Midwives Lose When PEBB Switched to Providence
Under the old contract, Regence BlueCross BlueShield paid for in-home deliveries by licensed midwives
April 7, 2010 -- There’s a glaring omission in the benefits offered to state employees now that Providence Health Plan holds the reins -- licensed direct entry midwifes can no longer be paid for in-home deliveries.
Women previously had that option until Regence BlueCross BlueShield lost the contract last year.
“This change has broken what used to be a well-rounded maternity benefit,” said Christine Olsen, a faculty member at Oregon State University.
For the time being, Providence may be off the hook – even though its contract excludes direct entry midwives. The health plan has agreed to continue paying for such services for women who started their maternity care before Jan. 1 when the contract started. Regence specifically listed direct entry midwives as physicians.
“This covers most (though not all) women who are pregnant right now,” Olsen said. “We're uncertain whether Providence took this action on its own, or whether it was at PEBB's direction. We now have a few more months' cushion. I assume they took this action because of all the commotion we created. Many of the letters we submitted were strongly worded...pointing out how unethical it was to dump pregnant women from coverage when they were seeing state-licensed providers that had been part of our insurance for over a decade, especially when we'd been given no warning about this change.”
The Public Employees Benefit Board will consider restoring this benefit when it meets April 20 after 391 PEBB members, their spouses and a few members of the public signed petitions protesting the changed policy.
“With a licensed midwife, I only need to know and trust one maternity provider rather than an entire team of OBs, OB alternates, and nursing staff,” said Mandy Lindgren, a University of Oregon employee. “With a homebirth, I can birth my son in an environment familiar to me – my own home – rather than an alien one. I can become part of a group of women who receive better infant and maternal outcomes -- all at a fraction of the cost of a traditional hospital birth.”
It’s much cheaper to hire a licensed midwife, according to Olsen. Such practitioners only charge between $2,500-3,000 which covers all prenatal care, birth and postpartusm care, which is about $10,000 less than similar care at a hospital. Also a study conducted by Amanda Whitmire, PhD, a research associate at Oregon State University, indicated that PEBB would have to spend an additional $265,000 to $560,000 a year by excluding midwives.
“This change impacts my family directly as we’ll be forced to pay the $3,000 for my midwifery care directly out of pocket, in spite of having what I thought to be great maternity benefits,” said Bonnie Cox, the spouse of an OSU employee. “Ironically, the Providence/PEBB statewide plan would gladly cover the estimated $12,000-$16,000 in maternity care fees for an uncomplicated delivery at the hospital while denying what would be a $2,100 claim for licensed midwifery care and a home birth.”
Oregon has among the highest rates of out-of-hospital births in the nation, according to Melissa Cheyney, PhD, a professor of medical anthropology and reproductive biology at OSU, who chairs the Board of Direct Entry Midwifery. The national rate is 0.9 percent births, while Oregon’s rate is 2.5 percent.
“There’s a common misconception in the U.S. that the hospital is the safest place to give birth,” she said. “This is certainly true for higher risk women. But for low-risk women there are now 33 studies that demonstrate that with a trained care provider, when a complication arises, and the home birth is planned, that home birth is as safe as or safer than the hospital. It also results in enormous cost savings, lower rates of intervention, higher rates of psychosocial outcomes that are considered positive like prolonged breast feeding and high satisfaction rates for the mother. So these women are actually practicing evidence-based maternity care.”
Midwives also serve a diverse demographic, she added. About 50 percent of pregnant women who choose a midwife are college educated and have middle to high socioeconomic backgrounds, while the remainder live in rural areas and face transportation barriers to hospital care.
When PEBB published the draft handbook last fall, it failed to mention that midwives would not longer be part of the Providence contract. Because that error wasn’t corrected until January, state employees couldn’t increase the amount of money set aside in their flexible spending account to cover such services.
“Either way,” Olsen explained, “PEBB members are left with no choices, a plan that we don’t like and additional expenses for maternity care. Most PEBB members don’t even realize we’ve lost these important choices yet because we were so adamantly told our benefits would stay the same.”
Apologizing for the misinformation, Kathy Loretz, deputy administration of PEBB, said: “I don’t have an explanation. We’re sorry if we did something to lead them (PEBB members) astray. Now we just want to figure it out going forward.”
TO LEARN MORE
The PEBB Members for Maternity Care Choice has a website that explains their concerns in more detail. Click here to learn more: http://pebbmembersformaternitychoice.wikispaces.com
Or, to learn more about the Board of Direct Entry Midwifery, click here: http://www.oregon.gov/OHLA/DEM/docs/Publications/Births_Risks_Rifts.shtml#_Lay__Not_the_Same_as_LDM
Apr 7 2010