Insurance Coverage/Reimbursement
I am at at 29 weeks and will be having a home birth using a certified midwife. I have insurance coverage with Aetna and am trying to navigate my way through their system to figure out how much they will cover/reimburse me for. Have any of you successfully dealt with Aetna or any insurance company for that matter with this issue? When I have called to discuss with them, they keep asking me what the medical necessity is for a home birth, so I don't quite know what to say to them or if they use this question as a way of getting out of paying anything?
Replies to This Discussion
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Permalink Reply by Kathy Boyer on -
My understanding is that Aetna has a "no homebirth" policy. If most of your care is in your midwife's office, you may be able to bill as the place of service for the entire global fee (59400) as in office, not at home, and maybe they'll pay that way. Good luck! Insurance is ridiculous!
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Permalink Reply by Reese on -
Hi. I am also having a homebirth and have Aetna. I have never called them because it also my understanding they have a no homebirth policy. I didn't want to put myself "on alert" with them! :) My midwife will simply bill when everything is said is done with the appropriate codes that she has used in the past and from there we'll simply cross our fingers and hope we get reimbursed. I was going to do a homebirth regardless of whether or not insurance would cover any of it so if they do that will just be even better. A girlfriend of mine birthed with my midwife and I believe her insurance company covered it some months later at 60% (and I think this was Aetna). I rationalized that by the time I paid all my "co-insurance" payments (which I did with my first child) on all the different hospital procedures I was approaching a great deal of money anyhow. Good luck!
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Permalink Reply by Sarah Atondo on -
I have Blue Cross Blue Shield and they told me they cover 70% of everything as long as it is a CNM. It can't be a CPM. They were actually really nice about it, didn't ask any questions or give me any crap about it, which I was totally surprised about.
When I weighed the cost of what it would cost me to have the baby at home or at the hospital...the hospital ends up costing me about $300 more than a homebirth.
I am having my baby at the hospital unfortunately...it's a long, complicated story, and I'm not happy about it, but anyway I just thought I would let you know what I learned when I was trying to figure out what would happen with my insurance either way. Good luck...and I hope you have a safe, happy and wonderful homebirth!!
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Permalink Reply by Erin Buxton on -
I struggled for 6 months to get coverege by Cigna but finally got it covered. First, if you have coverage through an employers, get them involved. In our company, they have a Benefits Advocate who has a direct contact at the insurance company so that you don't end up with a different person and different answer each time. My advocate didn't fight as well for me as I hope as they didn't seem to think it was an option I should have. I also worked with senior management to pressure the benefits group to fight for me. It was a luxury to have that support but you'd be surprised how fast they jump on it when they realize that home birth is cheaper.
The other major thing was the concept of a "gap exception". My midwife told me about this and who it helped many of her pateints get covered. The trick is to prove that they didn't give you an option of a specialist in the plan so you had to go out of network. I had a United Heathcare EPO plan so you only could pick in-network doctors unless you could prove they didn't offer a specialist in your area and get a gap exception. I read the rules in my policy and home servies were covered and allowed. I asked specifically if there was anywhere in the policy that prohibited home birth. They weren't able to find anything and neither was I. So even though midwives were in network and in my area, I called each midwife to confirm that they didn't do home births. So I argued, well, I want a home birth, home services are covered by the plan, and no doctors/midwifes offer home birth services. Therefore, you have to cover my midwife with a gap exception. In the end, they covered 95%.
Good luck!
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Permalink Reply by Kacey Elkins on
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Erin-
Thank you so much for your advice. Because of your suggestion, I was able to get my midwife added as an in-network provider, so now they are going to cover her at 80%. Thank you so much!!!!!!!
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