My husband and I have been through a whirlwind of change in the past week.. going from the decision to deliver at a hospital with an OB from a large practice; to a water birth in a privately owned Birth Center attended by an OB, family practioner and midwife.  Everything was falling gracefully into place for us, UNTIL the insurance.  Because the Birth Center is not an in-network facility, and "Maternity care is available at an HCA (in network) hospital within a 30 mile radius", insurance will only cover 25% of the facility fee.  They don't care that the birth center is the only place to offer water birth (among the other countless reasons to use a birth center over a hospital).

NOT using the birth center is not an option for us...it's like giving a fat kid a chocolate, and trying to pull it back out of their mouth.  We are not giving it up. 

 

Anyone have any suggestions on how to go about an appeal?  Our insurance is Aetna PPO in Virginia.  Looking for some advice on the right things to say to get this pushed through.  My EDD is April 30th.

 

Thanks!

 

 

Tags: Aetna, birth, center, copay, coverage, insurance, water

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We are dealing with a simmular kind of situation.  We live at least 100 miles from any facility and our insurance only covers deliveries at the two hospitals in the area.  There is a birth center close to both hospitals that I was interested in, but I didnt think we could afford it.  After talking to the midwife she said that many mothers whos insurance wont cover care at the center apply for pregnancy medicaid and that is how they get it covered.  This isnt something I would normally want to do, but  I think it is the best thing I can do for my safety and the safety of my baby.  That may be a route to check out.

thanks Mel - I'll definitely look into it!

 

Good Luck to you!

So, we have Aetna PPO as well.  And they told us our homebirth would not be covered when we called.  We were all geared up to pay $3400 that we really didnt have and post-birth, boom, they paid.  No clue why.  But we are thrilled!!!  My MW says they will pay if there is anything unusual about your delivery.  But if it goes completely normal, then they dont (even if you just have slightly elevated BP).  haha.  Delusional right?  But I ended up tearing pretty bad and needing a bunch of stitches, plus I couldnt stop bleeding and was given pitocin, followed by cytotec.  So, not a perfectly "normal" delivery.  But we really dont know why they ended up paying.  But were pretty thrilled and dont want to rock the boat by asking!

 

P.S. we live in MD.  and our baby was born in DEC.

 

GOODLUCK!!!  I hope they will pay!!!!

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