Starting this year health plans are prohibited from discriminating against licensed or certified health care providers who want to participate in their networks. However, the law says, insurers aren’t required to contract with any particular provider.
Midwifery and birth center advocates say they’re uncertain how the nondiscrimination provisions will be applied or enforced, and the Department of Labor says it’s not issuing any further guidance.
“It leaves us in the dark,” says Jesse Bushman, director of advocacy and government affairs at the American College of Nurse-Midwives.
It can be difficult to learn whether a health plan covers a particular service or provider, particularly on the health insurance exchanges, say advocates. Kim Dau, chair of the policy committee at ACNM’s California affiliate, has been trying to learn the extent to which nurse-midwives are included in plans on the California health insurance marketplace. Sometimes certified nurse-midwives are incorporated into physician directories and hard to find in a search, she says.
For consumers, if having access to a midwife or birth center is important, the best and perhaps only remedy is to call the plan directly and ask about coverage.
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This story was updated to make correct several references that misidentified Stephanie Taylor's insurance company. Her coverage is through Blue Shield.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
Mon, Mar 03 2014