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

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 outcomes. Group members said midwifery care is associated with lower cesarean rates and can reduce overall maternity spending when facility and anesthesia costs are factored in. Participants worried that low reimbursement forces midwives into unsustainable high-volume practices or out of the profession, reducing access for Medicaid and low-income patients.

Top takeaways from the discussion

- Mandates and law: Baker said a state-level coverage mandate (her example: New York) is the most effective tool for securing payment for licensed midwives and negotiated rates with managed-care organizations. She said mandates make it possible for Medicaid recipients to access midwifery care through negotiated MCO contracts.

- How insurers limit payment: Baker described tactics by insurers including very low “allowed” charges for out-of-network claims, high patient cost-sharing and administrative denials even after a signed contract. She said managed plans often structure out-of-network benefits so they will not cover midwifery services at sustainable levels.

- Connecticut specifics: Dante, staff at the Connecticut Department of Public Health, noted the state’s Medicaid program uses fee-for-service rather than MCOs, which changes how rates are set and how the group might engage state agencies on reimbursement questions.

- Cost comparisons offered by Baker: In the meeting Baker said the facility bill for a routine hospital vaginal delivery she sees in New York City typically runs about $15,000 to $20,000, with anesthesia adding about $3,000–$4,000. She estimated birthing-center and home births can be substantially less — in some cases roughly half the hospital bill — producing meaningful savings when the full set of hospital-related charges is considered.

- Patient advocacy and billing work: Baker described her practice of working directly with patients and employers when needed, calling insurers, and using statutes or employer HR intervention to secure payment. She said insurers sometimes deny payments “even after we have a signed contract.”

Discussion, next steps and deliverables

Meeting participants asked for clear materials that compare what midwives provide against hospital billing line items. Baker said she has a packet for midwifery practices and is preparing a condensed chart that lists the services and the comparable hospital charges; she agreed to share that material with the group. Participants also identified a Medicaid expert in the room and suggested follow-up questions specific to Connecticut’s fee-for-service Medicaid structure.

No formal votes or policy actions were taken during the meeting. Participants described the conversation as a continuing education and strategy session: clarifying the role a state mandate plays, documenting cost differences, and drafting materials to present to state agencies and payers.

Quotes used in this story are verbatim from the meeting transcript.