Homebirth with Aetna? - Page 3

[WAmommy]

Just happened upon this.

My homebirth and prenatal care were paid for 100% by Aetna.

I only submitted my claim once and they paid every cent. They only would have paid 90 % of a hospital birth .

[veralevitt]

Originally Posted by WAmommy

Just happened upon this.

My homebirth and prenatal care were paid for 100% by Aetna.

I only submitted my claim once and they paid every cent. They only would have paid 90 % of a hospital birth .

What state are you in? CA by chance?

[FoxintheSnow]

I'm in FL and I have Aetna through dh's work. I just got a letter that they are paying for my homebirth and prenatals as in-network. I was so happy! My midwife said she is a pro at getting insurance companies to pay.

[lrmama]

Aetna paid for our hb with no problems, even though I'd been told over the phone that they don't pay. My mw was a dem, not a cnm, which are available through our plan (in a birth center, which I didn't want). Apparently, because the billing codes were correct, there was no issue. If someone needs the codes that we used, pm me and I'll go look them up.

[Baby Hopes]

Well, we had our babe on September 14th and Aetna has covered our homebirth. As "out of network" because all their in-network midwives don't offer homebirths. : With our $4,000 out of network deductible and 20% co-pay, the translation is that Aetna paid $112 towards our birth.

Honestly, the whole thing is just a tad insulting.

I'm in the process of trying to find the TX laws regarding homebirth to see if TX mandates homebirth coverage by insurance companies. If that's the case, then I'm going to submit an appeals letter requesting they pay for my midwife as "in-network" because they don't offer any other in-network midwife who does homebirths.

Well, see. I'm not feeling very hopeful.

[Jessmomto2]

Originally Posted by Baby Hopes

Well, we had our babe on September 14th and Aetna has covered our homebirth. As "out of network" because all their in-network midwives don't offer homebirths. : With our $4,000 out of network deductible and 20% co-pay, the translation is that Aetna paid $112 towards our birth.

Honestly, the whole thing is just a tad insulting.

I'm in the process of trying to find the TX laws regarding homebirth to see if TX mandates homebirth coverage by insurance companies. If that's the case, then I'm going to submit an appeals letter requesting they pay for my midwife as "in-network" because they don't offer any other in-network midwife who does homebirths.

Well, see. I'm not feeling very hopeful.

Please update if you find anything out. I'm also in TX and trying to get Aetna to pay for my homebirth. My midwife said she has had good luck with Aetna before so I'm hoping it will carry over and I will have good luck.

Forgot to add, Congrats on your new baby!


Edit: for the person who asked if people have PPO or HMO; I have EPO which is basically just HMO that we can use in other states.

[stelly]

Could the last few people who posted please clarify if they have PPO or HMO policies with Aetna?

Thanks.

[Baby Hopes]

I have "Aetna Choice Pos II" Whatever that means. (Baby's sleeping on me, or I'd look it up.)

Well, we went to Dh's HR dept yesterday to ask about forcing an in-network designation for our out-of-network midwife. The woman there was less than encouraging. I quote: "Aetna has never covered an out of network provider as in-network."

When I pressed her on the issue she then told me that "Well, technically it's our policy that states that."

So Aetna may do it, but because Dh's employer is cheap, I'm out of luck? Honestly, she was so brisk with me that it caught me off guard. I wasn't expecting to go in with my "fight face" on. I really just wanted a copy of our policy. In fact, she so befuddled me that I almost left without asking for the policy in writing! And even then, she insisted that it was only available online through Dh's special work intranet. When Dh asked her to print the part of the policy that states we can't force an in-network designation, she told him it would take too long and that the whole policy was 80 pages and she wasn't going to print the whole thing.

Needless to say, I left discouraged.

The one upside was that I insisted she at least ask Aetna what our options were.

I got a message today to go ahead and submit an appeal.

So now I need to write my appeals letter! Gulp. I feel so overwhelmed.

[majormajor]

i had a hospital birth with aetna, but i wanted to let you know that they routinely underpaid my claims. however, when i called, the people were usually very friendly and helpful, and re-routed the bills to be paid properly. (i haven't read through your responses so sorry if this has already been touched on). if you happen to get a rude person, just say thanks anyway, hang up, and try again. it's much easier that way!

ok that's all i have to add. good luck!

[Molck]

We have PPO, in CA. Baby's not due until Spring, so we'll see what actually happens, but our MW called to see what they'd cover, and they said 70%.

She also said they were OK with homebirth. Strange. All their literature says they don't cover homebirth, as far as I've seen. I'd be happy with 70%, happier with more, so we may fight to see what we can get.

[Baby Hopes]

I've read the correspondense my Dh's HR dept has had with Aetna and they clearly mention "homebirth." In fact Aetna's response to our HR lady is titled something like "Homebirth covered as in-network." Inside their body of text is where they say I need to submit an appeal. Although, they do say that I should have done this pre-certification BEFORE the baby arrived. (I didn't because I was hoping I would luck out and they'd just pay it. lol.) There is no "anti-homebirth" wording and my first impression is that they could care less that it was a homebirth, but rather I would have taken care of this before the baby arrived. :

[ktmama]

I'm in CO and my 2005 homebirth was covered 60% by Aetna as an Out of Network provider. MW billed them for pre and post natal care only I think. I guess that means I got my birth for free!

[gabeyho]

hope this sin't too late!

I homebirthed with Aetna about 3.5 years ago. I did it in CA with a CNM, RN. We were out of network and my mw billed through the physician with which she was affiliated, or however that worked so she could make referrals and such to labs. Anyhow, we just paid our deductible and she billed and received payment from Aetna pretty fast.

Interestingly, a few months later when I contacted Aetna about the new plans for open enrollment I asked about homebirth coverage since I had moved and was now in network and was told that it was never covered. When I told them that I had just had one and that my midwife had received payment, they about flipped a lid but there was nothing they could do since she had already been paid. I would imagine that the difference between being covered and not would be how Aetna is billed, and being in or out of network. Out of network I had many more services and almost no restrictions available to me from pretty much any care provider I wanted to see. My midwife told me that she had no problems receiveing payment from Aetna in the past, so good luck!

Hope this helps someone!

[Sol_Solved]

Thanks for all the info! Now that I'm actually pregnanct and we're about to switch to Aetna this is worrying me even more, especially since it'll be in NY.

[SusannahM]

My midwife billed each appointment, the vaginal delivery fee, the after-appointments, etc. I had a deductible of $2000, I think. The claims covered that plus an additional approximately $2500, so the birth was almost free. If I'd started going to her at the beginning of the pregnancy, I'm pretty sure it would have been free, since I would have had more appointments to bill.

It probably depends on a lot on *how* they bill. If anyone wants to PM me, I can pass on the info for the billing lady my midwife used, and I think her fee was only $125 to bill, which came out of the money the insurance paid out. I'm assuming she was very good, because she got a lot of money out of them. All the midwife had to do was turn over my file to her, she figured out the appointment dates and what to bill from all the papers in the file.

[~minnow~]

Originally Posted by Sol_Solved

Thanks for all the info! Now that I'm actually pregnanct and we're about to switch to Aetna this is worrying me even more, especially since it'll be in NY.

Congrats on your pregnancy! You are going to be on Chickering, right?

I'm in IN. I had my homebirth on Sept. 20. Just now I got a check in the mail. The birth was billed at $1850. Minus my deductible ($500, grr), then paid at an out-of-network rate (they cover 50%), so I ended up with a check for $675.

Not as much as I'd hoped, but more than I'd feared, since "officially" they don't cover it.

[Sol_Solved]

Yes, I'll be with Chickering. We're moving this month so I'm not really looking forward to this new insurance thing, but oh well.

Thanks for the info!

ETA: does anyone know if universities fit into the "self-insured" thing? We're getting insurance through DH's job, but he'll be a postdoc at a university, so I'm not really sure how that works out.

[papschmitty]

I have Aetna and usually the coverage is awesome. It even covered my infertility treatments! I just kind of assumed that it would cover homebirth but after reading this thread, I'm worried! I found this policy statement on their general website. I would LOVE to find out which states mandate coverage for homebirth. I'm in WA, I know our state-sponsored health insurance (medical coupons) covers homebirth but I have no idea if it's because it's mandated or not. I'm not pg yet but home to be soon and really wanted a homebirth this time!

Clinical Policy Bulletin:
Home Births


Number: 0329


Policy


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.

See also CPB 127 - Home Uterine Activity Monitoring.




Background
According to the policy statement on home delivery of the American College of Obstetricians and Gynecologists, labor and delivery, while a physiological process, clearly presents hazards to both the mother and fetus before and after birth. These hazards require standards of safety which are provided in the hospital setting and cannot be matched in the home situation. The Guidelines for Perinatal Care published by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists state that the hospital, including a birthing center within the hospital complex, provides the safest setting for labor, delivery, and the postpartum period. The use of other settings is not encouraged. Further, any facility providing obstetrical care should have the services listed as essential components for a level I hospital. This includes the availability of blood and fresh-frozen plasma for transfusion; anesthesia, radiology, ultrasound, electronic fetal heart rate monitoring and laboratory services available on a 24-hour basis; resuscitation and stabilization of all inborn neonates; nursery; and other services that are not available in the home setting.


CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes not covered for indications listed in the CPB (not all-inclusive):
59400 - 59430
59510 - 59525
59610 - 59622
99199
99432
HCPCS codes not covered for indications listed in the CPB (not all-inclusive):
G0154 Services of skilled nurse in home health setting, each 15 minutes [not covered for planned deliveries at home]
S8415 Supplies for home delivery of infant
S9123 - S9124, T1000 - T1003, T1030 - T1031 Nursing care in the home [not covered for planned deliveries at home]
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
640.00 - 677 Complications mainly related to pregnancy, normal delivery and other indications for care in pregnancy, labor, and delivery, complications occurring mainly in the course of labor and delivery, and complications of the puerperium [not covered for planned deliveries at home]
V22.0 - V24.2 Supervision of pregnancy and postpartum care and examination [not covered for planned deliveries at home]
V27.0 - V27.9 Outcome of delivery [not covered for planned deliveries at home]
V30 - V39 with 4th digit 2 Liveborn infants according to type of birth, born outside hospital and not hospitalized [not covered for planned deliveries at home]



The above policy is based on the following references:
Bastian H, Keirse MJ, Lancaster PAL. Perinatal death associated with planned home birth in Australia: Population based study. BMJ. 1998;317(7155):384-388.
American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). Guidelines for Perinatal Care. 5th ed. Elk Grove Village, IL: AAP; 2002.
American College of Obstetricians and Gynecologists (ACOG). Statement on Home Delivery. Washington, DC: ACOG; September 1999.
American College of Obstetricians and Gynecologists (ACOG). Home births double risk of newborn death. ACOG Press Release. Washington, DC: ACOG; July 31, 2002.
Pang JW, Heffelfinger JD, Huang GJ, et al. Outcomes of planned home births in Washington State: 1989-1996. Obstet Gynecol. 2002;100(2):253-259.
McKenna P, Matthews T. Safety of home delivery compared with hospital delivery in the Eastern Region Health Authority in Ireland in the years 1999-2002. Ir Med J. 2003;96(7):198-200.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Home births. College Statement. Statement No. C-Obs 2. East Melbourne, Australia: RANZCOG; November 2006.





Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
CPT only copyright 2006 American Medical Association. All Rights Reserved.
Copyright 2001-2008 Aetna Inc. Web Privacy Statement | Legal Statement | Privacy Notices | Member Disclosure


Policy History Last Review: 06/26/2007
Effective: 04/20/1999
Next Review: 04/24/2008
Review History
Definitions Additional Information Clinical Policy Bulletin Notes

[papschmitty]

Good News!

I was digging through our Aetna plan specifics and I found this:

Maternity care is covered if provided by:
a physician or registered nurse whose specialty is midwifery; or
a midwife licensed by the State of Washington.
Covered maternity care includes:
complications of pregnancy or delivery;
hospitalization and delivery, including home births and licensed birthing centers for low-risk pregnancies;
postpartum care;
pregnancy care;
related genetic counseling when medically necessary for prenatal diagnosis of congenital disorders; and
screening and diagnostic procedures during pregnancy.

I wonder if WA mandates coverage or if it's just that my plan is so good.

[nashvillemidwife]

I love a lot of experience with Aetna. Of course YMMV.

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.

There is only one CPT code for billing for global services, it's not even possible to differentiate a home birth procedure. However, the diagnosis codes that must be given for the procedure are for "baby born in hospital" and "baby born out of hospital". You can't tell them the baby was born in the hospital in order to get payment. That's insurance fraud.

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.

This is actually not conflicting information. Paying for services and paying for providers are separate issues. For example, of course insurance is going to pay doctors. Physician is a class of provider. If you break your arm and go to the family doctor for an x-ray and a cast, those are services that insurance is going to pay for. If, while you're there, you ask for a Botox injection and laser hair remover, they're not going to pay for that because those are services that aren't covered under your policy. Home birth is a special service that is not covered.

There are more midwives in this country working in hospitals than doing home births, so it's completely understandable that they cover midwives as providers but not home birth as a service. I've never known them to care whether the midwife was a CNM or CPM. They just wanted a license number, or now an NPI.

I've also never known them to say they'll only pay for midwives at out-of-network rates. Like any other insurance company, they pay in-network providers at in-network rates, out-of-network providers at out-of-network rates. Most home birth midwives are going to be out-of-network so that's not some kind of penalization for choosing a midwife, that's just how all insurance works. If you happen to find a home birth midwife who is in-network, they are going to pay her in-network.

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.

As lots of others have already mentioned, what they say to patients is not what they practice. I always bill the global fee anyway, and in my experience usually they just pay it. Maybe because they are only looking at the service performed and glossing over the diagnosis code that reveals it's a home birth. I suspect they pay it because they know it saves them money, and that's the bottom line.

If they deny the global fee I immediately re-bill itemized fees for every other service I performed for the client, and it is not unusual for these claims to equal or even exceed the global fee. They then pay it, usually no questions asked. This thread is the first place I've ever seen it mentioned that they don't pay for prenatal or postpartum care if you have a homebirth. In fact, they have specifically told my patients they will.

When talking to your insurance company first ask what your maternity benefits are; usually their answer will give you in-network and out-of-network rates, but if they don't then ask them if there's a difference. Don't even bother to ask them about home birth, but ask if they cover midwives.

You can never know for sure what or how much they will cover until they actually process the claims, but the answers they give to those questions are generally pretty reliable.

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?

State law, not federal. I can't remember which states specifically, but very few.

I don't mean to come off as a know-it-all, but these have been my direct experiences with Aetna and I've had quite a few of them. And again, your mileage may vary.