Billing expert tells Connecticut working group insurers resist paying midwives absent state mandate

Summary

Billing specialist Catherine Baker told a June 27 virtual meeting that insurers often refuse or underpay for midwifery services unless a state law requires coverage; Connecticut staff said Medicaid here is fee-for-service, and the group asked Baker to provide materials comparing midwifery services to hospital billing.

Catherine Baker, owner of Hamilton Billing, told a June 27 virtual meeting of a midwifery stakeholder group that it is “extremely difficult to try to help midwives get coverage from large insurance companies or any insurance company really, when there's no mandate in place.” Baker, who bills for midwives primarily in New York, described repeated denials, low allowed charges and billing-system barriers that leave many autonomous midwives operating out-of-network.

Baker said the New York statute that mandates coverage for midwives gives her leverage with managed-care organizations. “If a midwife catches the baby, you've gotta pay her,” she said, summarizing how some state laws require payment when licensed midwives provide services and there is a network deficiency. She contrasted that with Connecticut, where she said no such mandate exists and where she has had limited success persuading insurers to pay.

Why it matters: Speakers linked coverage to access and…

Billing expert tells Connecticut working group insurers resist paying midwives absent state mandate

Summary

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