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|Claim processed according to your benefit plan.|
I just wanted to update quickly and tell you that after spending some time on the phone with a few UHC representatives, they said that since there are no midwives in-network within 30 miles of me, they can do something called a "gap exception" to get a midwife covered for my home birth. I will find out in 7-10 days what, if anything, is going to be covered. I will let you all know. This information might help another person who has UHC and is trying to get a home birth covered!
Wish me luck!
|After discussing my birthing options with my current health care provider, Ms. Jane Doe, CNM of Local Medical Practice, we have decided that a homebirth is the right option for me. I have included a letter of referral from Jane Doe,CNM, which indicates that Ms. Homebirth Midwife CNM, of Homebirth Midwifery Services is able to provide home birthing services.
I would like to begin seeing Ms. HB Midwife right away for my prenatal care. However, under my current insurance plan with HMO Big Shot Insurance, maternity care by Ms. HB Midwife, is not a covered benefit since she is an out-of-network provider. I am writing to request a an exemption to this policy and authorization for full coverage at the In-Network Benefit Level for my prenatal care, homebirth, transfer to hospital if necessary, and postpartum care under the care and supervision of Ms. Homebirth Midwife CNM, of Homebirth Midwifery Services.
Since my current CNM cannot provide these services, I ask you to please consider New York Insurance Law § 4303(c)(1) as it states:
“If an HMO does not have a midwife who assists in home births in its network, it must allow the prospective mother to access such a midwife, so long as that provider meets the minimum requirements of the plan, who is not in the HMO's network.”
Ms. HB Midwife is fully licensed and legally able to provide home birthing services in the state of New York. She has a collaborative agreement with Dr. Nice Guy and Dr. Supportive who are both In-Network Providers under my current insurance plan. These doctors are unable to perform home birthing services themselves, however, they will be available for consultation, collaboration and transfer of care if necessary. I understand that the safest place for induction/augmentation of labor, regional anesthesia in labor, and surgical birth is at a hospital, and if any of these medical interventions becomes necessary, I will be transferred to the hospital.
I sincerely hope that you will grant me coverage at the In-Network Benefit Level in response to this request. I wish to have a well-monitored childbirth that is responsive to my needs and I feel I am best able to obtain that care with a Certified Nurse Midwife who can attend me at my home. I know that HMO Big Shot Insurance is committed to patient needs and providing high-quality, cost-effective care.
For further questions, please feel free to contact Ms. HB Midwife at (xxx) yyy-0000.
Thank you for your consideration,
Here is the response I received from HMO Big Shot Insurance dated a mere 2 days later!
December 13, 2007
Dear Ms Julian,
Thank you for your request for home birthing coverage.
We have reviewed the benefit structure and policy coverage of your health insurance coverage. Your request for us to provide coverage of home birthing under your contract is a VALID and REASONABLE service. The claim for services rendered by a licensed practitioner will be adjudicated and processed in accordance with the provisions of your contract.
While we support your decision on home birthing, we would like to make you aware of the following information. There are several issues that are central to question home birthing services.
We are aware that many medical liability insurance carriers will not provide coverage for practitioners when the series is performed at home instead of a medical facility. This is an area you may want to investigate prior to the expected delivery of your child.
We do not examine the credentials of practitioners who provide services to our members who are not participating with us. The quality and experience of the practitioner you select is a personal choice. HMO Big Shot Insurance does not make any claims regarding the quality or experience of practitioners who may perform home birthing.
We asked the physicians who participate in our Credentials Committee to review the issue of home birthing. The Credentials Committee physicians raised several issues. In addition to the above credentialing and liability issues, the physicians were concerned about the care of newborns in a home birthing environment. If a newborn infant requires any special care or emergency treatment, a detailed response plan should be in place at the time of delivery.
Thank you for the opportunity to provide the above details. If you have any questions, please feel free to call XXX-YYY-0000.
Ms. Almost Supportive, MD
Medical Director of HMO Big Shot Insurance
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