Health Insurance Appeal Input

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Joined: 08/03/07
Posts: 3193
Health Insurance Appeal Input

My insurance company (BCBS though a plan through my employer so the employer has to officially approve or deny the appeal) covers midwives as long as I give birth in a birth center, they don't cover them for a home birth. I am planning on a home birth since my labors are very quick so I'm filling out an appeal to see if I can get them to cover the midwife even with a home birth. They want detailed descriptions, expected outcome, and supporting documentation (if any).

I plan to give them an over view of my prior two births, 1st induced at hospital 6 hour labor from the start of the pitocin 5 pushes and he was out. 2nd no contractions to give a warning, woke in the middle of the night (3:30) with my water breaking (though she blocked it from leaking out so I wasn't sure) progressed very quickly and wound up with an unplanned/unassisted homebirth around 7:30, 3 pushes and she was out.

I know part of the concern is that something goes wrong and I will need medical assistance. When we called 911 with my daugher we had EMT's at our house in under 5 minutes. A trip to the hospital from where I'm located is a 10-15 min trip, with sirens probably closer to 10 min.

What else should I cover in my appeal? The typical length of time it takes to prep an OR compared to the length of time it would take us to get to the hospital?

Any advice/input/help is appreciated.

Cindy

kridda_88's picture
Joined: 01/28/08
Posts: 1798

I have no advice but I know that my midwife billed the same for a home birth vs a birth center birth so the insurance couldn't tell a difference in the billing. Maybe your midwife could do that. I was going to attempt an appeal but couldn't get any information from the insurance on who to send it to. They just kept telling me that I couldn't do things like that. I gave up very frustrated at the situation and was not in the mood to sit and fight with them anymore. We just paid out of pocket because my midwife wasn't covered at all by our insurance.

Spacers's picture
Joined: 12/29/03
Posts: 4099

Does your state license home birth midwives? If so, then the insurance company should cover their legally-provided services no matter where the service is provided. The insurance company pays for the service, not the location. They would cover your pediatrician if he made a home visit for a newborn, correct? Then they need to apply the same logic to the midwife's services. Anything less should be illegal under your state law. Most states that license midwives have a law that states insurance has to cover them. Call your local elected representatives & see if they can offer some guidance, and if your state doesn't have these laws, suggest they be the one to write it! Smile

I'd also throw in some statistics about the safety of home birth in general, statistics for this midwife specifically, maybe mention the cost of 911 responders coming to your home a second time for another precipitous birth, and some talk about the dangers of delivering a baby unattended on the side of a road somewhere. Good luck!

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