Homebirth with Aetna? - Mothering Forums

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#1 of 73 Old 08-18-2006, 01:52 PM - Thread Starter
 
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I would love to hear other's experiences with Aetna paying part or all of the fees associated with a homebirth. Does the type of midwife you use make a difference? Thanks!

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#2 of 73 Old 08-18-2006, 10:41 PM - Thread Starter
 
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#3 of 73 Old 08-19-2006, 01:59 AM
 
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It matters how the midwife bills. I have not yet billed Aetna, but have worked with midwives who have. Billing as a "global vaginal delivery" (which includes the fees for ante- and postpartum) not a "home birth" will usually see some return, even with Aetna who has a statement against home birth.
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#4 of 73 Old 08-19-2006, 03:09 AM
 
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They said on the phone and in writing that they would not pay. Then they said they would pay at out of network rates. They ended up paying at in network rates, without us even having to argue with them. So I guess you just send a bill and take your chances.
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#5 of 73 Old 08-21-2006, 10:52 AM
 
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We are about to tackle this in the next few weeks. I don't have much hope for it since homebirth is exluded from coverage AND midwives are not able to be licensed in GA (although my mw is licensed in TN, which gives me a little hope). She isn't even bothering filing the actual birth, but is filing for prenatal care, a home visit, breastfeeding help, etc. We've already paid her in full, so anything that gets paid will come to us, which will be SO helpful right now. I know if it is paid, it will be out of network, but still anything is better than nothing. We're also filing for the rhogam and trying to file for flex dollars for our birth kit. I'll let you know what happens...

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#6 of 73 Old 08-21-2006, 02:47 PM
 
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They wouldn't pay for mine. I didn't bill them though because they just told me over the phone they don't do homebirths.

Expecting #9.  Always busy hsing.
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#7 of 73 Old 08-21-2006, 03:21 PM - Thread Starter
 
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I guess I'm confused because I did a search and found several posts on MDC saying that Aetna was very good about homebirth. Sigh.

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#8 of 73 Old 08-21-2006, 03:29 PM
 
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What matters the most is what your "Out of Network Provider" policy says, and how the midwife or billing service actually bills for it.
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#9 of 73 Old 08-21-2006, 03:31 PM - Thread Starter
 
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Quote:
Originally Posted by midwifetx
What matters the most is what your "Out of Network Provider" policy says, and how the midwife or billing service actually bills for it.
Ah. See I've heard that they say they won't but they do. And my midwife says she's had success in billing so that they pay some if not all. I guess it's sort of a crap shoot then.

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#10 of 73 Old 08-21-2006, 03:32 PM - Thread Starter
 
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Oh, and thanks all for your input. This is the first time we've homebirthed, so I have lots of questions!

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#11 of 73 Old 08-21-2006, 05:30 PM
 
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Yep, it's like just about any policy if you call and ask, "Will you cover my moon birth?" They will say no, moon birth is not a covered benefit and don't believe birthing on the moon is safe. But if you have a moon birth and your midwife bills simply for the care she provided while you were on the moon giving birth, they will almost always reimburse it. The facility, in this case the moon, isn't a network contracted facility
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#12 of 73 Old 08-21-2006, 06:17 PM
 
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I don't ask if they cover homebirth, I ask if they cover Out of Network Providers. The only insurance I've ever gotten guff from over the 'birthsite' was BCBS. Aetna paid the practice I work in very well last year for a couple of births.
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#13 of 73 Old 04-11-2007, 07:44 PM
 
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I'm in the middle of trying to have Aetna pay for my homebirth (or at least the prenatal and postpartum charges). It doesn't look very hopeful for me. However, I am planning on writing to them and suggesting they review their policies and cover homebirths with a licensed midwife attending. There is more informaton on a CA midwife's website (including email address of Aetna folks if you feel compelled to write them, too).

http://www.gentlebirth.org/archives/homsafty.html

Hopefully with enough of us complaining, the policy will be changed!
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#14 of 73 Old 04-12-2007, 12:12 PM
 
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My current midwife says that she has no issues with Aetna. And the 2 others that I interviewed said that they are one of the easiest to get to pay for at least a portion of the homebirth. I think it does matter how they are billed.

I did read that Aetna has a statement that they don't pay for homebirths, or births in a facility that isn't attached to a hospital. But apparently, if the midwife bills, you have a good chance at them paying.

They also refused some women u/s at the 20 week mark, and generally regular OB care does this as a standard of care. Basically, I was told that if they deny you, if you refute it, you have a better chance at getting it paid. Lots of people don't refute or even bother to try in the first place, and Aetna wins in that case.

Good luck!
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#15 of 73 Old 04-12-2007, 12:14 PM - Thread Starter
 
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Do you think it makes a difference what state you are in? I'm due any minute, and trying to think of the best way to tackle this.

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#16 of 73 Old 04-12-2007, 12:47 PM
 
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Aetna has a policy statement that they don't view homebirth as appropriate and therefore do not cover it, unless it is mandated by a certain state. (Their policy statement doesn't disclose which states, though...) You can find this online if you google for it. They cite that BS Australian study and some ACOG statements as their justification for not finding it appropriate.

I would NOT under any circumstances say the words "homebirth" while you are on the phone with Aetna, as they will flag your chart and will not pay. Aetna originally said they were paying for our prenatal midwifery care, and have since reneged on this, even though we have a letter stating they'd pay for it In-Network. My midwife is being asked to return the money they've paid her for my prenatal visits since they're now considering it a "related service to a planned homebirth."

Needless to say, we are appealing this. Aetna has gone from being what seemed like very accommodating to completely hostile. I can understand if they don't want pay the homebirth, but to not support midwifery either, when they say they do and told us they would, is just ridiculous.

Luckily, through a loophole with DH's work, we're going to be able to switch to another insurance provider, so the birth won't have to be billed to Aetna. Aetna will be getting a piece of my mind once this is all said and done.
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#17 of 73 Old 04-12-2007, 12:52 PM - Thread Starter
 
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I thought, though, that there was a federal law that basically said a woman can't be compelled to give birth in the hospital, and that insurance had to cover it as long as the care provider was legal in the state in which the birth occurred?

Thanks for the tip about not using the words "home birth" though. Now I'm wishing we had switched to Blue Cross Blue Shield, the other insurance provider we could have through the church. I'm guessing it's too late now since I was due yesterday, LOL!

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#18 of 73 Old 04-12-2007, 12:55 PM
 
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I had Aetna cover my homebirth 100%, and I had no out of network coverage and they don't cover homebirths??? It's possible, keep on them. Be polite.

I had a CPM

Carrie, The Birthteacher CCE and Doula, real mom to five; and womb-mom to G. born at 23w by emergency C. 12/09
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#19 of 73 Old 04-12-2007, 01:10 PM
 
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I am pretty sure it depends on what state you are in if they'll cover it. I think you need to find out what your state's insurance code says.

Here's what Aetna has to say:

Aetna considers planned deliveries at home and associated services not medically appropriate.

Note: However, provision of home births will be considered when mandated by law.

The other thing your midwife can do is bill it as generically as possible in the hopes that it just goes through.
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#20 of 73 Old 04-13-2007, 10:44 PM
 
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I started off by searching Aetna's network for a MW. None were listed. I was told that if they don't have anyone listed for a certain specialty, they have to cover as in-network whomever you pick.

My MW says Aetna is one of the easier ones for her to get money from.

She got pre-approval in advance.

Unfortunately, my husband's company is changing to Oxford as of June 1. So, we will have to do it again.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#21 of 73 Old 04-14-2007, 11:09 AM
 
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We've been told that our CNM will only be covered out of network since they do offer ONE other CNM in-network. (A CNM who does not do homebirths.) My Midwife, though, says that she's had success getting payments... so as it stands we're paying for our birth out of pocket and then will be happy with any reimbursement that we recieve.

If any.
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#22 of 73 Old 04-20-2007, 01:31 AM
 
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I sure hope they will cover our homebirth in TX... guess I need to check into it. Course I am not preggo yet- but hope to be soon. :-)

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#23 of 73 Old 04-20-2007, 04:35 PM
 
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I had (and now have again) a traditional midwife licenced in the state of MN. Aetna was so rude to me on the phone and absolutely denied that they would pay a penny toward a homebirth. Well, I got a check in the mail...
My midwife says they always say they won't pay but often do.

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#24 of 73 Old 04-20-2007, 06:34 PM
 
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Quote:
Originally Posted by annettemarie View Post
Do you think it makes a difference what state you are in? I'm due any minute, and trying to think of the best way to tackle this.
I called my states office for the Insurance Commissioner and they stated since my insurance is supplied by my employer it is considered self-funded and isn't required to follow state regulations. Which I guess is why state insurance will cover but not other insurance. I have been hesitant to call Aetna about it. I have heard both though that they will and won't cover it.

Ok so this is interesting I just called BSBC and they said it is up to my employer. Hmmm.
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#25 of 73 Old 04-20-2007, 08:55 PM
 
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I think basically it is up to the PLAN. Different plans cover different things.

But I was told that in NY they can't deny you a specialist if your plan covers specialists. And, if they offer no specialists of that type in your network, you get to pick one and have him/her approved.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#26 of 73 Old 04-22-2007, 08:42 PM
 
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Quote:
Originally Posted by Lady Lilya View Post
I think basically it is up to the PLAN. Different plans cover different things.

But I was told that in NY they can't deny you a specialist if your plan covers specialists. And, if they offer no specialists of that type in your network, you get to pick one and have him/her approved.

that is how we got ours covered. I checked their website yesterday and it offers conflicting advice. On one hand they state that it is "unsafe" but on the other they list midwives as care providers. Mine was billed (or coded) as "home health services" ( same code as hospice??) and 100% covered. It took over 5 months of phonecalls.

The best time to work this out is BEFORE you are pregnant.

I've found them to be great.

Carrie, The Birthteacher CCE and Doula, real mom to five; and womb-mom to G. born at 23w by emergency C. 12/09
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#27 of 73 Old 07-16-2007, 09:55 PM
 
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Bumping this thread up because I'm about to switch to Chickering / Aetna in a few months and I can't find enough information about this. My plan states clearly that:

A referral is not required for the following:

Obstetrical and gynecological services including:
– Maternity care;
– Treatment for acute or emergency gynecological conditions;
– An annual gynecological exam and any subsequent necessary obstetric or gynecological services provided by an obstetrician, gynecologist, certified nurse midwife, or family practitioner, as a result of the exam.

Please note: While a referral is not required for women’s health care, the Student Health Center has a gynecology clinic three days a week – routine exams and annual Pap smears are covered by the Health Center fee that all students pay. Also, for those students seeking maternity care or mammograms, the Health Center can offer suggestions about local providers. Services that are normally provided without charge by the Student Health Center or by Health Care Providers will not be covered when rendered outside of the Student Health Center.


Would this mean we'd have a chance of using a midwife and somehow billing a homebirth through that? I'm rather clueless about this all, and I want to decide if I should get pregnant while we have this insurance or wait three years for the next change. We'll be living in Albany, NY. Also, how much does a waterbirth/homebirth normally cost, if it's not covered?

ETA: there are three midwifes listed under specialists for our region in our plan.
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#28 of 73 Old 07-29-2007, 09:44 PM
 
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Anyone?
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#29 of 73 Old 07-30-2007, 02:10 PM
 
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We had to fight bitterly to get my prenatal care covered by Aetna. My prenatal care was provided by a midwife in TX. They wouldn't pay for it until they saw proof that I didn't have a homebirth. (I did wind up transferring to the hospital, so i guess it worked out.) Aetna sucks the BIG ONE. Luckily my husband's job let us change insurance companies and now we are with UHC. Much better, IMO. Be ready for hours on the phone with Aetna, lies, major BS and headache.

Please check out their policy statement--they do not think homebirth is medically necessary and therefore won't pay for it NOR any "related services," which was in this case, my prenatal care. :
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#30 of 73 Old 08-11-2007, 02:59 PM
 
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Thanks Bellita! I'm so worried about it. I'm not from US so I'm really not used to fighting HMOs or whatever. I'm hoping I'd end up with a midwife who's "been there done that" regarding Aetna and can guide me through the process because I feel quite lost, and I'm completely sure I want to try and have a homebirth.
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