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


Small Claims Court for Health Insurance Reimbursement (in California)

Easy Steps to a Safer Pregnancy - View e-book or Download PDF - FREE!
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.

Other excellent resources about avoiding toxins during pregnancy

These are easy to read and understand and are beautifully presented.

Your ultimate tool is Small Claims Court - this is a system where you can easily represent yourself and present your "case" to a judge:

First of all, the legal cost to the insurance company in representing themselves in Small Claims Court is large.  The Public Relations cost is atronomical.  It just doesn't look good for them to be denying coverage for a less expensive plan of treatment for homebirth, especially when they agreed to cover it in pre-arrangement. Can you imagine a "60 minutes" piece about this.  Or maybe Anderson Cooper could champion the downtrodeen mothers who just want to give birth without exposing their babies to drugs, and who just want to have their babies near them so they can breastfeed, and who just want to protect their babies from hospital germs, and . . .   You get the picture.

Small Claims Court is your trump card.  Don't be afraid to use it.  It's actually quite easy.

If you didn't get pre-approval for your homebirth healthcare, you may still be able to pressure your health insurance company to reimburse your homebirth expenses through arbitration or by filing a claim in small claims court.

Often, the consumer/member/subscriber can't file a claim in small claims court because their health insurance policy (which is a contract), requires arbitration instead.

For homebirth midwives, who are usually not able to become in-network providers, their only legal recourse for repeated denial of claims is through Small Claims Court.  In California in 2006, the limit has been raised to $7500, which makes it quite worthwhile to file a claim!

Steps to successful recovery of your fees through Small Claims Court in California:

  1. File claims that are sensible, accurate and use correct coding.
  2. Respond to initial denials with appeals letters that describe how homebirth care is different from hospital-based care, i.e. how the homebirth midwife provides services normally fragmented among obstetricians, neontal teams, pediatricians, and nursing staff, and the large collection of expensive and specialized equipment that midwives bring to births.
  3. Respond to second denials with the same appeal letter with a specific notice that if the second appeal is denied, you will file a claim in Small Claims Court.
  4. If they deny your second appeal, gird your loins, take a deep breath and remember that you're doing this so you make enough money to run a business, maintain a professional midwifery practice, support midwifery organizations, support yourself, make sure you have access to decent healthcare for yourself, and maybe even put aside a little money for retirement!
  5. Read about the Small Claims process - here's the information about Small Claims Court in California.
  6. Figure out where to send the claim - here's the info for some companies in California: Blue Cross of California, [Blue Shield of California (contact page, phone #(415) 229-5000)], HealthNet
  7. Use EZ Legal File to help you fill out the form
  8. Go to the court to file the claim.
  9. Take three copies of supportive documents - 1 copy each for yourself, the insurance company representative, and the judge.


Additional Resources

Santa Clara County has some nice web page:

Small Claims Home

Small Claims Court Self-Service Center

This Web page is referenced from another page containing related information about Money and Paperwork


SEARCH gentlebirth.org

Main Index Page of the Midwife Archives

Main page of gentlebirth.org         Mirror site

Please e-mail feedback about errors of fact, spelling, grammar or semantics. Thank you.

Permission to link to this page is hereby granted.
About the Midwife Archives / Midwife Archives Disclaimer