Impatient | Helping make the health care system work for you

Ask Impatient: Which kind of insurance is best for an out-of-hospital birth?

eyeliam via Flickr Creative Commons

Vanessa Villegas, 31, of Los Angeles, and her husband would like to start a family soon. She says she's interested in having the baby at a birthing center or at home with the help of a midwife. She asks Impatient: What type of health insurance plan would provide the best coverage for an out-of-hospital birth?

Villegas currently has a high-deductible health plan. Now that Covered California has begun its new open enrollment period, she wonders whether it would be wiser to keep this type of plan and use her Health Savings Account to pay for any birthing expenses not covered by insurance, or whether she should switch to a plan with a higher premium and lower deductible.

Before I answer her question, let's review a few facts:

OK, back to Villegas' question: I reached out to Nicole Lee, founder of Natural Health Advocate, a company that helps women navigate the health insurance system when they're interested in giving birth outside of the hospital. She also does the billing for GraceFull, a birthing center in Silverlake that I featured in a previous post.

I asked Lee what advice she'd give to women like Villegas, who are interested in buying insurance that would accommodate their birthing preferences.

First of all, she says, here are a couple of things to keep in mind:

Lee says the question of whether to select a plan with a higher premium or a higher deductible depends on individuals' financial budget and preferences. It's a tradeoff, she says: Would you rather pay more each month, regardless of whether you see a doctor? Or would you rather pay more out-of-pocket when you do need medical care?

These decisions are complicated by the fact that, at least in the greater Los Angeles area, most birthing centers and midwives are considered out-of-network care, Lee says.

Neither Lee nor I can recommend one specific plan or insurance company over another, but she says women like Villegas should research each health plan they're considering. Here are a few factors that Lee recommends considering:

Lee offers two more options:

Do you have health insurance-related questions during open enrollment season? If you e-mail me at, I'll try to find you some answers!