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Background: I currently live in Wyoming and work for the state. Midwives can not be licensed here and thus there are not many to choose from. We are very close to the Colorado border so we chose to go down to Ft. Collins to find a homebirth midwife. I immediately contacted our insurance and they informed me that they covered midwifes but that she would be considered "out of network" so they would only cover 65%.

Current Situation: I had my baby at home in early March and have since sent in all of the documentation requested for the insurance claim. My claim was recently denied based on the fact that I used a midwife who was not supervised by an OB and that my birth, in fact, took place at home.

Now I have to begin appealing this denial and do not know were to start. Can some of you who have been successful in winning your insurance appeals tell me what you included in your appeal letter? I would love to bombard them with facts about how safe and affordable homebirths are but am not sure what would be the most convincing.

Thank you so much,
Michelle
 

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I need to do this too. I live in a very HMO saturated place, so people around here have not had too much luck getting home births paid 4 because of the whole out-of-network thing. But, I am going to write a letter anyway. I figure if enough people request that homebirths be covered, maybe we will eventually make some progress.

Here is one sample letter I found. It's very birth center-focused, but I thought I would share it to give you some ideas/give you some language you can use if you want:
http://www.madisonbirthcenter.com/faq.asp
 

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Alright, so I'm going to be a different voice here instead of going the educate about homebirth route. I have had both of my homebirths paid for. Once with an HMO that did not cover out of network anything (We submitted a few small bills and they paid for them - goof on their part - early on. Then, we billed for the rest of the birth months later, they denied it. My main argument was that the first small bills were paid in full leading me to believe that they would cover my health provider. That took a lot of work. I NEVER mentiond homebirth.)

With the second homebirth this situation was more like what you two are going through. The insurance was PPO and would cover 80% of out of network providers. I never mentioned homebirth, I merely submitted paperwork for my out of network provider. Most insurances do not cover homebirths. While you could make your claim into a big education for the one person who will read it, you probably 1. Won't effect change in your insurance company and 2. Won't get your claim paid, because the person who is reviewing your claim has no power to change policy, only the ability to deny your claim because you had a homebirth.

My advice is to stop trying to get your homebirth paid for. Instead, get the treatment that you recieved from you care provider paid for. If your MW needs rebill the total amount but write them all up as prenatals then so be it. THEN, after everything is paid for write a letter explaining why you want your insurance company to cover homebirths, don't send it to the claims department, send it where people that make changes actually will read it. Then, write your state representative and your state's govener with a pretty much identical letter. You can find out where to send your letters to at http://www.congress.org

That's my recommendation. It's merely what worked for me. You may find your idea works better, but I just found it much easier to play the game to get what I wanted AND THEN voice my opinion and concern.

Good luck to both of you!
 
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