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Score One for the Underdogs…

2 March 2007

Over the past week, I have been having a battle of wills with Aetna HMO.  Now I finally get to announce a definitive victory for myself and any other woman covered by them during pregnancy who wants to do something besides get drugged up and give birth — probably via c-section — in a hospital.

I have always been interested in alternative options for birthing situations. I have NEVER EVER pictured myself getting an epidural and laying in a bed for 12 hours not eating and not being allowed to do whatever feels best to me as a means of bringing a child in to the world. For one, I’m just too darn stubborn. For two, the thought of a needle that close to my spine makes me want to vomit.  Quite some time ago, I heard about waterbirth and I had a feeling it would be the right thing for me to do one day. I’ll blog more about the specifics of that in another entry, but suffice it to say it is not real popular with the insurance/pharmaceutical/in-it-for-the-profit hospital folks.

The first time I called Aetna to ask them about coverage for a midwife (who are the only ones who will do that around here) and a homebirth, I was told they did not cover those services unless it was supervised by a doctor.  That defeats the whole purpose since (due to liability and malpractice worries) no doctor will sign off on a homebirth around here anymore.  Unfortunately for Aetna, I’m a determined pain in the butt.  A few days of research and many phone calls later, I miraculously have FULL coverage for my midwife and a home waterbirth — at the same rates I would have if I went to a regular OB and gave birth in a hospital. And every time I call Aetna they are exceedingly nice to me.  I still have to get my PCP to kick things off by submitting a request but Aetna has already told me that it will be approved as soon as it is received.  This, thanks to my newly found knowledge of Virginia law and insurance mandates.

Since I had such great results and my midwife has several clients who are on Aetna and had/have the same problems I did, she asked me to write something up that explains how I got them to cover me.  I’ll post that on a separate, non-blog page for permanent referral.  I hope I can help make this more accessible and affordable to as many women as possible because it should be a right to give birth however you see fit, not a privilege.

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4 Comments leave one →
  1. 23 March 2007 21:59

    Boy am I glad to have found you!!! Please put that information about Aetna up as soon as you’re feeling up to it. I’m 4 weeks now and am planning on a homebirth with a CPM. If we could make them cover even 60% I’d be soooo thrilled. Thanks!!

    Celeste Youngblood
    Winchester, VA

  2. 7 April 2007 15:05

    Well, I was hoping to have some updates by now but I am at a major impasse, mostly because I can’t figure out a way to get a referral from an OB or any other doctor. Since we’re getting married, we are going to have the opportunity to switch insurance to a non-HMO with better out-of-network benefits so I’m going to try that route instead. But, sometime this week I am still going to post the information I have on Aetna and what got me as far as I did with them so maybe it will help other moms.

  3. 29 March 2008 22:44

    Hey, I know you posted this a long time ago, but I’m looking into this exact situation and I’d LOVE to know what you did (even if it didn’t end up working!) Thanks!

  4. 6 April 2008 09:57

    I get questions about this a lot and I wish I had a successful outcome to report, but I was eligible for Tricare through Tim’s Reserve coverage, so we switched insurance and ended up not having to deal with Aetna.

    For the record on Tricare, they paid for EVERYTHING. My midwife visits, the homebirth (even though it ended up in a transfer) and the hospital, c-section and post-natal care with my midwife. They were awesome. I hope the coverage is as good for active duty and dependent mamas who want to have homebirths.

    I think, though, if I had stayed with Aetna I could have gotten them to cover my homebirth because I found out that under Virginia state law, insurance companies are not allowed to deny coverage for midwife services if those same services would be covered for an obstetrician. This may or may not work in your state because a) midwives must be licensed to practice completely independent of a doctor and b) your state must mandate that midwife services cannot be excluded.

    Even with those laws on the books, I had to call Aetna a lot and argue with them. Right before I switched, I had gotten them to agree to cover it and then when I called back again I got a different person who said “no” and I had to start all over again. My best advice to you is to be persistent, write down the names & extension numbers of everyone you talk to and the dates and times you talked to them.

    I wish I could be of more help. I’m happy to answer any other questions about this via blog or e-mail!

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