VBAC Facts

Letter to Insurance Requesting Homebirth Coverage

Below is a letter I’m posting with permission from the poster.  I’m sharing it here because I hope that others would benefit from the structure as this letter resulted in CIGNA covering their home birth after initially rejecting their claim.

The strength of this letter lies in a few key pieces of information.  First, it cited state law.  Research the laws in your state as they relate to midwives as some states compel insurance companies to cover midwives.  Also, research your state laws to see how they handle gaps in insurance coverage.  If your insurance does not have a contracted home birth midwive within your area, you can argue that there is a gap of coverage and thus appeal to your insurance to cover the home birth midwife you hired.

Second, cost effectiveness.  Homebirths are less expensive than hospital births and since insurance companies are all about reducing costs, this should be compelling to them.  The typical hospital vaginal birth runs about $7,000 which is way more than the typical homebirth midwife who charges between $2,000 - $4,000. 

Third, homebirth is a healthier option by eliminating the elevated risk of cesarean section one faces simply by setting foot in a hospital, eliminating all the risk that routine hospital procedures introduce, as well as eliminating the chance of catching a hospital acquired infection such as MRSA.

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December 7, 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 XYZ on MM/DD/YY.

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 ABC. This was the group that we used when my son 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 ABC 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) forced us to decide weather 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 ABC CIGNA was trying to provide an in network provider in Orlando that was commensurate with the in network providers in other areas of Central Florida. I also understand that the gap in coverage created by the closing of ABC 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 my company 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 companies 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.
Sincerely,

Cc: (name removed), Human Resources
Enc: Midwifes notes