Aetna stopping coverage???

[ee_lime]

I just came across this....
http://www.gentlebirth.org/archives/homsafty.html

WARNING!!! If you have Aetna health insurance, you may want to change at the next opportunity, when your employer has their annual "open enrollment". Aetna doesn't cover homebirth, citing a single study based in rural Australia which shows that high-risk births far away from a hospital are high risk. They further cite the policies of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, both business competitors to homebirth providers. Their policy statement ignores a mountain of evidence that homebirth is as safe as or safer than hospital birth for normal, healthy pregnancies.. If their policymakers have any integrity, this logic will soon lead to cessation of coverage for planned VBAC's . . . there's no dearth of studies and AAP and ACOG policies proclaiming the danger of VBAC's . . . and then they'll stop coverage for any woman who declines standard ACOG/AAP recommendations regarding routine ultrasound, routine induction, routine IV's, routine use of continuous electronic fetal monitoring, routine administration of antibiotics for all GBS positive women (up to 40% of birthing women), and prompt cesareans for any woman who fails to progress in a timely fashion during labor and pushing. They may also stop coverage for children who are not vaccinated according to the full schedule of vaccinations recommended by the AAP, even though many intelligent parents decline the newborn hepatitis B vaccine and practice selective vaccination according to their child's own needs.

If this is troubling to you, as it should be, let them know. You can easily send e-mail to Aetna's National Media Relations Contacts and simply tell them that they should not be in the business of denying coverage for reasonable healthcare choices, such as homebirth, waterbirth and VBAC. They will especially want to know if you are choosing another health insurance provider because of this unreasonable policy. You might also suggest that they expand their research beyond ACOG and AAP recommendations. They could start at: http:

This worries me now because I am planning a homebirth with a midwife for dc2 in early may. I was going to submit my bill for reimbursement after the birth. I thought I had nothing to lose besides not being reimbursed, but this seems to say that Aetna can cancel your insurance??? yikes!!!! If that is true then it doesn't seem worth it to try to be reimbursed. kwim?

Does anyone know anything more about this?

[Kidzaplenty]

No answers, but sure would love to find some more facts if anyone has some.

[nashvillemidwife]

i believe that information has been posted there for a very long time, and aside from stating their home birth policy, everything else is only one person's speculation.

[Gilby]

Does that not mean that they will stop coverage of the actual birth and not your entire plan? I don't believe that health insurance companies are sent information about what procedures are declined, they are billed itemized lists with procedures performed, are they not?

I know many people who have had their births covered, some who were declined and others who had their prenatal covered but not the birth.

I plan to file but not mention that it is a homebirth. Simply bill for midwifery services and hope to have the prenatals covered at the very least.

There have been threads about aetna in the past if you did a search.

Hope your birth goes well!

[alegna]

If it's insurance through a company (ie not an individual plan) they can NOT legally stop coverage for any of those reasons.

-Angela

[nashvillemidwife]

As far as billing, there is one procedure code for vaginal birth and does not specify location. However, you must submit diagnosis codes for each procedure, and those diagnosis codes are very specific ("baby born in hospital" or "baby born out of hospital"). They won't process it without the diagnosis code, and to use the in-hospital code when the baby was born at home is insurance fraud.

The passage quoted above is imaginative speculation, that if Aetna can get away with not covering home birth they will start applying that to other procedures they don't want to cover until it gets all the way down to denying you a policy. This is a slippery slope argument intended to stir you to action. Logical perhaps, but not realistic.

Insurance companies do not have to pay for outcomes resulting from going against medical advice. For example, if your un-vaccinated child gets whooping cough after you have declined vaccinations against medical advice, insurance can deny payment. However, most doctors (especially ones that will see your un-vaccinated child) are not going to be so petty as to make such a big deal out of it. You can appeal and likely win with a second opinion. I wouldn't worry about it.

[nashvillemidwife]

Forgot to point out that since the diagnosis code denotes "baby born out of hospital" they could take that to mean birth center and not be an issue. This assumes, of course, that they haven't changed and added another home birth diagnosis codes (those darn things are changing all the time).

[kltroy]

That article is very speculative. We have Aetna and I'm planning a VBAC, so I checked. Aetna does have a policy on their website that basically says "we think hospitals are where babies should be born". Stupid, but as a private company I guess what they decide to cover is their business. There is NOTHING on their website regarding VBAC, GBS etc etc. They cannot cancel your policy because you do something that is not covered. They may choose not to reimburse, but that's all they can do.

[Kidzaplenty]

This is all very interesting. We have had Aetna for years. I have had several different OBs with no problems, however, I do UC, so never really tested the homebirth or refusing treatment stuff. But I don't vaccinate my children and our pedi's know this. Never had a problem with them denying anything. But then again, I am probably just living below the radar and not making too many waves for them to notice.