Getting Aetna To Pay For A Birth Center

[mama2myangels07]

I called aetna seeing what they would cover of the costs for a birth center. Our plan is one of the health fund plans. They said they'd pay 60% of the costs after the deductible for out of network. I was also told they would not cover for me to see a certified nurse midwife for prenatal care, gyn only. I've heard of many people getting aetna to cover for a birth center no problem, but we'd have to pay $1500 for the deductible which is a lot for us to come up with.

[mamatolevi]

have you checked with your employer? sometimes they can pull strings you can't.

[kltroy]

Ask your CNM if she has an MD that she works with (she probably does). Most CNMs will bill through their partner doctor to get around these insurance issues. I, too, have an Aetna HealthFund insurance plan and saw a CNM for all my prenatal care w/ my last pregnancy. My state doesn't have free-standing birth centers so that wasn't an option, but Aetna didn't seem to bat an eye about the rest of it.

Esp. with the healthfund, all of the out of pocket expenses will come from the fund versus out of your pocket (assuming your fund has enough $ in it), so even if they don't cover very much you will probably max out your personal annual limit and the rest will get covered by Aetna. Remember even if they only cover 60% the other 40% comes out of the healthfund until you reach your out of pocket maximum, after which they will cover 100%. This is what happened for me.

[mama2myangels07]

Originally Posted by kltroy

Ask your CNM if she has an MD that she works with (she probably does). Most CNMs will bill through their partner doctor to get around these insurance issues. I, too, have an Aetna HealthFund insurance plan and saw a CNM for all my prenatal care w/ my last pregnancy. My state doesn't have free-standing birth centers so that wasn't an option, but Aetna didn't seem to bat an eye about the rest of it.

Esp. with the healthfund, all of the out of pocket expenses will come from the fund versus out of your pocket (assuming your fund has enough $ in it), so even if they don't cover very much you will probably max out your personal annual limit and the rest will get covered by Aetna. Remember even if they only cover 60% the other 40% comes out of the healthfund until you reach your out of pocket maximum, after which they will cover 100%. This is what happened for me.

Thank you! This does help a lot. I will see what she says.

[mysticmomma]

There is a fed. law (can't find it now) that insurance plans must cover midwives.