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Getting Your Homebirth Covered By An HMO
Second appeal statement presented in person before a Blue Shield HMO greivance panel
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Thoughts after presentation to panel

This is the statement I read to the Blue Shield appeal panel. That was fun. read the "thoughts" page for my reaction and what that was really like.

I find when I mention midwives and any sort of out of hospital birth, I am astounded by

the amount of misinformation and misperceptions people have. My decision to use

midwifery care and birth out of hospital was made after much thought and extensive

research, as well as my personal experience with hospital birth with my first child.

So I would like to start by requesting that we look at the scientific evidence rather than

make decisions based on an emotional reaction.



The largest study ever done of freestanding birthing centers (where midwives are the

primary providers) in the United States was published in the New England Journal of

Medicine in 1989. The results found that the infant death rate for all births at birth centers

was comparable to that for low-risk births occurring in hospitals. It was also found that

the cesarean rate was 4.4 percent - less than one-fifth the typical hospital average.

Satisfaction with the birth centers was so high among the women in the study that 99

percent said they would recommend the birth center to friends. To top it off - costs

averaged 30 percent less than hospital maternity care.

(New England Journal of Medicine: "Outcomes of Care in Birth Centers- The National

Birth Center Study" 12/28/89)



A study published in the Journal of Epidemiology and Community Health compared

outcomes of low-risk deliveries for physicians and nurse-midwives found:

-The risk of neonatal mortality was 33% lower for births attended by CNMs;

-The risk of delivering a low birth weight infant was 31% lower for CNM attended

births;

-The mean birth weight was 37 grams heavier for CNM attended births;

-The infant mortality rate was 19% lower for CNM attended births.

(Journal of Epidemiology and Community Health: & Midwifery care, social and medical

risk factors, and birth outcomes in the US. 1998; 52:310-317)



I am seeking the appropriate level of care for my circumstances, NORMAL pregnancy.

The specialists in normal pregnancy are midwives.



I called the member services line months ago to find out what kind of midwife, birth center

would be covered, and to find out if home birth was covered. I was told :



Professional services for maternity care provided by a Certified Nurse Midwife

(CNM) are a covered benefit at a birthing center, hospital, doctors office, clinic, or

at home.
-Read to me off of Blue Shield's computer intranet over the phone by Blue

Shield's customer service employees: Rae Anino & Jennifer Huff 1/11/02,

Torwanda Cammack 2/20/02, Tammy Bond 2/25/02 Sue Beuelson 3/4/02

Danielle 5/9/02 and Noel Neptune (customer service supervisor) 5/9/02.



I searched for an in-plan CNM for months while my prenatal care was delayed, only to

find that there were none. Blue Shield's own employees could not direct me as to how to

obtain these benefits. I was even willing to temporarily relocate, if necessary.

It seems it is the intention of Blue Shield to continually insist this benefit is covered

and yet not provide access to it. This is a clear violation of the HMO's own members

bill of rights, and, I think, California law.



Evidence of coverage book pg. 4. I read this paragraph to them; it's about if there is no plan provider to provide the covered service then an out of network referral will be given. Details will be handled thru the primary care physician.



The first nine people I talked to told me eight different things. I had no way of knowing which was correct and I received little help from any of the member specialists.

The medical director that rejected my original out of network request was ignorant of the medical literature RE: quality of care. He then failed to respond to my follow up letter.

Other out of network requests for CNMs have been approved before and even one for a

Licensed Midwife (see documentation).


I am currently paying for my prenatal care out of my own pocket while my husband and

his employer continue to pay insurance premiums to Blue Shield in my name.

It is not acceptable to stick me with the bill.



Costs:

I am saving Blue Shield money!

I also understand that if I were to give birth at the hospital (Los Alamitos Medical Center),

the fees ($7,400.00-$9,8000.00 for a normal birth) would be covered without question,

and without so much as a $5.00 co-pay! Then there is a 20% chance of even greater

expense for a C section.



Blue Shield should truly and happily cover the fees of CNMs and licensed midwives and birthing center fees.

If you have any questions, feel free to call me at ...

My midwife, is also willing to answer questions, her phone is ...



Sincerely,



me