I hate Aetna... - Mothering Forums

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#1 of 12 Old 12-07-2007, 02:53 PM - Thread Starter
 
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Hi ladies. I just found out that my husband's company is switching from Premera to Aetna Jan 1st. Im due Jan 6th with my first baby. Of course Aetna does not cover my direct entry midwife that I've been with my whole pregnancy or my home birth. I'm kinda freaking out here.

There is NO WAY in HE77 Im changing care providers to a CNM (they dont cover DEMs but even if they didnt Im not changing anyway).

I'm not terribly worried about the Midwife's fee. If I have to pay the whole thing out of pocket it wouldnt be the worst thing that happened. Im pretty sure Premera is going to cover the predominance of the prenatal care since all but a week of my 40 weeks was on their plan.

What I am worried about is that if we HB and God forbid something happens and I have to transfer that Aetna will refuse to pay those fees because we had tried to HB.

I talked to my midwife and she said not to worry about it, but did confirm that Aetna was horrible and that I should do everything I can to not change to one of their plans.

Unfortunately that isnt an option.

Also, Im in WA state. Its so hard to get valid information but Ive heard that here in WA they have to provide access to every provider category. They have CNMs but no DEMs on their plans. Ive heard they have to cover my DEM at in network because they have no other options on their plan. The plan is not self insured. I've also heard that WA is one of the few states where Aetna will pay homebirth fees regardless of what they tell me on the phone. I've been careful not to give them my name and ask general questions.. we have also asked the broker who is no help whatsoever.

Can anyone share their experience with Aetna in WA? Or their experience with what would happen if I transfered while trying to do something they prohibit? Also, can anyone give any insite on how all this works when your pregnancy straddles a year like this? Optimally the baby will decide to make his or her arrival before the first of the year. I really feel like that is what is going to happen, but this whole thing has me rattled.

Thanks for any input you have and for letting me vent!
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#2 of 12 Old 12-07-2007, 03:13 PM
 
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I don't know about how an insurance switch would work with homebirth, but I switched insurance a couple of days before the hospital birth of my first and my original insurance paid all of my doc's fees. The entire thing was billed as a global fee, I think. The insurance that I switched to paid the hospital fees. I'm wondering if your midwife can just go ahead and bill for everything.
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#3 of 12 Old 12-07-2007, 03:20 PM - Thread Starter
 
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She is talking to her biller.. she did mention global fees but it just wasnt making sense to me as to how she could charge a global fee to both places.

Is that what you did? Global fee and then the insurance companies duked it out on what percentage each would pay?
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#4 of 12 Old 12-07-2007, 03:22 PM
 
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See if you midwife can bill heavy for prenatals for the rest of your time on the first insurance and then accept what they give her as her fee. Other than that try to negotiate a lower fee you can pay out of pocket or pay one month of Cobra on the old insurance and see if you can switch over to the new a month later.
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#5 of 12 Old 12-07-2007, 03:54 PM
 
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I'm actually not sure how it worked. The doc's office did the billing and they just told me it was covered on the old insurance through the 6 week visit. For the hospital we just gave them the new insurance and they took care of the rest.
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#6 of 12 Old 12-07-2007, 05:06 PM - Thread Starter
 
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Quote:
Originally Posted by homewithtwinsmama View Post
See if you midwife can bill heavy for prenatals for the rest of your time on the first insurance and then accept what they give her as her fee. Other than that try to negotiate a lower fee you can pay out of pocket or pay one month of Cobra on the old insurance and see if you can switch over to the new a month later.


Cobra doesnt work that way. It would switch over to the active plan, which would be aetna. We even tried calling Premera and paying the complete cost out of pocket to carry the insurance for the additional month. No go. My husband seriously thought of quitting so we could just carry cobra. He has had it with his company anyway. I am going to talk to my midwife about stretching the bill as much as possible on the Premera plan.
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#7 of 12 Old 12-07-2007, 09:51 PM
 
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You may also want to ask them if they have a Continuity of Care for 90 days. I am not sure about the laws in WA but out here in MD if your provider is becomes non par and they were previously par you can get a Continuity of Care authorization where you can use that provider for 90 as an in network provider even if they are non par with your plan. This is supposed to give you a window of opportunity to shop for a new provider with out loosing care with your current conditions. It should apply for switching insurances as well. It can't hurt to ask.

Livin' surf.gif Laughin' lol.gif Lovin' joy.gif - Just Me and Sammers, my homebirthin' little girl. 

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#8 of 12 Old 12-07-2007, 09:56 PM
 
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As for how your provider will bill the insurances, they would bill fee for service for the old insurance and then globally for the new insurance. Global charges are for delivery and the provider just lists how many prenatal visits they had. For the fee for service charges they just bill the office visits individualy. I don't know if both will pay globally if you only delivered under one.

Livin' surf.gif Laughin' lol.gif Lovin' joy.gif - Just Me and Sammers, my homebirthin' little girl. 

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#9 of 12 Old 12-08-2007, 04:48 AM
 
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I went around the bend with Aetna, I am in WA too. I called the insurance commisioner, load of information by the way you can just give them a ring, and basically if your insurance is privatly funded they cannot be forced to pay. My company pays my premium so it is considered privatly funded. I ended up asking for a review with Aetna and they said the birth would be covered in an ambulance during a transfer and in the hospital just not the actual midwife fees. It is possible if your midwife just submitted the charges they would pay. I paid for it out of my pocket. Worth every single penny.
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#10 of 12 Old 12-08-2007, 12:26 PM
 
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We have Aetna and duked it out with them. They paid for my non covered HB midwife before the birth. There is a difference between a HB and CNM and I just had to point that out, and get a referral from one of their accepted providers. I was denied twice.

I'm always hearing Aetna bashed, but I found them pretty reasonable if you know how to talk to them.

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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#11 of 12 Old 12-08-2007, 08:56 PM
 
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[QUOTE=HypnoMama;9943632]I'm not terribly worried about the Midwife's fee. If I have to pay the whole thing out of pocket it wouldnt be the worst thing that happened. Im pretty sure Premera is going to cover the predominance of the prenatal care since all but a week of my 40 weeks was on their plan.

The worst case scenario-which isn't as bad as it could be-is that Premera pays for your prenatal care but you pay for the remainder out of pocket.

What I am worried about is that if we HB and God forbid something happens and I have to transfer that Aetna will refuse to pay those fees because we had tried to HB.
Can anyone share their experience with Aetna in WA? Or their experience with what would happen if I transfered while trying to do something they prohibit?

Aetna absolutely, positively CANNOT NOT pay your hospital bill because of where you INTENDED to deliver.
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#12 of 12 Old 12-10-2007, 03:01 PM
 
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We have a version of Aetna and did a "don't ask don't tell." Althouh my homebirth CPM would officially not have been covered, we submitted the bill without asking for approval. They treated her like an out-of-network provider and paid 50 percent.
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