at your insurance company! Totally worth it!
  • Place of Birth
    Some insurance companies only cover hospital births. Some may pay part of the cost of having your baby at a birth center, but will not cover a home birth, and vice versa.
  • Provider’s Credentials
    Your coverage may also depend upon your provider’s credential. Most plans cover midwives.  However, some will only pay CNMs (certified nurse midwives), and not CPMs (certified professional midwives). CPMs are the “new kids on the block” when it comes to insurance. More and more insurance companies are covering CPMs now, but there are a few holdouts.
  • In-Network vs. Out-of-Network
    Ask your midwife if her practice is in-network, and which plans she’s contracted with. Most CPMs are not contracted with insurance, so your reimbursement would be at the out-of-network rate.
  • Deductibles & Co-pays
    You’ll be responsible to pay all of your deductibles and co-pays before your insurance will kick in. Most insurance companies have separate deductibles for out-of-network vs. in-network providers. Once your deductibles and co-pays have been satisfied, your insurance will reimburse a percentage of the cost.
  • In-Network Exceptions
    Some plans have an option for an in-network exception. If you’re able to get an in-network exception, your insurance company will reimburse at the in-network, rather than out-of-network rate. You’ll have to meet certain criteria to be eligible for an in-network exception. Usually, if there are no contracted providers within a certain radius of your home, you may be granted an in-network exception.
  • Medicaid
    Some midwives are Medicaid providers. If you qualify for Medicaid, there will likely be some extra hoops to jump through, but you may be covered. Medicaid doesn’t cover all of the expenses for your birth though, so ask your midwife for details.

2. No matter how much you think you know about your insurance coverage, be prepared for some surprises.

  • Your insurance provider may deny your claim
    This happens a lot, but your insurance billing company will usually handle the appeals process. Having a billing company takes a lot of stress off of you, which is great, because you’ll have much more important things on your mind — like your baby!
  • It can take a long time for the claims to be paid
    Once your baby is born, your midwife will usually bill for the global fee. This fee covers your prenatal care, birth, and immediate postpartum. After your 6 week postpartum visit, your midwife will bill for the postpartum and baby care. Sometimes, it can take up to a year for all of the dust to settle. This is especially true if the billing company had to appeal denied claims.
  • Your midwife’s fee is what she bills insurance
    Your midwife will usually expect a deposit towards what she bills towards your insurance. This amount varies from midwife to midwife, but is generally around $4000 to $5000. She usually expects to receive that deposit by the time you reach the 36th week of your pregnancy. If the total payments (what you pay plus what your insurance pays) exceed what she bills insurance, you may receive reimbursement for part of what you paid.
  • Your reimbursement will probably not be as much as you expect it will be
    Remember, your midwife’s fee is what she bills your insurance. Your insurance company pays a percentage of what they consider to be “usual and customary” for the codes your midwife bills. The “usual and customary” amount varies from insurance company to insurance company, and they will not tell your midwife up-front what their usual and customary is. So, while you might have 70% coverage for an out-of-network provider, that’s 70% of the usual and customary, after the deductibles and copays have been satisfied.

3. Talk with your midwife about your financial situation

Your midwife will do everything she can to help you find a way to pay for the care she gives you. She really wants to make it work for you.

4. Explore creative financing options

Many midwives will accept credit cards, and even PayPal payments. Some midwives offer loan programs, payment plans, and discounts for early payment.

Are you uninsured? Does your insurance not cover your midwife’s services?

Many midwives have payment options for uninsured clients, or for people with high deductible insurance plans. Ask your midwife if she offers a self-pay discount if you don’t have insurance coverage.

What other costs should I expect?

Additional costs can be minimal, or can be even more than what your midwife charges! It all depends upon your needs and preferences. Some additional expenses to consider are:

  • Hiring a Doula – Sometimes, insurance will cover part of this cost, but if you hire a doula, you should expect to pay anywhere from $300 to $1800 for your doula’s services, depending upon where you live and what her experience level is.
  • Childbirth Education – Having a baby naturally can be very challenging, and you don’t want to be unprepared for it. Childbirth education is absolutely critical. Birth can be very challenging, and some people say preparing for birth is like preparing for a marathon. You wouldn’t show up to run a marathon without having at least gone jogging a few times. A comprehensive childbirth education class is absolutely essential. Expect to pay several hundred dollars for it.
  • Birth Photographer – This is optional, of course, but it is important to many people. Having a professional birth photographer at your birth will help capture memories of your experience and the first moments with your new baby.
  • Birth Supplies – If you’re planning a home birth, you may need to purchase a birth kit. The birth kit contains all of the disposable supplies your midwife needs for your birth. These vary in cost from midwife to midwife, but are generally less than $100. You’ll also need to gather other supplies, like sheets, towels, washcloths, etc. Some of these things you’ll already have around your house.

So, how much does it cost to have a homebirth or a birth center birth? The answer is different for everyone, but the investment is usually within your reach. It is good to keep in mind that the service your midwife is giving you is unique and valuable. You have to want this out-of-hospital birth so much that you’ll still be happy even if the cost is totally out-of-pocket. Then, if and when you do receive some reimbursement, you’ll be happy with whatever it is, even if it is much less than you thought it would be. After all, many people spend thousands of dollars on vacations and HD televisions. This birth is a once-in-a-lifetime experience, one that you will remember for the rest of your life. It is worth the investment. Will it really matter to you 10 years from now that your insurance reimbursement wasn’t all that great?