I Fought My Health Insurance for my Home Birth and Won (Mostly)

When I chose to attempt a home birth, I knew the financial side of my decision was going to be a fight. I read story after story online of home births rejected by health insurance or covered after long fights. I prepared myself for a battle, and a battle I got. These insurance firms are horrible on purpose to encourage customers to give up. But I kept at it. And I mostly won.

I have UnitedHealthcare, one of the two worst health insurance companies I've ever had. And I've only had two. They've both been horrible. I would never voluntarily choose UnitedHealthcare, but it was my employer-provided insurance last year and it is my husband's employer-provided insurance covering the whole family this year. It's a terrible company that hires almost entire incompetent employees. But, if I wanted my home birth to be covered, I had to deal with the UnitedHealthcare headache.

My policy while I was pregnant did not specifically cover and did not specifically forbid home birth. I live in Florida, and Florida state law requires maternity-covering health insurance to cover home birth. So, one would think that my insurance would cover my home birth and that would be the end of it. Not even close.

No home birth midwives were considered in-network in my area (a 50 mile radius). My licensed and certified home birth midwife had gotten approved by UnitedHealthcare many times previously to be covered in-network, but because UnitedHealthcare is awful, they classify her as out-of-network by default. They require customers to jump through hoops to get her approved every single time. The approval process is called a gap exception. My midwife suggested I use a third party company that handles health insurance companies. This third party filed a gap exception for me. Easy!

It was denied. The reason: the gap exception needed to be submitted by an in-network service provider. In other words, they erected a nonsensical barrier in order to make it difficult for me – on purpose – in the hope that I would give up. And I almost did give up. My obgyn wouldn't submit a gap exception for me even though they approved me for a home birth because it would be helping their competition. I don't have a general physician to talk to. I do have an orthodontist who I've known for two years. She told me no. I had no one else. I didn't have a relationship with an in-network service provider who would submit this paperwork for me.

Finally, through my doula, I found a chiropractor (who could help sooth my pregnancy-strained back) who supported home births. He agreed to help me. He's British. In Europe, home births are much more common. His wife had had two home births. I wrote a gap exception letter for him, he signed it, and I mailed it off. The whole situation was a ridiculous barrier that UnitedHealthcare put in my way, but I didn't let it stop me.

Finally, I got my approval letter! UnitedHealthcare agreed to cover my home birth midwife in-network! This was great news because in my policy, out-of-network expenses would not be covered at all, but in-network would be covered 100% after a deductible. I won. My work should have been done. But of course it wasn't.

After the birth of my child (which ended up being a non-emergency hospital transfer), I shouldn't have had to worry at all about health insurance. But to my surprise, my midwife's claims for my prenatal care and her time and equipment during labor were denied. The reason: she's out-of-network. The morons at UnitedHealthcare had conveniently forgotten that they approved her in-network, despite the copy of the approval letter that my midwife submitted with her claims.

Every single week shortly after the birth for eight consecutive weeks, I called them. I spent hours on the phone with UnitedHealthcare representatives asking them to please resubmit the four claims. Each phone call meant being passed around by different call representatives because my old policy was special. Each phone call meant time wasted explaining that my child was born in December but my policy changed in January, so this goes under the old policy, not the new one. Each phone call ended with the representative assuring me that he/she would personally handle the situation and call me back. None ever did. I did talk to some very nice employees over the course of those eight weeks, and I feel bad that good people work for such a bad company.

Finally, two months after my baby was born, three of the four claims were resubmitted and approved. The fourth one was denied. This one was my midwife's fault. She had neglected to give me two medical codes to include in my gap exception letter. My gap exception approval only covered codes listed in my letter. Two codes were missing. The healthcare representative assured me that those codes would normally have been covered. She advised me to write an appeal letter asking for my gap exception to retroactively cover those two codes and for the fourth claim resubmitted.

Yesterday, two months after I sent my appeal letter, it was denied. The reason: my midwife is out-of-network. The moron who read my appeal letter ignored where I had explained my gap exception. The moron who read my appeal letter also ignored the copy of my gap exception approval letter which I sent along with my appeal letter. Conveniently, that appeal decision is final. UnitedHealthcare refused to cover the fourth claim because they employ idiots and/or they purposely play the part of idiots to steal money from their customers.

In the end, UnitedHealthcare covered all of my hospital fees and 83% of my home birth fees. I'm calling that mostly a win. The next time around, I'll be attempting home birth again, and I'll need to prepare to battle the greedy health insurance firms once more. Not looking forward to it.