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.