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Old 06-21-2011, 08:22 AM   #1
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Paying a Lay Midwife

I may be considering working with a lay midwife for this pregnancy. For my health insurance, I have a high deductible health plan with a health savings account. Her fee is definitely way less than my out-of-network deductible, so I know I wouldn't get any reimbursement from them, even if they would allow the claim.

What I would want to do is pay her out of my health savings account. I am trying to find out if that is allowable by the IRS. I tried calling the health insurance company, and they didn't know? Really, the don't know what are allowable health costs? Anyway, they told me to call a tax lawyer - I can just imagine how that conversation would go . Pretty sure most tax lawyers aren't up to date on the different kinds of midwives, etc.

I'm fairly confident it wouldn't be an issue to pay a CPM out of an HSA account, as she would be a certified professional by a governing body. What I am unsure of is paying a lay midwife.

This lay midwife is NOT licensed by the state (no licensure is available), but she is authorized by the state to submit all the paperwork for the birth certificate - proof of pregnancy and proof of live birth. So, she isn't licensed or certified, but she is *recognized* by the state.

With all that information, I have no idea how paying her out of my health funds would fly with the IRS. So what are your experiences?

Oh, also, I think if insurance would reimburse her, then it is likely a qualified medical expense, but I don't know if lay midwives are ever reimbursed by insurance. Does anyone have input for me here? Thanks, mamas!

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Old 06-21-2011, 11:49 AM   #2
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Re: Paying a Lay Midwife

It depends on a lot of things.

I had a licensed professional (lay) midwife for my first pregnancy. She worked with a billing agency and said that sometimes they could get the claims through, but I got the impression that it mostly depended on how much attention they were paying. My health care plan specifically said it didn't cover home birth (or, by extension, lay midwives).

I was also told it wouldn't qualify under a HSA, though for the life of me I can't remember who told me that. It was someone official enough that I figured they'd know.
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Old 06-21-2011, 03:57 PM   #3
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Re: Paying a Lay Midwife

Are you talking about a flex account or a cafeteria plan? If so I used my flex account to pay for part of my midwife's fee. I called the service that takes care of the account for my husband's work and they said that it would be covered. My midwife also said that she does it all the time. My midwife is a Certified Practicing Midwife. Not sure if that makes a difference. Have you tried asking your midwife? Or is there a company that deals with that account? We have a debit card account, so that's how I paid. I was told that any prenatal care that wasn't covered by insurance would be eligible. I did have to show them proof of service and give them dates of care and all of that stuff, but they have me do that almost every time I use the card.

ETA: As for insurance reimbursing I think it all depends. With my first I submitted all of the paper work for the claim and I got a small portion of the cost of the birth back. I did the same with my youngest and got denied. When I called to ask them why they said that my midwife was not a provider. I told them what happened the first time and they said that they had made a mistake and thought she was another provider, so I shouldn't have gotten that money back anyway. Honestly, every time I talk to the insurance company I feel like I get a different story. I think I can still submit the claim and have it count towards my out of pocket expenses. I don't remember now, but I think it counts toward that. You would have to call your insurance and talk to them about it. It's not fun and I swear that every person I talk to tells me something different. Good luck!
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Old 06-21-2011, 05:07 PM   #4
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Re: Paying a Lay Midwife

It probably varies by state, but I'm going to say no.

They are "cracking down" on what you can and can't use your HSA for. You may be able to buy your birthing supplies with the HSA, but I can't see them allowing you to pay an unlicensed professional. (not saying unlicensed to be rude, we have similar archaic rules about home births and who can attend without risking their "real" license)
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Old 06-21-2011, 07:25 PM   #5
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Re: Paying a Lay Midwife

You can call the IRS at 1800-829-1040, or go to their website. Here is the 2 HSA publications from the IRS:

Publication 969
http://www.irs.gov/pub/irs-pdf/p969.pdf

Publication 502
http://www.irs.gov/pub/irs-pdf/p502.pdf

I had a couple of questions about HSA yesterday and I just called the number on the back of my HSA bank card and they had some answers too.
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Old 06-21-2011, 08:07 PM   #6
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Re: Paying a Lay Midwife

is she also a doula? you may be able to get her covered as a doula instead a midwife if she is
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Old 06-25-2011, 01:04 PM   #7
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Re: Paying a Lay Midwife

:bumping: this. We are in the SAME boat. Our deductible is 5,000. So basically its cheaper to pay the whole thing OOP. We have and HSA though and dh work matches the amount put on the card monthly. We ARE able to withdraw the funds though to pay for apts or just use the card as a debit/cc. SO here my question. HOW do u find a lay mw? Is there somewhere i can look? Ive contacted a few but still its a bit more than we can afford.
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