Homebirth with Aetna? - Page 2

[Baby Hopes]

We've been told that our CNM will only be covered out of network since they do offer ONE other CNM in-network. (A CNM who does not do homebirths.) My Midwife, though, says that she's had success getting payments... so as it stands we're paying for our birth out of pocket and then will be happy with any reimbursement that we recieve.

If any.

[KingsDaughter76]

I sure hope they will cover our homebirth in TX... guess I need to check into it. Course I am not preggo yet- but hope to be soon. :-)

[Wugmama]

I had (and now have again) a traditional midwife licenced in the state of MN. Aetna was so rude to me on the phone and absolutely denied that they would pay a penny toward a homebirth. Well, I got a check in the mail...
My midwife says they always say they won't pay but often do.

Annette, are you expecting #4? I'm right behind you with #3!

~Tracy

[lyttlewon]

Originally Posted by annettemarie

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.

I called my states office for the Insurance Commissioner and they stated since my insurance is supplied by my employer it is considered self-funded and isn't required to follow state regulations. Which I guess is why state insurance will cover but not other insurance. I have been hesitant to call Aetna about it. I have heard both though that they will and won't cover it.

Ok so this is interesting I just called BSBC and they said it is up to my employer. Hmmm.

[Lady Lilya]

I think basically it is up to the PLAN. Different plans cover different things.

But I was told that in NY they can't deny you a specialist if your plan covers specialists. And, if they offer no specialists of that type in your network, you get to pick one and have him/her approved.

[Rockies5]

Originally Posted by Lady Lilya

I think basically it is up to the PLAN. Different plans cover different things.

But I was told that in NY they can't deny you a specialist if your plan covers specialists. And, if they offer no specialists of that type in your network, you get to pick one and have him/her approved.

that is how we got ours covered. I checked their website yesterday and it offers conflicting advice. On one hand they state that it is "unsafe" but on the other they list midwives as care providers. Mine was billed (or coded) as "home health services" ( same code as hospice??) and 100% covered. It took over 5 months of phonecalls.

The best time to work this out is BEFORE you are pregnant.

I've found them to be great.

[Sol_Solved]

Bumping this thread up because I'm about to switch to Chickering / Aetna in a few months and I can't find enough information about this. My plan states clearly that:

A referral is not required for the following:

Obstetrical and gynecological services including:
– Maternity care;
– Treatment for acute or emergency gynecological conditions;
– An annual gynecological exam and any subsequent necessary obstetric or gynecological services provided by an obstetrician, gynecologist, certified nurse midwife, or family practitioner, as a result of the exam.

Please note: While a referral is not required for women’s health care, the Student Health Center has a gynecology clinic three days a week – routine exams and annual Pap smears are covered by the Health Center fee that all students pay. Also, for those students seeking maternity care or mammograms, the Health Center can offer suggestions about local providers. Services that are normally provided without charge by the Student Health Center or by Health Care Providers will not be covered when rendered outside of the Student Health Center.

Would this mean we'd have a chance of using a midwife and somehow billing a homebirth through that? I'm rather clueless about this all, and I want to decide if I should get pregnant while we have this insurance or wait three years for the next change. We'll be living in Albany, NY. Also, how much does a waterbirth/homebirth normally cost, if it's not covered?

ETA: there are three midwifes listed under specialists for our region in our plan.

[Sol_Solved]

Anyone?

[Bellita]

We had to fight bitterly to get my prenatal care covered by Aetna. My prenatal care was provided by a midwife in TX. They wouldn't pay for it until they saw proof that I didn't have a homebirth. (I did wind up transferring to the hospital, so i guess it worked out.) Aetna sucks the BIG ONE. Luckily my husband's job let us change insurance companies and now we are with UHC. Much better, IMO. Be ready for hours on the phone with Aetna, lies, major BS and headache.

Please check out their policy statement--they do not think homebirth is medically necessary and therefore won't pay for it NOR any "related services," which was in this case, my prenatal care. :

[Sol_Solved]

Thanks Bellita! I'm so worried about it. I'm not from US so I'm really not used to fighting HMOs or whatever. I'm hoping I'd end up with a midwife who's "been there done that" regarding Aetna and can guide me through the process because I feel quite lost, and I'm completely sure I want to try and have a homebirth.

[annettemarie]

We ended up not even trying to fight. The Board of Pensions is doing away with Aetna as an insurance choice and everyone will have to be on Blue Cross Blue Shield, so there's not really any incentive for them to work with us.

[~minnow~]

Originally Posted by Sol_Solved

Bumping this thread up because I'm about to switch to Chickering / Aetna in a few months and I can't find enough information about this.

fwiw: I am on Chickering/Aetna and am planning a homebirth next month with a CPM. (I'm in Indiana, a state that does not license midwives currently, so the only "legal" midwife is a CNM.)

We've paid for the birth out of pocket ($1700) but will be submitting fees (for prenatal care, etc) to the insurance company just to see what happens. I will update to let you know what my experience with Chickering is like!

[Sol_Solved]

Thanks Minnow! I hope you get great results!

[Baby Hopes]

I was coming back to this thread in hopes of finding some encouraging news and instead am feeling bummed. I've been reluctant to use the word "homebirth" with Aetna and need to get my hands on a copy of their policy. Do I need to just call Dh's employer? The stupid Aetna Navigator is horrendous to try to find concrete information. And I don't trust the reps on the line at all! Today I called with a simple question and it took the representative 20 minutes (most of which I was on hold) to figure out we'd been looking at the wrong YEAR. Gah.

[annettemarie]

If you go to aetna.com and search "homebirth" I think it brings up their policy

[Human_Being]

Aetna has gone so far as to read a printed statement against home birth to some policy holders I know, but its State law in Florida that if its not a self funded plan, if it covers maternity it must cover CNMs, LMs, birth center birth, and homebirth. My expereince as a midwife is that they usually said no to the customer when they called to ask about covered services, but actually paid pretty well in the end, close to the $4200 we charged plus all the labs.

[Baby Hopes]

My Aetna Navigator doesn't have a search feature. *scratches head.* I do know, however, that Aetna as a whole has a strong anti-homebirth policy. I also know that the State of TX has something on the books that requires insurance companies to cover homebirths. (Need to dig a little deeper on this one.)

Aetna has gone so far as to read a printed statement against home birth to some policy holders I know, but its State law in Florida that if its not a self funded plan, if it covers maternity it must cover CNMs, LMs, birth center birth, and homebirth. My expereince as a midwife is that they usually said no to the customer when they called to ask about covered services, but actually paid pretty well in the end, close to the $4200 we charged plus all the labs.

My midwife has indicated that she has a good track record with Aetna covering her billings. Although the Aetna rep I talked to about Midwives (I did not mention "homebirth") made it clear that if the midwife had to be in-network to be covered at in-network deductibles. My issue is that there is only a handful of midwives listed on the Aetna site and all of them are a fair distance from me.

Truthfully, my midwife is not any closer... I just am curious what their policy says about having an in-network care provider available within a certain mile radius. I know with our last insurance we were able to get our midwife covered in-network because they didn't have an in-network midwife near us who provided our services.

Clear as mud?

If someone knows the link to Aetna's policies. I'd be happy to read through them. As it is, I'm having a hard time finding them ANYWHERE.

[Jane]

I have Aetna, but i haven't had a birth with them. I do know Washington State requires every category of provider to be covered if any is, so midwives are in, but it often takes a few tries to get paid, since they sometimes try not to pay. I think that one of the billers I know has a list of names as "good" contacts at each insurance company - getting the right person helps. I wish everyone had access to a billing specialist. They can be a very reasonably priced option.

[e(Lisa)beth]

Originally Posted by Human_Being

Aetna has gone so far as to read a printed statement against home birth to some policy holders I know, but its State law in Florida that if its not a self funded plan, if it covers maternity it must cover CNMs, LMs, birth center birth, and homebirth. My expereince as a midwife is that they usually said no to the customer when they called to ask about covered services, but actually paid pretty well in the end, close to the $4200 we charged plus all the labs.

Heidi, I'm in Florida, too. Do you by any chance know where I can find a copy of that law?

[Sol_Solved]

Bump! I'd love to hear some more experiences.