The American College of Nurse-Midwives (ACNM) released the results of a survey of health insurers on September 18th, 2014 that was rather eye-opening. Each provider surveyed offers coverage through the Health Insurance Marketplace, yet twenty percent do not contract with certified nurse-midwives (CNMs), even though nurse-midwives are licensed to practice in all 50 states and the District of Columbia.
Nurse-midwives are primary care providers in every sense of the word. Not only do we catch babies, and love doing so, but we provide care for women throughout their lifecycle, managing common conditions and diseases, such as hypothyroidism, poly-cycstic ovarian syndrome, infertility, sinusitis, bronchitis, asthma, and the plethora of dermatology concerns. Of course, we can provide the annual wellness visit for women, including all the recommended screenings. However, seventeen percent of healthcare plans do not cover primary care services offered by nurse-midwives, even though ACNM standards defining the scope of practice for these providers include primary care services. Worse, fourteen percent of plans impose restrictions on the practice of nurse-midwifery beyond those already restricting practice in state statute!
Fifty-six percent will not reimburse nurse-midwives for home birth services, and twenty-four precent of plans will not cover CNMs who provide services in birth centers.
Even if they do recognize nurse-midwives within their plan, fifty percent do not pay CNMs the same amount as physicians to the same service, and ten percent of healthcare insurers who extend contracts to nurse-midwives won’t list them in their provider directories! Nurse-midwives are therefore invisible to their current enrollees. Forty-percent that do list nurse-midwives, squish us underneath the obstetrician-gynecologist category, so again, midwives are hard to find. Eight percent of plans contracting with birth centers, will not list them in their provider directory.
ACNM has issued an invitation to the HHS to discuss the survey results and their implications for the Department’s efforts to ensure network adequacy and the absence of discrimination among providers on the part of health plans. Their response has yet to be reported, but now is time to communicate with your employer’s human resource department. Let them know your desires for midwifery covered services. Call your state’s insurance commissioner and your legislative leader. Don’t be intimidated! They work for you.
Help your midwife help you! It is challenging to work twenty-four hours, seven days a week and dedicate sufficient time to being an advocate for you to our legislative leaders. We need your help.