Hi all,
We are planning a homebirth for Feb/March and have Aetna's CDHP (community driven health plan). The plan pays for eligible expenses in or out of network up to the amount that is available in my fund (of which there is enough to cover the pre and post birth expenses).
So far my MW has billed them for our intial pre-natal/consultation of which they paid, no questions asked. She billed them again for a couple of prenatal appts and they were denied saying that the code that was used was for a one time use only. I called and was told that the code used to bill the prenatals was a global code and can only be used once (since it had already been used for the initial appt) and the other prenatal appts needed to be coded differently.
This is the first time my midwife has billed with Aetna, and after reading as much history as I have been able to find I understand that technically Aetna will not cover a homebirth, but many people have been successful with getting them to reimburse if the claims were coded correctly. What my midwife and I are hoping for is for a little bit of help from others who have been there/done that with Aetna...
i.e. which coding will work and which coding will not work (I also understand that it may be entirely dependent on who happens to process the claim and some may just let things slip, while others may not...). Is there a good schedule to file the claims on?
Any thoughts or help are GREATLY appreciated!
I feel hopeful, but terrified at the same time
TIA!
We are planning a homebirth for Feb/March and have Aetna's CDHP (community driven health plan). The plan pays for eligible expenses in or out of network up to the amount that is available in my fund (of which there is enough to cover the pre and post birth expenses).
So far my MW has billed them for our intial pre-natal/consultation of which they paid, no questions asked. She billed them again for a couple of prenatal appts and they were denied saying that the code that was used was for a one time use only. I called and was told that the code used to bill the prenatals was a global code and can only be used once (since it had already been used for the initial appt) and the other prenatal appts needed to be coded differently.
This is the first time my midwife has billed with Aetna, and after reading as much history as I have been able to find I understand that technically Aetna will not cover a homebirth, but many people have been successful with getting them to reimburse if the claims were coded correctly. What my midwife and I are hoping for is for a little bit of help from others who have been there/done that with Aetna...
i.e. which coding will work and which coding will not work (I also understand that it may be entirely dependent on who happens to process the claim and some may just let things slip, while others may not...). Is there a good schedule to file the claims on?
Any thoughts or help are GREATLY appreciated!
I feel hopeful, but terrified at the same time
TIA!
