I wanted to share this letter with anybody that is trying to get their home birth covered by their insurance After the denial of my first home birth I learned a lot and was able to get my second home birth covered at 100%. Also, here are a few tips that I learned:
- keep notes of every time you call the insurance company
- find out if there are any CNM in-network. Call them up and find out if they attend home births. If not, apply for a "gap exception" for your CNM to be considered in-network.
- keep the letter pretty straight forward with facts and use the insurance lingo that your company uses
- appeal! This appeal was sent 8 days before my son was born as a last ditch effort and it paid off.
May 20, 2010
Member #: XXXXXXXXX
Group #: XXXXX
United Healthcare Member Inquiry/Appeals
PO Box 30432
Salt Lake City, UT 84130-0432
Subject: Second Level Pre-Service Appeal
Dear Appeals Coordinator:
I am requesting coverage from United Healthcare for midwifery services from an out-of-network provider, Jackie Griggs, Certified Nurse Midwife (CNM) of Gentle Care Birth Services. The single reason for my request is to enable me to have a home birth.
My attempts to find a practicing midwife in-network have been unsuccessful. The only name of a midwife that your representative was able to provide me on Friday, October 23rd, 2009 during our 1:30pm phone conversation was XXXX XXXXX. After many phone calls to track her down I discovered that she does not even practice as a midwife and is involved in academic research at Baylor College of Medicine.
Jackie Griggs, my midwife of choice, will provide all of my prenatal care, part of which includes home visits, attendance at labor and delivery in my home, and finally, postpartum care for me and my newborn child. I encourage you to visit her website (http://www.houstonmidwife.com/index/component/option,com_frontpage/Itemid,1) for her philosophy of care and outstanding credentials. She was my midwife for the birth of my first child and both as a client and a Registered Nurse, I have full confidence in her professional abilities.
My first appeal for a gap exception to be granted for J. Griggs, CNM was denied on the basis that United Healthcare has in-network physicians providing obstetric care (Denial Notification Number XXXXXXXXX). However, none of them provide the service that I am requesting—a home birth. A home birth is not an unreasonable request on my part for many reasons:
- I am in the final weeks of a normal, healthy pregnancy with no complications and overall excellent health, which makes me a low risk pregnancy.
- A 2005 study in the North America British Medical Journal found that “planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births BMJ 2005;330:1416 (18 June) http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom
- The average hospital birth cost thousands of dollars more than the $3,400 “reasonable and customary home birth/birth center” charges allowed by Unites Healthcare (Global Maternity Care code 54900). According to your treatment cost estimator tool on your website, the estimated treatment cost for the delivery of an infant through the vaginal canal is $5,467-$6,813.
Please honor my request for a home birth allowing coverage of Jackie Griggs, CNM. Please feel free to contact me at XXXXXXXXX@hotmail.com or XXX-XXX-XXXX.
For your reference, Jackie Griggs contact information is as follows: