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.

The Home Birth That Wasn't Meant To Be

Being a first-time mom, I was quite cautious when I got pregnant. I did a massive amount of studying. I read everything I could get my hands on: books, articles, blogs, magazines, scientific journal articles, I even watched strangers' YouTube videos. I wanted to make sure that I was doing the right things for my baby and that I was prepared for what was to come. As prepared as one can be for the unknown, at least.

I knew that I wanted to go the natural route if I could. I'm a big fan of modern medicine and medical professionals, but I also knew that my body wasn't sick. I wanted to avoid medical interventions if possible. I especially wanted to avoid the unintentional cascade of medical interventions that seems to happen to every single person I've spoken to about their hospital births. As much as I could, I wanted to avoid anything that wasn't strictly necessary for the health and safety of my child.

I started seeing a group of midwives associated with a local hospital. But the more I thought about, the more I wanted to avoid the hospital altogether. I waited until my mid-pregnancy ultrasound to make a decision. I wanted to be sure that my pregnancy was low-risk and had no cause for concern. I received the go-ahead from two nurse midwives and an obstetrician to pursue a home birth if that's what I wanted to do.

I hired a certified and licensed home birth midwife and doula team. I took two hospital tours and attended a hospital birthing class in addition to my doula's birthing class just to make sure I had my bases covered. I wasn't against giving birth in a hospital if that's what was best. But my home was a lot more comfortable and relaxing for me. I was curious about a water birth and set up a birth pool in my living room just in case I wanted it, but I wasn't set on it.

Health insurance was an issue. Planned home births are increasing in the United States but are still very uncommon. A huge amount of fear and misinformation scares moms and insurance agencies against home births despite the actual facts and numbers. My health insurance policy didn't say one way or another whether a home birth was allowed, but my home birth midwife wasn't on the approved list. I had to file a gap exception request, jump through hoops, get my chiropractor involved, and even threaten to report them to the state government if they didn't approve it. Finally, they did.

(After the fact, they conveniently forgot my midwife was approved. I had to call and talk to multiple representatives every week for 8 weeks in order to resubmit each claim and have it paid. I hate health insurance companies.)

Even when my water bag broke at 5 AM on December 19, I hadn't experienced much in the way of contractions. It wasn't until the afternoon when I got oxytocin (the natural form of pitocin) going via my electric breast pump stimulating my nipples that contractions actually got moving. But I was still talking and joking in between contractions in the early evening. Being a first timer, I didn't know what I was in for.

I had been using the Hypnobabies method for the three months prior. I didn't listen to the recordings every day, but I did have a good grasp on how to self-hypnotize. I do believe that it did some good in calming me down during the initial period of the birthing process. I had read and seen videos of women  barely fazed by birth, popping out babies in calm, serene environments like it was nothing. I had even heard of so-called orgasmic births. It's mind over matter, they said. I was skeptical, but hopeful.

Oh boy, was mine the opposite of an orgasmic birth! I don't have a worst enemy, but if I did, I wouldn't wish that level of pain on him/her ever. I was the worst pain and exhaustion I could have imagined times 100. I vomited everything I tried to eat. I went into a natural drugged kind of state. Despite no anesthesia, I went in and out of fuzzy consciousness like when I had general anesthesia for my wisdom teeth removal. I was delirious and hallucinating. I hadn't slept since 5 AM and overnight I dozed for seconds or minutes at a time in between contractions. Each dream was like someone was flipping through stations on television and each contraction woke me into the nightmare that was my reality. It was the worst experience I've ever been through – and I didn't even have any complications!

Finally, at 5 AM on December 20, my midwife and I decided that it would be best if I transferred to the hospital. I wasn't even close to fully dilated, I didn't seem to be making progress, and I was utterly exhausted. I remember saying that I just wanted them to make me unconscious and wake me when the baby was out. I was tapped out, or so I thought.

It wasn't that I thought I wouldn't transfer to the hospital, I just assumed that I'd bag a hospital bag if I decided to transfer. Rookie mistake. I was out of it, so my poor sleep-deprived husband tried to pack my bag for me. It's totally understandable that he didn't do the best job. Even worse, he was forced to get behind the wheel of a car while convinced that he was unfit to drive and would end up killing us all in the 6 AM winter darkness.

Without my doula applying counter-pressure during my contractions and with my husband focused on not killing us on the road, I was left to deal with what was probably transition contractions myself. Counting to ten repeatedly was no longer working for me, so I began saying the Our Father prayer over and over and over again during the half-hour drive.

Getting into the hospital was no better. I fell to the floor in the lobby as my husband was signing me in. I fell to the floor in my hospital room before I could make it to the bathroom. I was making a scene but too out of it to even know it or care. The world could have ended around me and I wouldn't have known or cared.

I wanted a natural birth. I did not want a scary epidural. But at that moment, I was begging the nurses for ALL THE DRUGS. ALL OF THEM. RIGHT NOW. It took them a long time to get an IV me in because I was flailing and they were messing up which left some nasty bruises. They attached a fetal monitor around my belly which applied the worst pressure imaginable during my contractions and I screamed at them to take it off, but they wouldn't. I also begged for water which they refused to give me at first for some reason. I was a mess.

But somehow, among the chaos of driving and walking and thrashing in my hospital bed, I had transitioned and was ready to push. The doctor had left the room because no one expected it so soon, just an hour after arriving at the hospital. The doctor and nurses kept telling me to lay still on my back to labor and in my mind (I couldn't form coherent words at this point) I thought, “F that!” and kept flipping over on my hands and knees.

Pushing was the easiest part of labor for me. By far! I didn't feel a ring of fire. I felt the strong urge to push out a bowl movement, only this time it wasn't a large poop. I had been seeing a pelvic floor physical therapist since my second trimester who helped me control and strength my pelvic floor, and it made a world of difference. Three pushes and that baby was out, to everyone's surprise! If my midwife hadn't been standing there as an observer and hadn't pointed out that the baby was crowning, the nurses wouldn't have even noticed. Apparently I was on my side when I gave birth, though I had no real spatial awareness at this time.

Josephine Claire was born at 7:25 AM on December 20, weighing 6 pounds, 6 ounces.

Around 12 hours post-birth, still exhausted.

So there it was. I had done it. I gave birth to my baby, in the hospital but drug-free. I was still so out of it, so my husband held the baby first while I regained consciousness. I had the shakes for at least half an hour later. I had two little tears that needed sewing, but otherwise my birth was complication-free.

The worst part of being in the hospital was having to follow their silly “better safe than sorry” rules. I had to stay for 36 hours post-birth, and one doctor wanted me an extra 12 hours “just to be sure,” but I argued against it and won. I wasn't allowed to have my unused IV removed until 12 hours after the birth “just in case.” I wasn't allowed to hold my baby outside my hospital room. At least it was a modern hospital with rooming-in and lactation consultants. But as anyone who has ever stayed in a hospital knows, there is no rest for patients, and rest was what I needed the most.

One benefit to being in the hospital: an unlimited supply of disposable granny panties and gigantic pads. I need to stock up on those for my next birth.

I'm a little disappointed that I didn't have a home birth, I'm not overly so. It all worked out just fine. I'm still going to try for a home birth again next time, assuming I'm low-risk and a good candidate. Now that I know that I can survive an unmedicated birth and that the horrific pain is temporary, I feel empowered for the future. Or, should I need medical assistance, now know what an IV feel like and that medical interventions aren't the end of the world. Medical interventions are what saved my 6-weeks-premature self in 1984 and could save a future child of mine as well.

Our little cutie, minutes after birth.