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#1 of 43 Old 11-28-2006, 12:17 PM - Thread Starter
 
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hey ladies, I need lots of prayers and positive thoughts tomorrow (wednesday) at 9 AM. I am having my second hearing in front of a judge about a homebirth. It's kind of a long story, and if I loose, I'll just have a homebirth anyway but I think winning would be a good step foreward here for homebirth. We've been fighting state insurance about it for 32 weeks now, and this is supposedly the end of the road. And this time we've found a great lawyer that will work pro bono, so that's wonderful too. (the last hearing got thrown out basically I think because I didn't have a lawyer, so they could talk over me and they were trying to drag the whole thing out) So please think of us tomorrow and send us lots of good vibes.
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#2 of 43 Old 11-28-2006, 12:19 PM
 
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good luck

so the hearing is to get insurence to pay for it ??

or just to get to "allowed" ina state that doesn't allow it?

either way we'll be thinking baout you

A

Aimee + Scott = Theodore Roosevelt (11/05) and 23 months later Charles Abraham (10/07)....praying for a little sister; the search starts May 2014
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#3 of 43 Old 11-28-2006, 12:40 PM
 
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You'd think insurance companies would jump at the chance to pay for a home birth vs a hospital one :
Good luck with your case and your birth.
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#4 of 43 Old 11-28-2006, 12:55 PM
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I'll be thinking of you!

Kara, single mom of 4 girls (5, 8, 16 and 19) crochetsmilie.gif
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#5 of 43 Old 11-28-2006, 12:56 PM
 
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I'll be thinking of you. Good Luck!
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#6 of 43 Old 11-28-2006, 12:56 PM
 
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you'd also think the insurencew ould pay for doula to lower intervention rates, or birth classes for the same reason

(even we will pay for the doula if you do not have interventions that exceed XXX in money or some clause like that)

butttttttttttttttttttt

that is thinking out side the box

I submitted out bradely class and doula with letters siting the reduced level of intervetions, and cost saved, by moms who use them -- course we didn't save tha tmoney as we had a forcept delievery. I strong encourage all families to do the same --

like this hearing -- things won't change unless we change them

A

Aimee + Scott = Theodore Roosevelt (11/05) and 23 months later Charles Abraham (10/07)....praying for a little sister; the search starts May 2014
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#7 of 43 Old 11-28-2006, 01:58 PM - Thread Starter
 
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now that I have a few more minutes to post, I'll explain a little more. It's for a doctor prescribed "medically nessicary" homebirth. I have some ridiculous allergies, including one to latex (I go into anaphylactic shock even if I'm in the same building as an office using gloves, so if a little is in the air). My doctor said the risk of giving birth in a hospital was just insane, so since I've had a good birth before, unless there was some reason I needed to be in the hospital, it would be crazy to go there. This is a mainstream allergist we're talking about, so I was shocked to say the least. Insurance came back saying that a homebirth would be unsafe for me, and that they would just intubate me and put me on an epinephrin drip basically as soon as I came through the door. But with the drop in blood pressure and the irregular heartbeat during anaphylaxis, I would end up with an emergency c-section, the surgery would be very risky for me, and the baby would be at great risk before the surgery because of lack of oxygen and blood pressure. So naturally I am fighting this kind of birth, cause you know, it's not exactly anyone's dream birth, and I am just not going to do it. period. and so I have fought all the way to the top of the chain to have a homebirth. I mean the risk otherwise is just way way way too much. So although it's not necessarily a huge step for homebirth as a whole, it's vitally important to me. It just blows my mind that they would risk my childs life, and my life, just so that they could keep thinking inside the box. So regardless of wether or not I win, I will have a homebirth, but I just wanted to see this whole thing through to the end and make a point that it's not acceptable to put people's lives at risk that way just for their convienience. I'm pretty much totally a shut in anyway, so it's not even like I have a normal life elsewhere. So if I'm not willing to risk my life to go to the mall or something, I don't think it's fair that they're willing to risk my life and that of my baby for something like that. The whole thing just pisses me off. But anyhow, that's what it's all about.
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#8 of 43 Old 11-28-2006, 02:07 PM
 
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What insurance? Are homebirth providers legal in your state? I can't imagine that they're making you jump through so many hoops.

-Angela
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#9 of 43 Old 11-28-2006, 02:09 PM
 
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Oh my word, they aren't too bright, are they?? I hope you win just to make a point!

Amy ~ Web Designing Single Mom to 4: DD14, DS12, DS5, DS3
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#10 of 43 Old 11-28-2006, 02:10 PM
 
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wow

and the allergist is supporting you?

A

Aimee + Scott = Theodore Roosevelt (11/05) and 23 months later Charles Abraham (10/07)....praying for a little sister; the search starts May 2014
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#11 of 43 Old 11-28-2006, 02:29 PM
 
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: wow, I guess I shouldn't be surprised that they're fighting so hard, but I really am shocked.
Good for you for sticking to your guns and fighting for yourself and your child. How sad that you even have to.
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#12 of 43 Old 11-28-2006, 05:59 PM
 
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congrats for taking a stand good luck


"Well Behaved Women Rarely Make History"
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#13 of 43 Old 11-28-2006, 06:16 PM
 
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Wow, MotherWhimsey, it may seem to you like your case is unusual, but I think you're doing a great thing for homebirthers everywhere. It opens a can of worms, I think, that could apply to many women for many reasons.

Good luck, and good wishes for a safe, healthy delivery!
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#14 of 43 Old 11-28-2006, 08:49 PM
 
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Wow! I see why you'd just have the homebirth regardless. The insurance co. sounds crazy--if they "let" you have a homebirth they might even save some money- and isn't that what it's all about for them? The bottom line?!

Anyway, good for you for standing your ground! Let us know what happens!
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#15 of 43 Old 11-28-2006, 08:50 PM
 
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Good luck to you, mama!

Jenn, future midwife, mama to 2 sweet girls (6/05) and (5/07). 
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#16 of 43 Old 11-28-2006, 09:00 PM
 
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Bravo Mama! Sending lots of positive vibes your way!

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#17 of 43 Old 11-28-2006, 09:02 PM
 
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Sometime you have to wonder about the intelligence level at these insurance co. Maybe they know you would go hb anyway and not have to pay for it?

OT: Did you latex allergy worsen over time? I always worry cause I have a latex allergy. When touched by anything with latex it leaves horrible sores. Like its eating away at my skin. I know allergies can worsen over time and I just wonder how bad this can get.

Expecting #9.  Always busy hsing.
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#18 of 43 Old 11-28-2006, 09:42 PM
 
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Wow! Good luck to you! And I agree that this may actually be a big step forward for homebirth. Your medical necessity is extreme, certainly, but many others with less extreme conditions could use the precedent if you win. I'm keeping my fingers crossed for you. Let us know how it goes!
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#19 of 43 Old 11-28-2006, 09:55 PM
 
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Good luck. I'll be thinking of you tomorrow morning.

You are basically allergic to the hospital. I know it is a serious medical condition, but I can't tell you how amused I am. No judge in his/her right mind is going to force you to go to the hospital. It's just a matter of whether insurance will cover it, yes?
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#20 of 43 Old 11-28-2006, 09:58 PM
 
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Wow. I'll absolutely be thinking of you.

I thought it was a federal law that insurance companies HAD to pay for homebirths as long as the attendant was legal?

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#21 of 43 Old 11-29-2006, 10:39 AM
 
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Quote:
Originally Posted by annettemarie View Post
Wow. I'll absolutely be thinking of you.

I thought it was a federal law that insurance companies HAD to pay for homebirths as long as the attendant was legal?
no no, not at all. there are plenty of loopholes for insurance companies to jump through and each state has different laws concerning midwives, homebirth and insurance companies.

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#22 of 43 Old 11-29-2006, 11:54 AM
 
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This is what I was thinking about:
http://frwebgate.access.gpo.gov/cgi-...1999&TYPE=TEXT
Quote:
Code of Federal Regulations Title 45, Volume 1:

(iii) Attending provider defined. For purposes of this section, attending provider means an individual who is licensed under applicable State law to provide maternity or pediatric care and who is directly responsible for providing maternity or pediatric care to a mother or newborn child.

c) Construction. With respect to this section, the following rules of construction apply:

(1) Hospital stays not mandatory. This section does not require a mother to--

(i) Give birth in a hospital; or

(ii) Stay in the hospital for a fixed period of time following the birth of her child.

(2) Hospital stay benefits not mandated. This section does not apply to any group health plan, or any group health insurance coverage, that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.
So it was my understanding that any insurance plan that provided hospital maternity benefits could not compel a mother to give birth in a hospital and had to provide equal benefits for a homebirth, provided the attending provider was legal under state law.

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#23 of 43 Old 11-29-2006, 05:58 PM - Thread Starter
 
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So I believe I have just come from the worlds most bizzare hearing. It was just crazy! The hearing started at 9, I was the first witness, did fine. basically I just explained about my allergy and reactions in different situations etc. Then my midwife was on the stand, and was examined and cross examined. In the course of this it came up that she was a L&D nurse in an OB's office in the seventies for about 6 years. She had to do her round of appointments, so I requested that she be able to hang up (the other witnesses were on a confrence call thing). The judge asked if my lawyer or the states lawyer had any more questions, and the desk doctor (TennCare's witness) pipes up and says he just has a statement before my midwife got off the phone, he would like her to hear it. So he says, you know that OB office she worked in, yeh, that was mine, she's a wonderful person and he basically went on to give her a glowing character referance. Then she got off, we all picked our jaws off the ground and the case moved foreward. The doctor said that he had no issues with the concept of a homebirth, that he would prefer that it be attended by an OB (which they can't do because of malpractice insurance). Then he went on to say that since I could give birth at anytime, the ball had been dropped somewhere along the way (by tenncare and my appointed social worker is what he implied), that he doubted that we could find an OB that would take me this late even if we tried, so by default homebirth with the midwife could very possibly be the only option. But then he would go on to say that I was high risk and needed to give birth in a hospital with a highly coordinated team of doctors and immunologists, etc... so we were all rather confused in going in circles. Then TennCare's lawyer said in her closing statement that really what choice was there, that I may as well choose since it was all so helter skelter, but then went on to say that funding should be denied based on the out of network provider rules. So we all left very confused after a three and a half hour hearing. The judge said she can't possibly think it all through immediately and will give her verdict on friday. I think what she will probably do is charge my case worker to find someone who is willing to take me, and if that can't be done witin a week, they will pay for my homebirth. I'm not sure about that though. But it was such an interesting and unusual case that even after the doctor was dismissed he stayed on the line out of personal intrest just to see what would happen. I think if he hadn't been testifying against me I would have really liked him. But there you go, yet another doctor in this case (and this one has no personal intrest in me) that says he has no problem with the concept of a homebirth. And that was on the record. So who knows how it will all turn out on friday. In a way I think it was rather good luck that last months hearing was thrown out. I think this judge, being a woman and just more down to earth than the other judge, will really think about it more and be less apt to just side with the DR beacause he's a Dr. So that's good. Plus the fact that I'm due any time now helped my case since apparently no one would want to take me now anyway. Had that decision been made last month, they probably would have been able to find someone easier. Plus I didn't have a lawyer last time, I found a family friend willing to do it pro bono and he wasn't able to do it last month. SO all in all it was a good thing it was put off. Now Tenncare did blame me for "dropping the ball" which pissed me off, cause I've been trying to sort this out since I was 5 weeks along. They're the ones that dropped the ball. Even the judge was a bit surprised that they said that and said that "fault" was not the issue here, and it was to be thrown out and the matter dropped. But that's where the matter stands. So we'll see what happens on friday.
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#24 of 43 Old 11-29-2006, 06:55 PM
 
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Originally Posted by annettemarie View Post
This is what I was thinking about:
http://frwebgate.access.gpo.gov/cgi-...1999&TYPE=TEXT


So it was my understanding that any insurance plan that provided hospital maternity benefits could not compel a mother to give birth in a hospital and had to provide equal benefits for a homebirth, provided the attending provider was legal under state law.
That reg refers to the group health insurance market (private), not state insurance, so the rules are not the same.

Title 42 talks about medcaid, but I can't find anything comparable with Title 45...

http://ecfr.gpoaccess.gov/cgi/t/text...2/42tab_02.tpl

Choose a Title:
http://ecfr.gpoaccess.gov/cgi/t/text...l=%2Findex.tpl

"It should be a rule in all prophylactic work that no harm should ever be unnecessarily inflicted on a healthy person (Sir Graham Wilson, The Hazards of Immunization, 1967)."
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#25 of 43 Old 11-29-2006, 06:59 PM
 
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Ah, gotcha. I had missed the part in the beginning where it was state insurance.

MotherWhimsey, that does sound :

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#26 of 43 Old 11-29-2006, 07:03 PM
 
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Originally Posted by MotherWhimsey View Post
Then he went on to say that since I could give birth at anytime, the ball had been dropped somewhere along the way (by tenncare and my appointed social worker is what he implied), that he doubted that we could find an OB that would take me this late even if we tried, so by default homebirth with the midwife could very possibly be the only option. But then he would go on to say that I was high risk and needed to give birth in a hospital with a highly coordinated team of doctors and immunologists, etc... so we were all rather confused in going in circles.
Is there anything other than your latex allergy that makes you high risk? Otherwise it doesn't make sense; how could anyone possibly keep the "highly coordinated team of doctors and immunoligists" from contaminating you with latex? and the latex in the air?! Crazy : . They way the doc was going around in circles reminds me of the scifi trick of disabling a robot; give the robot a pradox so its head explodes .

"It should be a rule in all prophylactic work that no harm should ever be unnecessarily inflicted on a healthy person (Sir Graham Wilson, The Hazards of Immunization, 1967)."
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#27 of 43 Old 11-29-2006, 10:01 PM
 
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Money is disgusting, isn't it?

I hope you get your NORMAL homebirth paid for. What is the OB supposed to do at your house? Stand around waiting for surgery?Ohhh...make sure that you get that episiotomy that you need.

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#28 of 43 Old 12-01-2006, 02:25 AM
 
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I'm anxious to hear the verdict tomorrow! Good luck!

Shannon
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#29 of 43 Old 12-01-2006, 02:38 AM
 
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Yay!... I think?

It sounds good! Fingers crossed for you!

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#30 of 43 Old 12-01-2006, 12:02 PM
 
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: Of course they are talking in circles. It is the insurance company's job (and anyone who is paid by them) to keep your money for as long as possible.

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