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Homebirth with Aetna? - Page 4

post #61 of 73
Also, my last experience with Aetna was quite interesting.

The client called them before she even talked with us and they said they did not pay for home birth, so she never even said she had insurance. We ended up transporting her. After the birth she was talking to an Aetna rep about some other issue and mentioned her disappointment that home birth wasn't covered. When the lady learned that she had the baby in the hospital she told the client that since the baby was not born at home they would certainly pay for the midwife's other services.

This client came to us late so we had only 5 or 6 prenatals, but I spent 2 days at her house trying to induce her labor, then another 12 at her hospital induction and delivery. In addition to the prenatal and postpartums, I billed them an hourly fee for every waking hour I spent at her house that weekend and every hour I spent with her at the hospital. I also billed for reviewing and making copies of the medical records for my backup doctor, phone consultations with the backup doctor, phone consultations with the client, and a travel fee for every home visit. There was a bunch of other trivial stuff too like an extra charge for working on the weekend. These are all legitimate claims and there are CPT codes for them. I submitted over $11,000 in claims. They covered the full amount of almost every service, and when their paid their 70% of the claims I got over $7,000.
post #62 of 73
I think it depends on what type of Aetna coverage you maintain. When we initially called they said they cover CNM's but do not cover CPM's... My MW's medical biller is submitting her bills to both Aetna and my secondary insurance anyway to see what they're willing to cover....
post #63 of 73
Quote:
Originally Posted by nashvillemidwife View Post
Also, my last experience with Aetna was quite interesting.

The client called them before she even talked with us and they said they did not pay for home birth, so she never even said she had insurance. We ended up transporting her. After the birth she was talking to an Aetna rep about some other issue and mentioned her disappointment that home birth wasn't covered. When the lady learned that she had the baby in the hospital she told the client that since the baby was not born at home they would certainly pay for the midwife's other services.

This client came to us late so we had only 5 or 6 prenatals, but I spent 2 days at her house trying to induce her labor, then another 12 at her hospital induction and delivery. In addition to the prenatal and postpartums, I billed them an hourly fee for every waking hour I spent at her house that weekend and every hour I spent with her at the hospital. I also billed for reviewing and making copies of the medical records for my backup doctor, phone consultations with the backup doctor, phone consultations with the client, and a travel fee for every home visit. There was a bunch of other trivial stuff too like an extra charge for working on the weekend. These are all legitimate claims and there are CPT codes for them. I submitted over $11,000 in claims. They covered the full amount of almost every service, and when their paid their 70% of the claims I got over $7,000.
Wow! You are one smart woman! It's about time a midwife got paid for the amount of time and effort she puts into her clients!
post #64 of 73

2008 open enrollment - Aetna

We have Aetna through work. The open enrollment packet we just got in the mail stated that beginning this year "in home delivery" will be covered.

This is in washington state, so we may benefit from our laws that our generous to midwives.

Any way it's official here.
post #65 of 73
Sorry for reviving this old thread but I am about to submit my HB charges to Aetna...can anyone share the coding that worked for them?
post #66 of 73
Quote:
Originally Posted by mom2sol View Post
We have Aetna through work. The open enrollment packet we just got in the mail stated that beginning this year "in home delivery" will be covered.

This is in washington state, so we may benefit from our laws that our generous to midwives.

Any way it's official here.
I got a letter in middle of June that said as of May 31st HB will NOT be covered.
post #67 of 73
Quote:
Originally Posted by ee_lime View Post
I got a letter in middle of June that said as of May 31st HB will NOT be covered.
NAK
Now mind yuo, this is not Aetna saying this, this is a change in Costco's healthcare plan , but Aetna is the insurance company that Costco uses.
This is what it says:
"Healthcare Plan Exclusions
1.Home birth, including related supplies or services, is not covered.
2. Midwives are covered only when birth services are rendered in a network or PPO participating medical facility.
effective May 31, 2008"


I didn't even receive the letter in the mail until mid june.
My daughter was born May 10th 2008, so we beat the cutoff that we didn't even know about, but still
I have submitted my claim and it was denied the first time, they said it did noit have my name, my birthdate, service dates, service codes, diagnosis codes. I called the 800# and said that I need help because I thought (even though I knew I did everything correctly and completely) I had done everything correct but I guess I didn't, and asked what I needed to do different. The lady said, well we need your MW's tax id number, I said oh, ok here it is xxxx-xx-xxxx....(it was on the claims I sent in though). She said it is not a valid number. I called my MW to double check, it was correct. I called the 800# back, talked to a dfifferent person, he was very helpful, he explained that even though her number might be correct, it was not in their system and that my MW needed to complete a w-9 and fax it to them. He said for her to write a note along with it that it is for my claim # so that way my claim will be put back into action.

So my fingers are crossed !!
I will update whenm I hear more.
post #68 of 73
I just looked at my claim hopoing I could drill into my fax, but nope. And odd, the web lists it as "surgery". Whatever... LOL
http://www.icd9data.com has code listings.
I was a 1st timer, so my code was V22.0 (Supervision of normal 1st pregnancy).
V22.1 is Other normal pregnancy.

I am pretty sure that was the only code we used, but I could be wrong. I don't think we billed the delivery as a separate thing. Liveborn single infant born outside of a hospital and not hospitalized is V30.2. None of the V30s ring a bell for me so I think we just went with supervision. If I can find my orig document I'll report back.
post #69 of 73
Quote:
Originally Posted by ee_lime View Post
I got a letter in middle of June that said as of May 31st HB will NOT be covered.
Technically the letter said that as of May 31 out-of-network midwives will not be covered. The homebirth exclusion is a long-standing policy.
post #70 of 73
Quote:
Originally Posted by nashvillemidwife View Post
Technically the letter said that as of May 31 out-of-network midwives will not be covered. The homebirth exclusion is a long-standing policy.
It is more complicated than that. I have had a good record of payment with Aetna despite their policies and there are states where they are legally mandated to pay for homebirth. I have heard from more than a few people that they are good payers in those states.
post #71 of 73
like i said this letter was from costco benefits, not aetna....
but it said "effective may 31" "home birth....is not covered."
and
"Midwives are covered only when birth services are rendered in a network or PPO participating medical facility."
Quote:
Originally Posted by nashvillemidwife View Post
Technically the letter said that as of May 31 out-of-network midwives will not be covered. The homebirth exclusion is a long-standing policy.
I didn't see any in-network HB MW's in their list


whatever any of it means...lol...it is crap :
post #72 of 73

I have Aetna PPO.

Just wanted to say that I am in Tx and planning a homebirth with a CPM. Insurance co. in Tx are required by law to recognize any professional licensed by the state of Tx (which includes midwives) but they do not have to cover specific services such as homebirth. Some plans (your employers's choice) cover homebirth services.

I called before seeking care and they said the midwife I wanted would be covered at out-of-network rates (better than nothing!) but I asked if I could submit an in-network exception form because the midwife who is in network does not do homebirths, I figured it was worth a shot. They said the provider would have to submit the request.

Two visits to my midwife later and they say that I am actually the one who needs to call Aetna and submit the request. I call and they say I should have gotten approval before ever seeking care and that they could reject it on that fact alone. I told her I had called and the guy said I couldn't submit it. She made a note and I will find out in the next few weeks.

She also took the time to say "And you're INSANE by the way!" and then laughed. I thought about complaining just for that.

If I pay out of network I have a $1000 deductible and pay 40% after that. Normally it would be 30% out of network but midwifery isn't considered 'usual or customary' so they charge a different kind of percentage.

It pisses me off but at the same time I thought I might have to pay out of pocket anyway. I'm having my mw bill for as many services as could possibly apply for the most they can get. I've had two visits and already met 500 dollars of my deductible.

The best thing is we never use our insurance unless I'm pregnant, pretty much.:
post #73 of 73
Quote:
Originally Posted by Defenestrator View Post
It is more complicated than that. I have had a good record of payment with Aetna despite their policies and there are states where they are legally mandated to pay for homebirth. I have heard from more than a few people that they are good payers in those states.
They've always been a good payer to me too (not required by law), but that's in spite of their long-standing documented "no home birth" policy. I think their contradictory payment record has been well established here.

I have read the new policy statement (which doesn't say anything new, only quotes more recent citations). It does say home birth will continued to be covered where mandated by law (as if they have a choice).

What gets me is that all the studies they cite (except the Pang study, which the authors themselves note is flawed) show that home birth IS safe when it is planned, low-risk, and attended by a midwife.
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