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Distance from your mw/Reason for insurance to deny?

442 Views 2 Replies 2 Participants Last post by  marytheresa
We just got a denial for benefits to cover our homebirth next month. Our mw is out of network but since the insurance doesn't have any homebirth midwife in network, NYS insurance law states that they have to allow an out of network exemption. BUT, now they are saying she is too far away and her backup doctors/hospital are too far from our house. She is far, but she's the only one I can find around here and she and we are both comfortable with it.

I just don't get why they care about the distance. They say that they don't want someone more than 30 miles away. If there were an emergency I would obviously go to the nearest hospital which is only 10 minutes away and take whatever doctor was on staff. Even if I were going to have a routine hospital birth, if I was laboring so quickly that their fear of the mw not making it to our house was valid, I would be going to one of the nearby hospitals and would probably be just as rushed getting to the hospital. Why do they care if I'm going for "emergency" reasons or if I was going there routinely? Either way, they would cover the hospital delivery. I know that if I were to have decided to go to her doctors for delivery (who ARE in network) they never would have even noticed the distance and coverage would have not been questioned...right? I mean, they don't mapquest and figure out mileage every time you go to the doctor to make sure they're 'close' enough, do they? I don't even know if this post makes sense!

I'm hoping this was just part of the routine denial and that if I push hard enough, they will concede and cover. It's stressing me out and I don't want that right now!

So...I put in a verbal appeal on the phone today and have a letter typed and ready to go as well. I just wanted to see if anyone else has had this issue...and also if anyone else used a hbmw that was farther away. Any help appreciated!!

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I've never run into this. I know some policies only cover providers in a certain geographical area as in-network for your policy.

One thing to keep in mind is that insurance companies consider themselves legally liable for the care they cover. That is why some companies do not pay for home birth, citing safety concerns. If they think that your midwife is too far away to be reasonably safe that is their call.

Insurance is a scam.
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