Join Date: Feb 2002
Location: boca del infierno
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I've been going through something similar; I'm trying to get my PPO to pay for a home birth with a licensed midwife. There is an exclusion in the contract, apparently. Anyway, I would look into your state insurance laws first thing. Here in Oregon, Certified Nurse Midwives are on the list of approved women's health care providers, and I think that insurance companies are required to cover their services (I could be wrong about this). Also, your state insurance board ought to have some sort of statement of your rights posted on their web site. I bet you do have the right to appeal...not that it will necessarily do anything, but you can always try. I know that HMOs are much more difficult than PPOs about covering out-of-network stuff. It's possible that you could write a series of really well-researched appeal letters and have something happen....
I can't believe the hospital doesn't have midwives on staff! What gives?
Oh, if you want a copy of the appeal letter I wrote, PM me. It might not be especially helpful since it is a homebirth focused letter....