The average out-of-pocket cost of a vaginal birth in the hospital in North Carolina is $6,750 with insurance and $11,991 without insurance. These numbers are much much higher if you get an epidural or need a surgical birth (cesarean section). And these numbers don’t even include prenatal or postpartum or newborn care!

Because we are focused on making homebirth accessible, our global fee (all prenatal, birth, postpartum and newborn care) is between $4000-$9000 based on income. When you also factor in planning a homebirth greatly reduces epidural use and risk of cesarean section, this makes the out-of-pocket cost difference between planned homebirth and hospital birth even more stark.

Not factored into these numbers is the personalized, comprehensive, high-quality care of a one-on-one relationship with your midwife. This has been shown in and of itself to improve health outcomes and improve patient/client satisfaction. Evidence based. How does the cost compare?

If we are in-network with your insurance plan that means we can bill for the care you receive for prenatal and postpartum visits and possibly some of the birth. Private insurance may cover a portion of your care, but not all. Every plan is different and some plans put covered care toward your deductible or charge a coinsurance. Even with in-network insurance, there is a minimum out-of-pocket cost of $5000 depending where you fall on the sliding scale

If we are not in-network with your insurance, we may still be able to bill on your behalf to attempt to get out-of-network benefit coverage for your care. Again, all plans are different and some plans have out-of-network benefits and some do not.

In either case, sadly we cannot guarantee a level of coverage, payment, or reimbursement from your particular insurance plan and the client is ultimately responsible for their full global fee. 

For the medicaid plans we are in-network with (State Medicaid, Healthy Blue, AmerihealthCaritas, Caroline Complete Health, UHC Community Plan) we can bill your medicaid plan for prenatal and postpartum visits, and a portion of the birth. Some plans will pay a portion of the birth and some will not. For medicaid patients, the minimum out-of-pocket cost is $4000 depending on where you fall on the sliding scale.

This happens for mainly two reasons:

• For most birth facilities (hospital, birth center) the majority of your bill is under what is called a “facility fee”. This pays for things like doctor/midwife support, nurses/birth assistants, medications, supplies, etc. Since the facility for home birth is the patient’s home, we cannot bill insurance under this blanket fee and they consider these things “non-covered services”. Things that are not covered by your insurance or medicaid are an out-of-pocket cost.

• North Carolina does not have laws in place that protect insurance reimbursement for midwives. This means they are not required to pay us, even if we are in network with your insurance and it they are not required to pay for services we provide in your home. For example, in NY, Medicaid pays well over $10,000 for a homebirth! It’s a state-specific thing. Call your legislators!

We are happy to bill your insurance and medicaid on your behalf for in-network plans and some out-of-network plans. If a bill is denied due to a billing error on our part, we will correct it and submit it again. If a bill is denied due to your benefits, coverage level, deductible amount, etc. we cannot appeal on your behalf. If you would like to appeal your claims and need documentation or records, we are happy to provide those for you and advocate for you in any way we can!

If you transfer out of our care before 36 weeks of pregnancy, we will refund/only charge you for the care you have received.

After 36 weeks of pregnancy, we are committed to being with you for your birth wherever/however it takes place! We believe continuity of care is essential! Therefore, the full global fee will be due because we will still be providing you care.