[Your Family’s LetterHead]
[Date]
[Insurance Carrier Appeal Department Address]
Dear ( ):
Our request for an in-network exception/gap exception for care by Penny Lane MSN, CNM was denied. I am writing to appeal such decision.
[Insurance Company] denied such exception because other care providers were found within my territory; however, these providers are not Certified Nurse Midwives. They are either obstetricians or nurse practitioners. One might assume from this denial that your company assumes midwives and obstetricians or nurse practitioners to be one in the same. In fact, nurse practitioners are not licensed or trained to attend births. Obstetricians are trained to identify and manage disease processes. They are in fact, surgeons. Asking them to support and educate women with healthy pregnancies, or labor support and breastfeeding advice is outside their scope. It doesn’t utilize their strengths and has proven detrimental to mothers and babies.
The professions of midwifery and obstetrics are not one supervisory to the other, but in fact, complementary with different expertise. The World Health Organization states the midwife is in fact, “the most appropriate primary provider for the normal, healthy mother and baby.” While obstetrics are a vital component of maternal healthcare, utilizing them for high risk mothers alone would optimize healthcare dollars and decrease expensive intervention rates and ultimately, cesarean and maternal/fetal morbidity and mortality rates in our country.
The rate of cesarean section in our country averages more than thirty percent and is even higher in the community you have denied our in-network exception. The Nurse Midwives at Believe Midwifery Services have a combined experience of more than twenty years and have a 3% cesarean rate, meeting the World Health Organization’s recommended rate of surgical birth for optimizing maternal and fetal outcomes.
We simply seek a provider that has proven a high standard of care and will optimize our chances for a safe birth. In fact, Believe Midwifery Services was awarded with the Nursing Advancement award by the State Board of Nursing in 2009.
As I am sure you are aware, low interventive birth also decreases healthcare costs which greatly benefits your bottom line.
Penny Lane is licensed as a nurse-midwife in the state of Indiana, providing primary care to women and their infants - her scope and specialty not replaceable by a physician. After careful review, I believe your company will find that limiting or in fact, eliminating our option for midwifery care is not in either of our best interests, or your stock-holders. It is our hope that you will reconsider your decision to approve our client’s network gap exception for our pregnancy, labor birth and newborn care.
Sincerely,
[Name, Date of Birth, Address, Phone Number and Insurance Information]