To: BCBSTX

CC: Cassie Brown, Texas insurance commissioner

We are writing to express our deep concerns about the discriminatory and harmful nature of your policies towards midwifery care and home birth and the families who rely on it. The following points outline the critical issues that need immediate attention:

Midwifery Care as a Vital Solution

Midwifery care has emerged as an essential solution to the healthcare crisis, with universities, insurance companies (including BCBSTX), and nonprofits investing in programs that train midwives to fill the gaps in maternal healthcare. Half of the women in TX of child-bearing age live in maternity care deserts and rely on midwifery care. Studies show that midwifery care reduces intervention rates, improves maternal and neonatal outcomes, and provides cost-effective care. Despite this, your policies do not fully support this vital service, undermining these efforts and limiting access to high-quality care.

Diminished Women's Rights in Texas

Women's rights to choose their healthcare options are already severely diminished by policies in Texas. The state's restrictive reproductive laws have created an environment where many women are afraid of being pregnant. The fear of potential legal consequences has led many OBGYNs to stop practicing obstetrics, exacerbating the shortage of maternity care providers. In this context, the role of midwives becomes even more critical, yet your policies fail to provide adequate support for their services.

Vulnerability of Birth Experiences for Women of Color

Birth is an extremely vulnerable experience, and women of color, in particular, face abysmal outcomes in hospital settings. African American women are three to four times more likely to die from pregnancy-related causes than white women. They also experience higher rates of complications and lower quality of care. Midwifery care offers a more personalized, respectful, and culturally sensitive approach, which can significantly improve outcomes. Women should have the right to choose the birth setting where they feel safest, yet your current policies restrict this choice.

Non-Compliance with Section 2706 of the Affordable Care Act

BCBSTX's policy of only covering Advanced Practice Nurses (APNs) for home birth services and excluding midwives is in direct violation of Section 2706 of the Affordable Care Act, which mandates non-discrimination in healthcare coverage. This exclusion is not only illegal but also detrimental to families who rely on midwifery care for safe and effective maternity services.

SEC. 2706. NON-DISCRIMINATION IN HEALTH CARE.(a) PROVIDERS — A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.

Challenges Faced by Midwives in Providing Care

It is not in the best interest of midwives to be in-network providers under the current reimbursement structure. Obstetric CPT codes are based on obstetric care provided by physicians, not midwives. They assumes that each routine antepartum and postpartum visit is under 30 minutes of face-to-face time and that the provider spends less than 2 hours present during labor and delivery. Time-based billing ignores the holistic approach to midwifery care.

Midwifery care includes extensive face-to-face time with patients and continuity of care during birth, which has been proven to improve outcomes. However, this model of care limits the number of patients midwives can take on and does not compensate them adequately for the time and care they provide. As a result, many midwives struggle to sustain their practices under in-network agreements.

We believe that every family should have access to affordable and comprehensive maternal care. Our priority is to remove financial barriers for patients, ensuring they receive the necessary care without undue burden. At the same time, we advocate for fair compensation and support for midwives, recognizing their critical role in improving maternal and neonatal outcomes.

As one of the largest insurance providers in Texas, and as a company that has demonstrated an understanding of the importance of midwifery through your Boldly B.L.U.E program, changing your policy to include coverage for CPMs to attend home births would promote patient-centered care and significantly improve maternal care for women in Texas.

We believe that every family should have access to affordable and comprehensive maternal care. Our priority is to remove financial barriers for patients, ensuring they receive the necessary care without undue burden. At the same time, we advocate for fair compensation and support for midwives, recognizing their critical role in improving maternal and neonatal outcomes.

We urge BCBSTX to revise your policies to fully support midwifery care. Doing so will not only align with legal requirements under the Affordable Care Act but also demonstrate a commitment to the health and well-being of all families in Texas.

Sincerely,

Bear & Wolf Medical Billing

on Behalf of a Collective of Midwives and Families in TX, as follows: