Under my current insurance plan, care by_________________, a certified nurse-midwife/certified midwife (choose one) is not a covered benefit.  I am writing to request an exception to this policy and authorization for full coverage for my prenatal, birth, and postpartum care under the care of _______________ for a home birth, and hospital transfer if medically necessary.  Because I would like to continue to access the midwifery philosophy of care for my future gynecological and family planning services, I am requesting ______________be credentialed as part of the Plan's network.  Home birth is a safe, cost-effective and patient-responsive health care site for low-risk women. The safety of home birth increases when women who prefer this option have access to continuity of care from home to hospital.

Certified nurse-midwives are licensed professionals experienced in providing clinical care, health education and follow up for low-risk mothers and their families. Midwifery views child birth as a natural event and therefore uses technological and invasive interventions only when medically necessary. Midwifery care is safe, cost-effective and patient-responsive health care, which produces good outcomes, lower cesarean section rates, and high levels of patient satisfaction. According to a study reported in Obstetrics and Gynecology, the outcomes of intended home births in nurse-midwifery practices demonstrate outcomes which are comparable to hospital birth practices.*

I would like to obtain your authorization for an exception to cover my care by _______________ (name of midwife) and for you to include her/him in the plan network for the following reasons:

• I want non-interventive childbirth with competent labor and delivery assistance at home and safe hospital back-up in case of emergency. ______________ CNM/CM (choose one) provides this option.
• Home births are a safe alternative to hospital births for low-risk women.
• The lower costs associated with midwifery care and home births are due to less unnecessary technological and surgical interventions, lower overall personnel costs and decreased facility charges.
• I understand that the safest place for induction, augmentation or regional anesthesia in labor is at a hospital. If these or other medical interventions become necessary during my labor, I will gladly transfer to a hospital.  At my home, IM and IV pain medication may be available, if I desire.
• I want to breastfeed my newborn immediately after birth and to have total support and education by my provider in this. ___________ offers this support, as well as continuous breastfeeding advice for my child's first weeks of life.

• ____________'s rate of transfer is very low due to her/his screening process. S/he is careful to attempt home delivery of women with low-risk pregnancies only. A patient is co-managed with the physician and hospital delivery is planned if the woman becomes an inappropriate candidate for home birth.
• I have been a patient of another provider and have not been satisfied with the care.
• For your information, the ____________, CNM/ CM (choose one) contracts with the following insurers for home births: __________________________________________. (list all insurers they contract with, including Medicare and/or Medicaid.) 

I am now (   ) months pregnant and would like to transfer as soon as possible to care by_______________, CNM/CM (choose one).  I sincerely hope you will grant me an exception.  I wish to have a well-monitored childbirth responsive to my needs, and feel I am best able to obtain that care with a certified midwife at home. I know that ____________ Health Plan is committed to patient needs and providing high quality cost-effective care.

For further questions, please contact ___________, CNM/CM (choose one) at (xxx) xxx-xxxx. Thank you for your consideration.