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Homebirth with Aetna?

post #1 of 73
Thread Starter 
I would love to hear other's experiences with Aetna paying part or all of the fees associated with a homebirth. Does the type of midwife you use make a difference? Thanks!
post #2 of 73
Thread Starter 
post #3 of 73
It matters how the midwife bills. I have not yet billed Aetna, but have worked with midwives who have. Billing as a "global vaginal delivery" (which includes the fees for ante- and postpartum) not a "home birth" will usually see some return, even with Aetna who has a statement against home birth.
post #4 of 73
They said on the phone and in writing that they would not pay. Then they said they would pay at out of network rates. They ended up paying at in network rates, without us even having to argue with them. So I guess you just send a bill and take your chances.
post #5 of 73
We are about to tackle this in the next few weeks. I don't have much hope for it since homebirth is exluded from coverage AND midwives are not able to be licensed in GA (although my mw is licensed in TN, which gives me a little hope). She isn't even bothering filing the actual birth, but is filing for prenatal care, a home visit, breastfeeding help, etc. We've already paid her in full, so anything that gets paid will come to us, which will be SO helpful right now. I know if it is paid, it will be out of network, but still anything is better than nothing. We're also filing for the rhogam and trying to file for flex dollars for our birth kit. I'll let you know what happens...
post #6 of 73
They wouldn't pay for mine. I didn't bill them though because they just told me over the phone they don't do homebirths.
post #7 of 73
Thread Starter 
I guess I'm confused because I did a search and found several posts on MDC saying that Aetna was very good about homebirth. Sigh.
post #8 of 73
What matters the most is what your "Out of Network Provider" policy says, and how the midwife or billing service actually bills for it.
post #9 of 73
Thread Starter 
Quote:
Originally Posted by midwifetx
What matters the most is what your "Out of Network Provider" policy says, and how the midwife or billing service actually bills for it.
Ah. See I've heard that they say they won't but they do. And my midwife says she's had success in billing so that they pay some if not all. I guess it's sort of a crap shoot then.
post #10 of 73
Thread Starter 
Oh, and thanks all for your input. This is the first time we've homebirthed, so I have lots of questions!
post #11 of 73
Yep, it's like just about any policy if you call and ask, "Will you cover my moon birth?" They will say no, moon birth is not a covered benefit and don't believe birthing on the moon is safe. But if you have a moon birth and your midwife bills simply for the care she provided while you were on the moon giving birth, they will almost always reimburse it. The facility, in this case the moon, isn't a network contracted facility
post #12 of 73
I don't ask if they cover homebirth, I ask if they cover Out of Network Providers. The only insurance I've ever gotten guff from over the 'birthsite' was BCBS. Aetna paid the practice I work in very well last year for a couple of births.
post #13 of 73

Let Aetna hear our concerns

I'm in the middle of trying to have Aetna pay for my homebirth (or at least the prenatal and postpartum charges). It doesn't look very hopeful for me. However, I am planning on writing to them and suggesting they review their policies and cover homebirths with a licensed midwife attending. There is more informaton on a CA midwife's website (including email address of Aetna folks if you feel compelled to write them, too).

http://www.gentlebirth.org/archives/homsafty.html

Hopefully with enough of us complaining, the policy will be changed!
post #14 of 73
My current midwife says that she has no issues with Aetna. And the 2 others that I interviewed said that they are one of the easiest to get to pay for at least a portion of the homebirth. I think it does matter how they are billed.

I did read that Aetna has a statement that they don't pay for homebirths, or births in a facility that isn't attached to a hospital. But apparently, if the midwife bills, you have a good chance at them paying.

They also refused some women u/s at the 20 week mark, and generally regular OB care does this as a standard of care. Basically, I was told that if they deny you, if you refute it, you have a better chance at getting it paid. Lots of people don't refute or even bother to try in the first place, and Aetna wins in that case.

Good luck!
post #15 of 73
Thread Starter 
Do you think it makes a difference what state you are in? I'm due any minute, and trying to think of the best way to tackle this.
post #16 of 73
Aetna has a policy statement that they don't view homebirth as appropriate and therefore do not cover it, unless it is mandated by a certain state. (Their policy statement doesn't disclose which states, though...) You can find this online if you google for it. They cite that BS Australian study and some ACOG statements as their justification for not finding it appropriate.

I would NOT under any circumstances say the words "homebirth" while you are on the phone with Aetna, as they will flag your chart and will not pay. Aetna originally said they were paying for our prenatal midwifery care, and have since reneged on this, even though we have a letter stating they'd pay for it In-Network. My midwife is being asked to return the money they've paid her for my prenatal visits since they're now considering it a "related service to a planned homebirth."

Needless to say, we are appealing this. Aetna has gone from being what seemed like very accommodating to completely hostile. I can understand if they don't want pay the homebirth, but to not support midwifery either, when they say they do and told us they would, is just ridiculous.

Luckily, through a loophole with DH's work, we're going to be able to switch to another insurance provider, so the birth won't have to be billed to Aetna. Aetna will be getting a piece of my mind once this is all said and done.
post #17 of 73
Thread Starter 
I thought, though, that there was a federal law that basically said a woman can't be compelled to give birth in the hospital, and that insurance had to cover it as long as the care provider was legal in the state in which the birth occurred?

Thanks for the tip about not using the words "home birth" though. Now I'm wishing we had switched to Blue Cross Blue Shield, the other insurance provider we could have through the church. I'm guessing it's too late now since I was due yesterday, LOL!
post #18 of 73
I had Aetna cover my homebirth 100%, and I had no out of network coverage and they don't cover homebirths??? It's possible, keep on them. Be polite.

I had a CPM
post #19 of 73
I am pretty sure it depends on what state you are in if they'll cover it. I think you need to find out what your state's insurance code says.

Here's what Aetna has to say:

Aetna considers planned deliveries at home and associated services not medically appropriate.

Note: However, provision of home births will be considered when mandated by law.

The other thing your midwife can do is bill it as generically as possible in the hopes that it just goes through.
post #20 of 73
I started off by searching Aetna's network for a MW. None were listed. I was told that if they don't have anyone listed for a certain specialty, they have to cover as in-network whomever you pick.

My MW says Aetna is one of the easier ones for her to get money from.

She got pre-approval in advance.

Unfortunately, my husband's company is changing to Oxford as of June 1. So, we will have to do it again.
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