With just over a month left in their pregnancies, both Courtney Campbell and Mary Grace O’Connor believed their insurance company would cover expenses for their natural births and newborn care with Fika Midwifery.
In fact, they both said they got initial approval months earlier from Independent Health for prenatal care by Maura Winkler, a midwife and operator of Fika Midwifery in Buffalo. As a result, Independent Health paid several thousand in claims from Fika Midwifery for both women.
But a month or so before they were to give birth, the rug was pulled out from under them when Independent Health denied their claims for the out-of-hospital births and the newborn care through a series of confusing phone calls and letters.
“I mean, it’s total shock,” Campbell said from her home in Akron.
“I didn’t feel like there was anything that we were doing wrong, but I definitely felt like I was not smart enough to understand all of the terminology,” she said.
Both women were left scrambling to figure out if they were going to continue with care from their midwife, and how they would pay for it. Or would they have traditional births in a hospital, which they really did not want to do.
In the end, they moved forward with Fika, and both women gave birth to healthy babies. But they are on the hook now for thousands of dollars in unpaid bills that they expected Independent Health to cover.
News 4 Investigates is aware of eight similar complaints against Independent Health of denying members coverage of births and newborn care from Fika Midwifery, which is the area’s only independent midwifery practice that offers home and birth center care. Four of the complaints are active lawsuits, including ones filed for O’Connor and Campbell, and two more are likely to be filed soon.
Maura Winkler, a state certified nurse midwife who owns Fika Midwifery, said she is not having these problems with other insurance carriers.
“I think birth can be really political and community birth especially,” Winkler said during an interview at Fika’s The Coit House Birth Center. “And I just think there is some inherent belief that birth is not safe if a doctor is not there, and that goes against everything that every certifying organization I answer to says.”
‘We would never do something like this’
Independent Health declined interview requests. Chief Medical Officer Dr. Anthony Billittier said in a prepared statement that state law and the insurance contracts require midwives to have collaborative relationships with certified physicians and operate “in conjunction” with a facility that is licensed under state Public Health Law Article 28.
“Independent Health follows the law, and if you think about it, these state requirements make sense for the safety of the mother and baby because it helps to ensure quick access to advanced and comprehensive care if needed,” Billittier said. “You have to think about the unthinkable, the ‘what ifs,’ because childbirth can result in unforeseen complications quickly.”
Winkler disagreed. She said that while the state does not require midwives to practice “in conjunction” with any medical facility, “we consult, collaborate, and transfer appropriately to several area hospitals, all licensed pursuant to Article 28, which indicates our compliance with [Independent Health’s] policy and would be obvious in medical records.”
Frederick Cohen is the attorney who represents both women. He is also former general counsel for Independent Health.
“I can say this: that in 20 years of having been the general counsel to Independent Health, we would never do something like this to a member,” Cohen said.
“The money, and there is a lot of it there, is for the members. We never forgot that. And the interesting thing about these cases is there is nothing in the policy that’s called the certificate of coverage, nothing in the law, that will allow Independent Health to do what it did to Mary Grace and Courtney.”
More women using midwives
Home births with midwives are up more than 30 percent in New York during the Covid-19 pandemic.
One reason that women are choosing out-of-hospital births is to avoid facilities full of patients sick with Covid-19. The American Pregnancy Association states that other reasons include to have natural births free of pain medicine, more comprehensive care after births and lower costs for both the client and insurer.
Midwifes are trained medical professionals who can provide care for women during and after their pregnancies. But the births are natural, and can be at the mother’s home or at a birthing center, such as the Coit House, which has several private bedrooms and a birth tub.
The New York State Midwifery Practice Act of 1992 allows midwives to provide services in various settings, including birth centers and private homes, and requires insurance companies to pay for the services according to state insurance law.
Bad news comes late
In Campbell’s case, Fika got her notice of coverage authorization in February 2019 to provide in-network coverage for Winkler’s prenatal care.
But when Fika asked for extended coverage from Independent Health to cover Campbell’s home birth and newborn care, the insurer requested “an updated collaborative agreement,” according to Campbell’s lawsuit.
In June 2019, Fika said it resubmitted the request for extended coverage, and included names of obstetricians and gynecologists with whom Winkler had “collaborative relationships,” along with “medical records of a consultation with a board certified obstetrician-gynecologist.”
Winkler told News 4 Investigates that the information on collaborative relationships with other professionals is all that she is required to provide the insurance company, and that only Independent Health threw up roadblocks.
Campbell said she got a call on June 13, 2019, from an Independent Health representative who told her that her extended authorization was denied because her midwife did not have a “written collaboration agreement with a doctor” who could take over care if medical issues turned up prior to or during birth.
But collaborative agreements have not been required by law since 2009. Instead, the state only requires “collaborative relationships” with other medical professionals, and Winkler said that she provided Independent Health with that information back in June 2019.
A day later, on June 14, 2019, Independent Health sent a second notice that it was denying Campbell’s extended coverage, but this time the notice said the reason was because it was not medically necessary. She was almost 37 weeks pregnant at the time and has a history of early pregnancies.
“And I remember I told this woman on the phone, ‘well, I have a history of early births … and this is a month before my baby’s due. What am I supposed to do if I go into labor this weekend?’” Campbell said. “And she’s like, ‘well, any hospital will take you.’ And it seemed very insensitive, but I respected whatever she said at the time.”
Campbell said she got confused and couldn’t make sense of why Independent Health made these determinations.
Campbell appealed the decision. She began to have contractions about 30 minutes before the call with Independent Health was to begin for the appeal.
She said she remembers saying on the phone that, “I’m in labor, I’m pretty sure, and I don’t even know if you’re going to cover me.”
“What do you want me to do? And she said, ‘have your baby.’ I kind of took that as just move forward with what you were going to do.”
Different case, similar result
The matter did not turn out that much differently for O’Connor.
In January 2019, Fika received authorization from Independent Health for coverage of O’Connor’s prenatal care with Winkler as an in-network provider.
In June 2019, Fika sought an extension of the prior authorization for O’Connor’s birth and newborn care, but the coverage was denied. O’Connor was 32 weeks pregnant.
The reason for denial was that the care was not medically necessary. Independent Health said that Fika had not met their policy criteria for coverage, her lawsuit states. Again, Independent Health mentioned the “collaborative agreement” it believed was necessary.
“I remember just standing there in disbelief,” said O’Connor. “I didn’t understand why. And this woman basically intimated that Maura Winkler, our midwife, wasn’t following New York State protocol or law, and kind of painted her in a bad light.”
O’Connor said she called her husband as she sobbed in the pouring rain.
“What are we going to do?” she said she asked her husband. “We didn’t have the money to pay for it. We thought everything was covered.”
Independent Health said in a second prepared statement that Fika Midwifery and its midwives are “out of network” for its members, so the facility must follow the standards it set in the members’ contracts.
“Although we are not able to comment on a specific member’s claim due to HIPAA, or any pending litigation, in every instance Independent Health makes its coverage determination based on a thorough review of the specific circumstances involved in a claim for coverage, the member’s plan requirements, and New York State regulatory requirements,” Independent Health said.
Both women moved forward with Fika
Both women moved forward with having their babies with Fika Midwifery.
Both children were born, healthy and without any complications. Only out of frustration did they both turn to an attorney for help.
“We played by the rules,” O’Connor said. “We played the game. We did multiple appeals. We wrote letters. I talked to people on the phone. What more can I do as just a regular Joe? I don’t know the ins and outs of this.”
Campbell said she remembers telling her husband, “Somebody’s lying, and I know it’s not us.”
“Because there’s no reason for this,” Campbell said. “There’s no grounds for it as we began to understand through Maura [Winkler] and later on through [her attorney] that’s exactly what it was – just deceit. I don’t know how else to put it.”
Independent Health said it does work with local midwives – 58 of them – who are “subject to initial credentialing and approval by an independent committee, are reviewed every three years for re-credentialing and contractually agree to regular monitoring and oversight.” The insurance company said that includes one midwife who performs home births and is “practicing in conjunction with an Article 28 facility.”
“These standards mirror New York State Model Contract requirements and the Education Law regarding midwife licensure,” Independent Health said. “Our participating midwives performed 143 deliveries for our members over the past year.”
Yet, Campbell and O’Connor were not among those deliveries that Independent Health covered, and their lawsuits are seeking those benefits that they believe they deserved.
“They made the last six weeks of my pregnancy just incredibly stressful and it’s completely unjust that they are treating women like this,” O’Connor said. “But to treat a pregnant mother and a new mother with a brand-new baby this way?”
Dan Telvock is an award-winning investigative producer and reporter who has been part of the News 4 team since 2018. See more of his work here and follow him on Twitter.