Any Luck Getting Aetna to Cover a Homebirth

[SparklingGemini]

I KNOW their policy states no homebirths but I would really like to have a homebirth this time around. My hospital birth was extremely traumatic and now that my DF sees how horrid it was for me, has agreed with a homebirth.

However, we absolutely do NOT have the funds to cover a midwife's care and homebirth without at least being partially funded from our insurance.

So, I searched and see that some people have had some luck but I am wondering if anyone has had luck more recently? Or is attempting it in the future?

Any info is, as always, greatly appreciated!!!!

[nashvillemidwife]

I have had good luck getting them to pay. They will always tell you "no", so I don't know why it slips through the cracks. I've also been paid fantastically for prenatal and postpartum care when I did not attempt billing for the birth. However, this was before they re-issued their policy, so I don't know what to tell you, other than you will never get them to agree to it so you won't know until after all is said and done whether they will let it slip through or not. Pushing the issue is only likely to get your account flagged and ensure they won't pay.

[annanicole]

Originally Posted by SparklingGemini

I KNOW their policy states no homebirths but I would really like to have a homebirth this time around. My hospital birth was extremely traumatic and now that my DF sees how horrid it was for me, has agreed with a homebirth.

However, we absolutely do NOT have the funds to cover a midwife's care and homebirth without at least being partially funded from our insurance.

So, I searched and see that some people have had some luck but I am wondering if anyone has had luck more recently? Or is attempting it in the future?

Any info is, as always, greatly appreciated!!!!

I had my baby with a midwife at a birthing center and Aetna covered it 100%. Also if I would have been local to the area of the birth center my midwife group said they could get aetna to pay for a homebirth too. Since there's no difference in their billing between home and birth center.

[Sarah8Jane]

Haven't been fighting Aetna, but thought I'd add a suggestion.

Is it possible that they will cover midwife fees but not homebirth supplies (birthing tub, transportation of supplies, etc.)? You might be able to argue from that angle if they pay for midwives in hospitals/birthing centers. Also, seems like several months ago someone's husband got their insurance company to pay by explaining that home birth was cheaper than hospital.

[MamasBoys]

They paid mine in 2005 80-90% under Washington state's "every category provider" law. They initially declined but my MW fought them on it.

[pamamidwife]

I've been paid everytime I've billed.

[Bayleesan]

Wow...from what I udnderstand through trying to get my chiropractic care covered, that unless the care provider is "In Network" they will not cover it. This may be due to the fact that we have an HMO vs a PPO plan with them, which provides for no out of network care. How has this been addressed?

[pantufla]

Originally Posted by MamasBoys

They paid mine in 2005 80-90% under Washington state's "every category provider" law. They initially declined but my MW fought them on it.

They refused to pay us and I was in no shape to fight them on it. This law only applies to state-funded insurance, and ours is self-funded (through DH's employer). They will pay for my prenatal care and post-partum care, but not the actual birth at home.

[nashvillemidwife]

Originally Posted by Bayleesan

Wow...from what I udnderstand through trying to get my chiropractic care covered, that unless the care provider is "In Network" they will not cover it. This may be due to the fact that we have an HMO vs a PPO plan with them, which provides for no out of network care. How has this been addressed?

Yes, it's because it's an HMO. PPO plans pay me every time.

pamamidwife, I've always been paid too, but I'm wondering if they put out a crack down when they re-issued their policy statement last month.

[Lit Chick]

I paid out of pocket (2K) and after the birth I sent in a claim and got $1,700 back. I was shocked.

They told me "no" as well - but I have seen other posters say that it is illegal for them to ban midwifery care (so long as MWs are legal in your state). We had a PPO though.
Good luck.

[nashvillemidwife]

Originally Posted by Lit Chick

I have seen other posters say that it is illegal for them to ban midwifery care (so long as MWs are legal in your state).

Sigh... this is only true in states that have "any willing provider" laws, and that only means the companies are required to contract with them, not pay out-of-network.

[pamamidwife]

Originally Posted by nashvillemidwife

pamamidwife, I've always been paid too, but I'm wondering if they put out a crack down when they re-issued their policy statement last month.

I'm not sure - it would be interesting to see what happens.