Guaranteed Healthcare

Hi, I am seven months pregnant and have been enduring a five-month-long battle with United Healthcare relating to maternity benefits and coverage. It is my desire to give birth either at home or at a Birthing Center. I do not wish to give birth in a hospital setting unless there are complications that arise. Unfortunately, my healthcare plan does not support my decision and has denied two appeals to provide coverage for my choice, which by the way, is supported by Florida law.

Here is some background: My husband and I have United Healthcare insurance ("Choice" level coverage, which translates to In-network providers only). When I found out I was pregnant in late October, I began prenatal care at a Birthing Center with a licensed midwife. When I found out that UHC would not cover the costs, I applied for "Network Gap Exception" (if there is no provider or facility within a certain area radius--30 miles!--they can approve coverage for my preferred provider/facility. I could not find an in-network birthing center within my area, so I assumed it would all work out... I was denied the exception based on the fact that there is ONE Nurse Midwife who delivers in a hospital setting within 30 miles (FYI...when I looked her up on the UHC website, she did not show up as an in-network provider, or at all, for that matter).

When I called to speak with a care coordinator at UHC, I was told that "provider" and "facility" go hand-in-hand and that as long as they satisfied the requirement of an in-network Nurse Midwife, they did not have to satisfy my request to give birth in a birth center. When I appealed the case the second time, I cited numerous Florida State Statutes that clearly prohibit insurance health plans from forcing mothers to give birth in a hospital and which call for providing birth center options (or home birth options) with a licensed midwife. The appeal was focused on birthing location, not provider. My second appeal was denied on the same basis as the first denial: provider only with no mention of birth facility. The "catch" on the second denial was mentioned in the last paragraph of the letter. I was informed that my husband's healthcare plan through his employer falls under the authority of ERISA, a federal program that preempts all State laws...

So, that is where I am today. I am currently researching ERISA law and code, but getting discouraged the more I read about how difficult it is to fight ERISA and how few lawyers are willing to take a case due to limited financial restitution. I realize that my case will not be resolved before I give birth, so my husband and I are planning to self-pay for the birth we know is best and safest for me and baby. There are countless studies proving that home/birth center births are safe (many times with more favorable outcomes than hospital births) and result in fewer complications, interventions, and most importantly C-sections (which are at an all-time high in this country and many times are only performed to accommodate the schedules of a busy doctor/nursing staff).

Birth is big business for hospitals and the average cost of a "normal" hospital birth can run between $10K--$15K, on average, at least in my area. The cost to UHC if I birth in a birth center: $5500.00. Those numbers alone should make my case, but they don’t. If I can't even appeal to the insurance company's bottom line, there is a much bigger problem with our insurance industry than I ever thought possible or probable. A few more notes about my situation: I have been pregnant only one other time and delivered in a birth center with a licensed nurse midwife and her caring staff. The pregnancy was healthy, my labor and delivery was spontaneous and quick (8 hours total), not to mention drug-free, and my beautiful daughter was born without a hitch. There would have been no reason to be in a hospital setting. I was allowed to video tape the birth and I was allowed to walk, eat, and labor in any position I chose (I even labored in a birthing tub for a time)--all of these things are not possible in a majority of labor/delivery hospital settings, which are hard-wired for complications and the "what-if-something-goes-wrong" mentality.

I am a student of the Bradley Birthing Method, which treats the process of birth as a beautiful and natural process (only needing interventions when complications arise). My Bradley instructor happens to be an attorney (who also had natural, drug-free births in a birth center with her two girls). I actually spoke with the in-network Nurse Midwife referred to my by UHC. She came from a birth center background but is now practicing/delivering in a hospital setting. She told me that although she doesn't agree with the labor/birth practices in the hospital, she does her job knowing that she is making a small contribution to the way birth should and can be. We spoke at length about the state of childbirth in our country and while she could not help me out directly with the claim, she did encourage me to write to my Congress/Senators to help initiate much needed change. She recommended a couple of books that shed a glaring light on hospital births and SHE is the one who pointed me in the direction of the Florida Statutes to fight my denial (ironically).

I have done extensive research on this issue and the more I read, the more devastated I become knowing what is needlessly happening to mothers and their newborns in hospitals. While I understand that all women do not feel as comfortable as I do giving birth outside of a hospital setting, it is just as important to honor every woman's choice as to what is best for her, her baby and her experience. Birth should be a beautiful right of passage for all birthing mothers, not the painful nightmare that many walk into with blind trust and too-little information. It is a shame that our nation's health has merely become a number on a balance sheet. Thank you for the opportunity to share my story.