The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Appeals Letter

Dear Review Board:

I am writing in reference to insurance claims surrounding my pregnancy and birth that Blue Shield has denied.

All of the claims for <baby> were denied.  These included well baby visits and time immediately after the birth that had she been born in the hospital would have been performed by a pediatrician or nursing staff.  The claims should not be considered included in the global obstetrical care because they were for care of the child, not the woman giving birth.

All claims for <mother> outside of the global obstetrical care were denied.  The care went beyond this code.  There were complications monitored during pre natal visits such as <list your complications here.>  Specifics can be found in the attached medical records.  Also, time during labor and delivery would be outside of this code.  In the hospital, monitoring during labor would have been performed by nursing staff and not the obstetrician.  Since this was not a hospital birth, the midwife performed monitoring outside of the global obstetrical care code.    Post-partum claims were also denied.

Licensed midwives are not contracted with Blue Shield, but are paid at in-network rates.  <Midwife> is a licensed midwife who provided this care.

Thank you for your time,
 
 
 

<Clever Mother>