Stanley M. Warner, M.D.
Director of Memorial Healthcare IPA
2525 Cherry Ave. Suite 250
Signal Hill CA 90806
March 7, 2002

RE: Denial of out of network request for CNM maternity care

Dr. Warner,

I have recently received a denial of my request for an out of network Certified Nurse
Midwife for my maternity services. Blue Shield HMO assures me that “maternity services
provided by a CNM are a covered benefit.”

I believe we must have a miscommunication, perhaps my request form was not filled out
properly. I am requesting care by a Certified Nurse Midwife (CNM). CNM’s are RN’s
that have graduated from an accredited midwifery program, from such prestigious
universities as Georgetown, Harvard, and Stanford, and locally, USC and UCLA. Then
they must pass a national certification exam, and maintain continuing education. They
have written collaboration agreements with, and transfer clients to, physicians if necessary.
CNM’s come prepared with assistants, emergency equipment, and medications necessary
for immediate neonatal resuscitation and maternal emergencies. They also carry
malpractice insurance of the standard one million dollars. The state of California licenses
CNM’s and uses them in the medi-cal program. California also has laws mandating
private insurance reimbursement of CNM services.

I would like you to explain your statement: “For quality of care reasons, Memorial
Healthcare IPA only authorizes total OB care and delivery to be performed by a board
certified OBGYN.”

I am a healthy woman and I have an uncomplicated pregnancy. I do not require, nor do I
wish, the expertise of a board certified OBGYN. I tried very hard to find an in network
CNM to no avail. I have interviewed the local midwives and I have found one that is very
experienced and knowledgeable and whom I wish to have for my care.

My main goal is the health and welfare of myself and my baby. Medical journals (I have
several articles), government studies and healthcare organizations (i.e.: World Health
Organization) endorse midwives’ outstanding record of safety. Even the U. S.
government’s Institute of Medicine, has recommended “more reliance be placed on
certified nurse-midwives” in delivering primary care. The latest information I have been
able to find (1998) places the US 28th in infant mortality, one of the very worst rates
among industrialized countries. The countries with the lowest mortality rates use
midwives for the majority of births. I live in a wealthy industrialized country and I make
no excuses for the fact that I want the best of both worlds, midwife care unless a
complication develops.

I used Dr. Kizner with my first daughter, but sadly he is no longer in the IPA. I find it
surprising that you have gone suddenly from having 30+ OBGYNs to choose from to only
3 in the area, 6 total. Choosing a doctor, particularly a birth attendant, is a very difficult
process as you must feel that your personalities and beliefs match well. I find this
reduction of choice unacceptable. I assume most women will just change IPAs to obtain
their choice.

I find it personally galling that you saw fit to submit (in the name of my PCP, Dr. Chung)
and approve a request for me to see Dr. Carsten Ronlove, a doctor I never requested to
see, have not met, or even talked with on the phone. I did call his office after recieving
your approval form and the receptionist could not tell me such basic statistics as his
c-section rate, or episiotomy rate. She did tell me that she’d never heard him call himself
“pro-natural childbirth”, and that regular prenatal visits were 15 minutes long. For
comparison, my midwife’s regular prenatal appointments are 30 minutes and in late
pregnancy 1 hour.

It is clear to me that the “quality of care” for a healthy woman and baby is superior with a
CNM. I have been told by numorous HMO employees that “maternity services provided
by a CNM are a covered benefit”. Out of network providers and CNM’s in particular
have been appproved in the past. I do not wish to delay my prenatal care any longer.
Please revise your decision with this new information. If you need or desire any other
information I am usually home in the afternoons. Thank you.


Sincerely,


me



c: Dr. Donald Chung (PCP)
Blue Shield of California HMO