Under my current insurance plan, services at ____________________, a free-standing licensed accredited birth center staffed by midwives certified by the American College of Nurse-Midwives in ________________ are not covered by your health plan.  I am writing to request an exception to this policy and authorization for full coverage of my prenatal, delivery and postpartum care at this facility. In addition, I would like to request that________________ become part of the Plan's network for future obstetric and gynecological care. This center is licensed by the state and meets the national accredited standards for safe care. It is a cost-effective and patient-responsive health care site for childbearing women and their families.

The obstetrical services at _________________ include prenatal care, labor and delivery and postpartum visits. The total fee package for this care is approximately _____________.  In the event of a hospital transfer, _________________________________ (insert how your center handles finances regarding hospital transfers). The center's nurse-midwives and physicians deliver at __________________ Hospital.  For your information, Dr. _____________ is the Medical Director.

I would like to obtain your authorization for an exception to cover my care at the center at the rate equivalent to seeing a physician under my Plan and to include the center in the network for the following reasons:

• <!--[if !supportLists]--><!--[endif]-->I believe I should have a right to choose a nurse-midwife to provide my care.
• <!--[if !supportLists]--> <!--[endif]-->I want non-interventive childbirth with competent labor and delivery assistance and safe hospital back-up in case of emergency. The __________________ provides this option.
• <!--[if !supportLists]-->Birth centers are a safe alternative to a hospital birth with lower cesarean section and complication rates and overall costs as documented by studies including the National Birth Center Study published in the New England Journal of Medicine, December 28, 1989. This study presents data from the care for 11,814 women who were admitted in labor to 84  birth centers throughout the country and shows low infant mortality and a significantly reduced cesarean section rate.
• <!--[if !supportLists]-->The lower costs associated with birth centers are due to lower rates of technological interventions, shorter stays and lower overhead costs.
• <!--[if !supportLists]--><!--[endif]-->I want to breastfeed my newborn immediately after birth and have total support in assuring breastfeeding is well under way before I go home. The _______________ offers this support, as well as continuous breastfeeding advice for my child's first weeks of life.
• <!--[if !supportLists]-->The center's rate of transfer is very low due to their continuous screening processes. The care providers are careful to attempt delivery of low-risk pregnancies only. The physician is available for collaboration, consultation and referral of the patient if and when that is necessary.
• <!--[if !supportLists]-->I have been a patient of another provider and have not been satisfied with the care.
• <!--[if !supportLists]-->For your information, the ________________ contracts with the following insurers: (enter all insurers with whom the birth center has contracts including Medicare, Medicaid, etc).

I am now (   ) months pregnant and would like to transfer as soon as possible to the care of ________________.  I sincerely hope you will grant me an exception to use the ________________ under the plan, so that I can have a well monitored childbirth responsive to my needs, something I feel I am best able to accomplish at the birth center. I know that ________ Health Plan is committed to patient needs and providing high quality cost-effective care.

For information on birth centers, please go to www. Birthcenters.org or contact Kate Bauer, Executive Director, National Association of Childbearing Centers at 215-234-8068.  For further questions about the services at ___________________, please contact ____________________, Director, at (xxx) xxx-xxxx. Thank you for your consideration.

cc:        Birth Center/midwife