fighting health insurance for the right to homebirth

[mltjm]

I am pregnant and am seriously considering giving birth at home. However my insurance (aetna) has deemed it 'an unsafe way to give birth'. Have you ever fought an insurance company for the right to homebirth? If you did, how did you go about it? Any experiences, references and advice welcome.
Thanks!!

[sattygirl99]

Until your MW submits the claims, you won't know if they really cover it or not.

A lot of people find that even if insurance says they don't cover it, they get reimbursed anyway. DONT call your insurance company and ask them. Dont give them any inclination you are planning a 'non traditional' out of hospital birth. Just let your MW file the claims... The MW's know how to get things covered...

[bclare]

No where on the superbill do the midwives have to say it was at home-- so you have a better chance just hoping for getting reimbursed at the end and seeing what happens. Yes, it's a lot of money, but in the end, is it?

[gabeyho]

i don't know where you live, but when i had dd2 in northern CA 5 yrs ago I had AETNA, and my midwife submitted the claim afterwards, and was paid no problem. Good luck!

[MidwifeErika]

even if they have a policy against homebirth, there are many parts of care that can be billed for that did not take place in the home such as appointments. I would recommend working with a midwife who has a professional insurance biller or has quite a bit of billing experience herself.

[MamaVolpe]

I agree with the above, insurance co's dont know if you birthed at home or not. They just think oh the midwife sent her bill in but the hospital must have forgotten to send in theirs. Yeah, one less bill for us to pay. They almost never notice it. I would not stress about it unless you get a rejected claim. It will also help if your midwife knows how to bill insurances. If she is not familiar then you may have some problems as they have to bill globaly for maternity charges not for each individual appointment. Also check to see what kind of insurance policy you have. Do you have in network and out of network benefits? If you policy only covers in network providers then make sure your midwife is participating with the policy. And if the insurance still says they wont cover it then get a copy of your EOC-Evidance Of Coverage booklet and check the sections on Exclusions. If it is not listed as an exclusion on the policy then appeal, appeal, appeal. Good luck. If you need more tips or have any more questions please ask.

[jengacnm]

Aetna has a national policy of NOT covering home birth. The only way they pay is if it is mandated by state law-and I think California is one of those states.

Insurance claim forms DO have a "box" for "place of service". The trick is for the midwife (or her biller) to code place of service as OFFICE.

Good luck-

Jennifer
Home birth CNM

[MidwifeErika]

Originally Posted by jengacnm

Aetna has a national policy of NOT covering home birth. The only way they pay is if it is mandated by state law-and I think California is one of those states.

Insurance claim forms DO have a "box" for "place of service". The trick is for the midwife (or her biller) to code place of service as OFFICE.

Good luck-

Jennifer
Home birth CNM

Jennifer is correct.

Which if they are billing the global midwifery fee and met for prenatals and postpartums in the office, it would be a correct place of service code to use the office code. She might just not be able to bill for other things that are attached with the birth that occurred in the home.