I wrote a letter to my HMO. I said, "You should cover my CNM's services. It will save you a ton of money. Outcomes for low-risk out-of-hospital birth are just as good for babies and much better for mothers. Also: much much cheaper for you! Save money! Support great (and did I mention cost-effective?) care for women! Cover my homebirth!"
They said no. I figured they would say no, but I also figured it was worth a try. One sentence in their reply, though, gives me pause. It says that if I pay privately for her services, they will refuse to cover any resulting complications.
Now maybe that's just boilerplate for out-of-network denials, aimed at keeping in-network doctors from having to pick up the pieces after out-of-network poor outcomes. If I were to pay for a nose job that went wrong, say, they wouldn't want to get stuck with the cost of follow-up care. But I've been wondering all afternoon -- are they threatening to refuse to pay for a transfer to hospital care if that's needed? If I hemorrhage and need monitoring afterward, are they going to attempt to stick me with the bill? If the baby needs help, are they going to deny the claim?
The doctor who wrote the letter quoted the ACOG statement. (For you non-earthy-birthy folks, the ACOG statement said essentially, "We don't like homebirth, evidence be damned." They cited no literature, because there is no literature for them to cite -- not a single study supports their contention that planned attended homebirth is more dangerous for low-risk mothers or their singleton full-term vertex babies.) But the C-section rate in my town exceeds 40% -- wouldn't you think the insurers would be on a mission to cut costs while improving satisfaction? Isn't it silly for them to turn me down when I hand them just such an alternative?
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