Gap exception in NJ for home births under Aetna insurance. - Mothering Forums

 
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#1 of 4 Old 07-08-2014, 07:48 AM - Thread Starter
 
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Gap exception in NJ for home births under Aetna insurance.

I've been reading a lot on here about gap exception and some people have had success and others have not. Before I found out about gap exception I called my insurance (Aetna POS) and ask if they cover home births by CPM's ad instructed by my doula. They said they cover anything out of network 60% with $1000 deductible. Now I want to find out more about the gap exception and I'm not sure how to go about it. Has anybody had luck in NJ with it? Do I call and ask the insurance about gap exception or just submit paperwork for it without asking? I will be submitting all necessary paperwork myself unfortunately my midwife does not do it. She is licensed in NJ as a certified professional midwife, is that the same as a CNM? Basically I need step by step instructions on what to do and what to say so I don't look like a complete idiot when they start using medical jargon that I don't understand on me. Should I start doing this now or after the baby is born? If anybody could help me I would really appreciate it, or steer me to the appropriate threads in this forum. Thank you.
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#2 of 4 Old 11-29-2016, 06:22 PM
 
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Did you ever figure out the billing?

Hi,

I know this was awhile ago, but I'm hoping you will see this! Did you have any success getting your Homebirth covered? Did you try the gap exemption?
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#3 of 4 Old 12-01-2016, 08:43 AM
 
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Originally Posted by pockketz View Post
I've been reading a lot on here about gap exception and some people have had success and others have not. Before I found out about gap exception I called my insurance (Aetna POS) and ask if they cover home births by CPM's ad instructed by my doula. They said they cover anything out of network 60% with $1000 deductible. Now I want to find out more about the gap exception and I'm not sure how to go about it. Has anybody had luck in NJ with it? Do I call and ask the insurance about gap exception or just submit paperwork for it without asking? I will be submitting all necessary paperwork myself unfortunately my midwife does not do it. She is licensed in NJ as a certified professional midwife, is that the same as a CNM? Basically I need step by step instructions on what to do and what to say so I don't look like a complete idiot when they start using medical jargon that I don't understand on me. Should I start doing this now or after the baby is born? If anybody could help me I would really appreciate it, or steer me to the appropriate threads in this forum. Thank you.
This is what I know, I am in the same boat. I am in NY state.

Apply for gap the month before your due date.
CPM is NOT the same as CNM.
Do call your insurance all the time, write down medical jargon, ask the meaning, get reference number for call and name of person you spoke to.
HB midwives are usually NOT in network and that is a good thing, they can get paid more that way if they get the exception. I have United and what I am hoping is to get the out of network exception and get 90% covered after my in network deductible.
Good luck!


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#4 of 4 Old 12-01-2016, 08:45 AM
 
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Originally Posted by Jess2boys View Post
Hi,

I know this was awhile ago, but I'm hoping you will see this! Did you have any success getting your Homebirth covered? Did you try the gap exemption?
Yes you should have success having at least a part of your HB covered. I am working on it myself, find out your deductible, coverage and rules about the exception.


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