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)
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The Best Thing You Can Do for Mothers, Babies, Birth
and Families is to Become Net Savvy!
I just had my mind expanded this morning by Laureen Hudson's hour long
online session on how to use the internet to get a message out. Laureen's
session “Creating an Online Presence," gave me a wealth of information
in a short time and impressed me with how many people are out there who
completely rely on the internet for their information. I needed that, and
maybe you do, too.
- Ina May Gaskin
I just hung up the phone from doing the hour long session with
Laureen Hudson on “Creating an Online Presence”. Laureen’s know-how
and expertise were enough to wake up even the birth oldtimers like me and
Ina May to the many unused opportunities of the internet. Laureen’s
engaging and easygoing teaching style made even those scary (to me) terms
like “hypertext, streaming, wordpress, technorati, feedreader and trackback”
start to make sense. Her passion is to reach the generation of young
women who have not yet given birth BEFORE they fall into the black hole
of aggressive obstetrics. I came away from the class today with lots
of ways to improve my website and make it more modern, usable and interesting
for readers. This class will run again this coming Friday (August
22) and I heartily recommend it.
- Gloria Lemay
REGISTER NOW! SPACE IS LIMITED!
Cost: $35 per session
Each session will be 60 minutes in length
Creating An Online Presence
Sunday,
September 7 at 5:00 p.m. Pacific / 8:00 p.m. Eastern
Friday,
September 19 at 12:00 p.m. Pacific / 3:00 p.m. Eastern
Monday,
September 22 at 9:00 a.m. Pacific / 12:00 p.m. Eastern
Search!
This session will include a case study of Dr. Amy and how we shoot
ourselves in the collective feet by visiting and commenting on her website.
(PS Hope you enjoyed the Gotcha! page from our last email!)
Sunday,
October 5 at 5:00 p.m. Pacific / 8:00 p.m. Eastern
Friday,
October 24 at 12:00 p.m. Pacific / 3:00 p.m. Eastern
Monday,
October 27 at 9:00 a.m. Pacific / 12:00 p.m. Eastern
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Your ultimate tool is Small Claims Court - this is a system where you
can easily represent yourself and present your "case" to a judge:
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You had an obvious medical need for appropriate care for a normal, healthy
pregnancy.
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You pre-arranged coverage for a homebirth.
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Your treatment was less expensive than the standard treatment, i.e. hospital
birth.
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The insurance company refuses to honor their pre-arrangement to cover expenses
for your homebirth.
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:
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File claims that are sensible, accurate and use correct coding.
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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.
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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.
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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!
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Read about the Small Claims process - here's the information about Small
Claims Court in California.
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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
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Use EZ Legal
File to help you fill out the form
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Go to the court to file the claim.
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Take three copies of supportive documents
- 1 copy each for yourself, the insurance company representative, and the
judge.
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STILL IN PROCESS!
Additional Resources
Santa Clara County has some nice web page:
Small Claims
Court Self-Service Center
EZ Legal
File to help you fill out the form
This Web page is referenced from another page containing related information
about Money and Paperwork
Permission to link to this page is hereby granted.