Does Writing My Insurance Company Really Work?
Yes! Sometimes writing the insurance companies does work! Filing an appeal or taking the time to write them about your birth can make changes in reimbursement or coverage.
Here is just one example:
In 2007, a mom in Florida was tired of getting the runaround about her insurance company and the requirements for homebirth coverage in her state. After a cesarean left her feeling abused by the medical system, she chose a homebirth and had a successful VBAC with a midwife. In spite of a law regarding coverage of births and maternity care, a lack of care providers who were willing to help her have a healthy birth but were more than willing to give her a much more expensive surgery and the fact that a VBAC was safer for her and a cheaper option for the insurance company, her insurance claim was denied. This left her family holding a $3100 bill for the birth. Her husband decided to write the following letter to her insurance company:
October 22, 2007
CIGNA Health Care
National Appeals Unit
P.O. Box 5225
Scranton, PA 18505-5225
Dear Sir or Madam:
This letter is in response to the denial of coverage for the prenatal care, labor and delivery, and post partum care surrounding the birth of my daughter (name removed) on (date removed), 2007.
At the time that my wife and I started attempting to conceive in mid 2006, CIGNA was contracted with an out of hospital group of midwifes called (name removed). This was the group that we used when my son (name removed) was born and we found them to be an excellent alternative to the costly hospital birth. We found out later in the year, after my wife was four months pregnant, that (name removed) would be closing at the beginning of the year, more than four months prior to my daughter’s birth. At this point I contacted CIGNA to determine what other non hospital birth option would take their place. I was told that whatever contract changes would be made would probably not be in place in time for our birth.
This gap in coverage in our area (since there are non hospital midwife options outside our area in (name removed), (name removed), etc) forced us to decide whether the healthiest option would be a hospital birth or out of network midwife. Due to the many health issues surrounding a stay in the hospital, from sleeplessness to super bugs like MRSA, we determined that the healthiest and most cost effective birth option was homebirth with an attendant midwife.
I understand that in contracting with (name removed) CIGNA was trying to provide an in network provider in (our city removed) that was commensurate with the in network providers in other areas of (our area removed). I also understand that the gap in coverage created by the closing of (name removed) was unforeseen by CIGNA. I do believe that this kind of gap in coverage is covered here in Florida under Florida Statute 627.6471 which states:
“If any service or treatment is not within the scope of services provided by the network of preferred providers, but is within the scope of services or treatment covered by the policy, the service or treatment shall be reimbursed at a rate not less than 10 percentage points lower than the percentage rate paid to preferred providers. The reimbursement rate must be applied to the usual and customary charges in the area.”
Here in Florida, the desire to have a more natural birth, either using a birthing center or a Certified Nurse Midwife, is clearly evidenced by other Florida Statutes like 627.6406 which states that:
(1) Any policy of health insurance that provides coverage for maternity care must also cover the services of certified nurse-midwives and midwives licensed pursuant to chapter 467, and the services of birth centers licensed under ss. 383.30-383.335.
Clearly it is in the best interest of (our company’s name removed) to keep costs low for health insurance. The cost for an OB/GYN to do the prenatal care, a hospital birth with attending physicians, and the following stay in the hospital, would clearly have cost 3 times the $3100 I had to pay for the care and delivery of my daughter. And that’s if nothing went wrong. It seems that it would be in the company’s best interest to facilitate this less expensive option any time it is medically feasible to do so.
I don’t know how the delivery would have gone if we had acted solely on financial decisions and gone to a hospital. I’m sure it would not have been anything like the birth we experienced. With a 33% rate of cesarean births here in Florida there is a very good chance it would have involved surgery. What I do know is that at one week shy of six month old, my daughter has pulled herself up to standing for the first time. I could not ask for a healthier, happier baby or a quicker more complete recovery for my wife. These are the reasons that this option is so important to the people here in Florida and to us specifically.
Thank you for reconsidering coverage of the birth of my daughter.
(Loving Father’s Name Removed)
Cc: (name removed), Human Resources, Standard Motor Products
Enc: Midwifes notes
A few weeks later, a check arrived covering the birth.
You guys are welcome to use this letter however it will help the most women!!! I want everyone to be able to afford to have the birth I did, and to not have to hound the insurance company with a newborn in arms. The insurance companies really have you a disadvantage at that point. It’s HARD to formulate a good letter while you are sleep deprived and haven’t showered in days!
A little known fact is that state insurance commissioners and attorney generals often only look at individual complaints over time. It takes numerous complaints and women talking about what happened for policy to change at a state level or for them to look into it as a possible violation. If each woman who had problems with her insurance coverage for her birth or whose was affected by pre-existing conditions like cesareans then wrote to their state, the letters would quickly pile up and force the state’s attention to the matter.
A frequent claim of the insurance company is that they don’t have to cover your homebirth because they have OB’s for you to chose from in network. However, there are virtually no OB’s who attend homebirth in the United States. In many states, birth centers and certain midwives are restricted from attending a homebirth and so, having an OB or midwife in their policy structure would not help you to have the birth you choose. In the case of VBAC, a flat refusal to attend VBAC’s by hospitals, midwives or doctors would also restrict you from using that care provider and therefore, it doesn’t matter if they are in network, they won’t accept you as a VBAC patient and are not an option for you.