Aetna vs. Blue Shield for homebirth?

[tamagotchi]

We are planning a homebirth in October. It's now open enrollment at my DH's work and we can choose between Aetna PPO or Blue Shield PPO. The details of the plans are pretty much equivalent. We are in northern California if that makes any difference. Any suggestions / experience? Thanks!

[tamagotchi]

Ok, I guess I'll just ask my midwife what she thinks then, and go by that

[pamamidwife]

Aetna has a no homebirth clause policy.

BCBS does not.

[kristinc]

i much prefer bcbs to all others both from a patient's perspective and a health care providers perspective (as i am both). bcbs pays quickly and you don't usually have to fight them to pay claims. hope this helps.

[~Megan~]

Check with them because Blue Shield and Blue Cross rent out their names. Their policies are not the same from state to state.

[tamagotchi]

Thanks for your replies!

Originally Posted by pamamidwife

Aetna has a no homebirth clause policy.

BCBS does not.

The insurance laws in our state require insurance companies to pay for homebirths here, though. I asked my midwife and she thinks they are about the same but she is going to look in her records and get back to me.

[Defenestrator]

It is my understanding that in states where insurance companies have to pay for homebirth that Aetna reimburses very well.

They were *almost* willing to pay me as an in-network provider and do the paperwork to provide an in-network waiver for one of my couples, until they found out that I was in Michigan, where midwifery is not licensed. At that point they refused to pay at all.

[lyttlewon]

Originally Posted by tamagotchi

Thanks for your replies!


The insurance laws in our state require insurance companies to pay for homebirths here, though. I asked my midwife and she thinks they are about the same but she is going to look in her records and get back to me.

Please check with your insurance commisioner because Aetna is not required to cover me and could ignore my state laws because my company is self insured. They may pay once submitted but I am not betting on it.

[Rockies5]

Originally Posted by pamamidwife

Aetna has a no homebirth clause policy.

BCBS does not.

Pam you keep saying this about Aetna.

Be aware this doen't mean Aetna won't cover your homebirth. Mine was covered 100%. I have Aetna open access EPO which states it does not cover out of hospital birth. I was told 100x that they would not cover it, but I MADE THEM. It depends on which type you have, and the exact agreement they have with your employer. Itt took about 25 phonecalls and 5 months, but I'm glad we did it.

[pamamidwife]

Oh, I've been paid by Aetna twice, but this is not always the case and I wouldn't ever count on it. They are one of three specific health insurance providers to state they will NOT pay for homebirth. I consider the payments I did get to be flukes.

I am interested in what you did - no matter the phone calls that I've made, my clients have made, etc, have resulted in payment. The ones that we quietly just submitted "just to see" were the ones that were paid.

I would never count on payment and choose a plan based on that hope that I *might* get it covered. In a situation where it would cover me, I'd choose that policy. But especially if they tell you or your provider ahead of time that they will NOT pay for it, that is typically the last word in going back to the phone recordings.

[katie9143]

even though i ended up having to have a hospital induction, my hb mw that did all my pre and post natals and who was with me in the hosp too ended up getting about 25% of her fees refunded to be through the bcbs ppo. i had aetna and then switched when i read their no hb clause....seemed pretty cut and dried with their anti hb policy!