Even though Aetna claims not to cover homebirth, they should still pay the unbundled prenatal and postpartum care, which are not technically homebirth services, even if provided in the home.
http://www.gentlebirth.org/archives/preApproval.html
http://www.insurance.wa.gov/publicat...ve_Health1.pdf Page 6
http://www.aetna.com/cpb/data/CPBA0329.html
http://www.mothering.com/discussions...d.php?t=455253
http://www.mana.org/laws/laws_wa.htm
http://www.seattlemidwifery.org/action_progress.htm
1996: Washington State implements an unprecedented law requiring all health insurers and HMOs whose home base is in WA to provide access to all categories of health care "willing providers" who are licensed or certified by the state, including CNMs.
(from gentle birth)
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 healthcare provider because of this unreasonable policy. You might also suggest that they expand their research beyond ACOG and AAP recommendations.
Maternity Benefits Congenital Anomalies (Prenatal Testing) Mandated Group Offering RCW 48.46.375 WAC 246-680-020 The plan must cover prenatal testing for congenital disorders if it covers maternity 1. Carrier must determine medial necessity using the standards as set for by the Board of Health 2. Carrier may determine medical necessity on case by case basis if partner is carrier of genetic disease 3. Carrier may not impose restrictions which limit review for services to medical director determination only Contract Pg._______ Comments: Direct Access to Services WAC 284-43-250 Does the contract impose notification or prior authorization for receiving women's health care services unfairly: 1. Carrier may not impose a limitation on maternity services that would require all child birth to occur in a hospital 2. Carrier may not impose requirement which requires a physician to conduct a delivery 3. Carrier must cover medically necessary supplies of a home birth Contract Pg._______ Comments: Length of Stay Managed care Mandate RCW 48.43.115 ERIN Act PSHA 2704 Does the contract allow the health care provider in consultation with the mother to make decisions regarding care and length of stay in a hospital? 1. If length of stay guideline is stated must be no less than: 48-hour normal birth/96-hour caesarian section birth 2. The contract can not restrict follow-up care when ordered by the attending provider in consultation with the mother 3. The Carrier must provide notice to policyholders regarding this coverage yearly by January 1St . Contract Pg._______ Comments: Pregnancy PHSA 2701(d)(3) For group contracts there can be no pre-existing condition exclusion for pregnancy, no matter when pregnancy began and whether medical advice, diagnosis, care or treatment was recommended or received for the pregnancy. This contract may not contain a pre-existing exclusion for pregnancy even if the previous health plan did not cover pregnancy. Contract Pg._______ Comments:
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Pregnancy Discrimination Title VII of the Civil Rights Act EEOC Compliance Manual A plan may not unreasonably discriminate against pregnant women. Unreasonable discrimination includes: 1. Restricting travel during pregnancy including the 3rd trimester 2. Charging higher premium for care Contract Pg._______ Comments: Unfair Practices RCW 49.60.040(3) WAC 162-30-020 If the group contract is being sold to an employer who directly or indirectly employs either eight or more persons, does it include full health insurance
(from:
http://www.insurance.wa.gov/publicat...HMO_1-1-03.pdf) Page 11
Aetna says they do not cover homebirths except for when required by law. Well, washington law says they cannot mandate that all birth occur in a hospital or be attended by a physician. So, if there is no "in network" midwife to attend your birth OUTSIDE of the hospital, it stands to reason that they have to cover this midwife at least at out of network rates. Good luck.