17 July 2024
A Call to Action for BCBSTX: Addressing Discriminatory Policies & Promoting Patient-Centered Care

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:

66
signatures
60 verified
  1. rosalyn brickman, recruiter, apple, austin
  2. Laurie Fremgen, CPM, LM, Licensed Midwife, Austin
  3. Gillian Hatten, Austin
  4. Megan Chopra, Recruiting & Mom-ing, Apple, Austin
  5. Haley Harris, Birth Doula, Austin
  6. Lea Klumpp, Registered Nurse, HCA, Austin
  7. Rhianna Belcher, Katy
  8. Lillian Johnson, Natural Resources Specialist, TCEQ, Manor
  9. Leanna Hanson, Full spectrum doula, Austin
  10. Dana Minor, Dallas
  11. Jini Zuniga, Advancement, William & Mary, Williamsburg
  12. Kayla Tucket, CPA, CLC, Amarillo
  13. Sarah Hargrove, Mom, Georgetown tx
  14. Kayla Kartchner, Groomer, Tooele
  15. Joan Stephens, Recruiting, Apple, Austin
  16. Brittany Thornton, LM, CPM, Licensed Midwife, Belton, TX
  17. Darby Zumwalt, RN, Kerrville
  18. Janai Willians, Mom, San Antonio
  19. Nicole W, Teacher Mama, Austin
  20. Rajan Chopra, Co-Founder, Bear & Wolf Medical Billing, Austin
  21. Michele Howard, Student midwife, full spectrum doula, Detroit
  22. Carla khalsa, Traditional Chinese Medicine Doctor, VOLENTE
  23. Samreena Syed, Royal Oak
  24. Brigette Walters, Doula, Austin
  25. Meghan T., Business Operations Coordinator, Wisconsin
  26. Caleb Brice, Austin
  27. Ashley Blissit, Teacher/Mother, Pflugerville
  28. Meagan Noble, Birth Doula & Student Midwife, Austin
  29. Eleanore Frank-Cisneros, Student / Mother, Beside the Well: Full Spectrum Doula Care, Austin
  30. Teron Johnson, Round Rock
  31. Melanie Locklear, Paralegal, Austin
  32. Janiz Arceo, Account Exec, Austin
  33. Nikki Riggs, Full-spectrum doula and photographer, Austin
  34. Alexis Humphrey, herbalist, Stay at home mom and college student, Adkins
  35. Chelsea Smock, Homeopath, Austin
  36. Madeleine Mulalic, Law Office Manager, San Antonio
  37. Sarina Jones, LMSW, Perinatal Social Worker, Austin
  38. Stephanie Adner, Bertram
  39. Mandy Barrett, Psychotherapist, Flower Child Counseling, Austin
  40. Taylor Webley, Doula/ Massage Therapist, Self, Austin
  41. Samantha Willis, Mama, AUSTIN
  42. Ashleigh Stevens, Homemaker, Austin
  43. Margaret crivelli, Austin
  44. Catherine Stewart, Austin
  45. Mariya Charlton, Doula, Austin
  46. Ashleigh Hope, Research Statistician, Dale
  47. Meggie, Mom, Dripping Springs
  48. Diane Dreier, Licensed Midwife, Northeast Texas Midwifery PLLC, Mt Pleasant
  49. Kristin Green, Midwife, Seeds of grace midwifery, Henderson
  50. Brianna Halbrook, Longview
  51. Jazmyn Stotts, SAHM, Big Sandy
  52. Jennifer Perry, Civil engineer, JMT, Longview
  53. Madelyn Crowder, Wife and Mother, Longview
  54. Delise Lockett, Engineer, Killeen
  55. Alex Soliz, Optometrist, Longview
  56. Rachel Harvey, Caregiver, None, Tyler
  57. McKenzie Weldon, Mother, Longview
  58. madison penton, Diana
  59. Hayley Luby, Stay at home mom, Harleton
  60. Natalie Moorman, Wife and Mother, Cushing
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