New Hampshire Midwives Association

Letter to Midwives

Dear Midwife,

As we prepare to formally confront the NH insurance companies who are not reimbursing NHCMs, I want to assure you that we are doing this as a group. This is not for the good of any particular midwife, entity, center or interest. It is solely for the purpose of allowing more consumers access to our professional, wonderful, woman-centered care. The option of accepting third party reimbursement, if and when this is enacted, is your individual choice. Before you send this to your clients, take a moment to discover how this will affect you, your clients, the babies and the evolution of midwifery in this state - and country, for that matter.

As you may well know, many insurance companies are not allowing state licensed midwives to become preferred providers, and often will not reimburse for our services, even if the insured has out-of-network coverage. NHCM are state recognized and licensed practitioners, as deemed by the Attorney General, and have every right to participate in third party reimbursement. This is a restraint of our trade, and unfair to both midwives and NH families! Our care is worth it. The most hard-hitting violators are Anthem Blue Cross/Blue Shield and Cigna, as approximately 2 out of 3 women in NH are insured by one of these companies. The number of consumers who can pay out of pocket for our services, and pay their very expensive insurance premiums as well, is dwindling. These insurance companies are essentially eliminating the out-of-hospital care option for the middle class woman, as only the wealthy can afford both, and lower income are on Medicaid (which does pay for us!). We have no idea how many women we are losing, who are not even offered this option.

Regarding the Medicaid process. they have not required NHCMs to perform or not perform certain tests, no restrictions have been placed on our profession and our care, nor tell us who we can or cannot see. These issues have been posed from concerned midwives, as doctors complain viciously about the holds of the insurance companies. As a group, NHCMs order far less tests, perform far less invasive procedures, and care for healthy, low risk women. If the Medicaid process was so smooth, why not this one?

Another issue raised is that of reimbursement of less money than usually received for services. Lump this with the possibility of having to hold malpractice insurance, and the financial rewards may not seem worth the invested time and effort. However, we are NOT required by law to hold malpractice insurance. If the insurance company itself requires a NHCM to have malpractice, to become part of their network, then you must abide to collect. Remember, YOU DO NOT HAVE TO BECOME A PROVIDER for any network or company. The whole purpose of this "fight" is to make the option of reimbursement available to you as a professional provider. As far as terms, concessions and/or compromises go, they shall be voted upon throughout this process by the NHMA. Those who choose to become reimbursed providers should see an increase in the volume of women choosing out-of-hospital birth, which will quickly make up for the financial output or lower payback rates possibly involved with this endeavor.

We have turned our cheek enough to the insurance companies. Our services are worth getting paid for. By not demanding reimbursement, we harm our credibility and professionalism in NH that we have already worked so hard for. The midwives are one piece to this puzzle, and the NH families are another. Out-of-hospital midwifery care should be an option for EVERYONE.

Enclosed are 3 letters to be copied and sent to every one of your clients and midwifery supporters you know. One is a letter of explanation/request, another (2 sheets) is a formal complaint form letter to the NH Insurance Department, and the last is a form letter of complaint to the individual insurance companies they can copy and send to as many insurance companies as they want! We have requested that these letters be sent by the end of November. Legislation is in place NOW for this, and we need the letters to be sent right away! This legislation will mandate the insurance companies to reimburse us. The idea is to bombard the Insurance Commissioner/Insurance company's complaint departments and get enough attention to initiate action, this action being a cost effective analysis of midwifery care. There is no doubt this analysis will prove their reimbursement savings will be astounding. But, this only begins with consumer interest, so let's get those clients/supporters writing in!

Yes, this is a lot to ask of you and your clients but it is the only way to create change and push forward the evolution of midwifery. If you have any questions or concerns, feel free to contact me, Adrian Feldhusen at (603) 673-6010 or , or Jeanne Browne at (603)226-1039 or If you need help getting these packets together and out in the mail, let us know. We have midwifery students ready and willing to be involved- getting client lists typed, copying letters, and sending envelopes. Also, we have interest from supporters in the state government NOW for this issue. That window of opportunity may close if we do not act quickly. Thank you so much for your time and effort.


Adrian E. Feldhusen, NHCM
NHMA Secretary, on behalf of all
New Hampshire Certified Midwives

Jeanne Browne
Consumer, Apprentice Midwife,
Supporter of Consumer Rights

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