Who's Your Baby Daddy

Scene One: The Phone Call

Ring ring! Ring ring!

Aetnabot: Thank you for calling Aetna! Please make sure never to do so again, as anything you need can be taken care of half-assedly on our website. Press 1 to hang up now. Marque el numero dos para hang up en espanol.

Me: Operator! Operator!

Aetnabot: Are you calling about a claim?

Me: No! Operator!

Aetnabot: Okay. Please hold for the next customer service representative. In order to properly waste your time, please enter or say your Aetna member number, or the primary policy holder's Social Security number, followed by your bank account number and home address. Also please enter the next time you plan to be out of the house, using the pound key for A.M. and the star key for P.M.

Me: SP@$%ASD44398223.

Aetnabot: Please hold.

~~~~~hold music~~~~~

Customer Service Rep: Hello! Thank you for calling Aetna! How may I help you today?

Me: I need to secure coverage for a service not provided by any of your affiliates.

CSR: Um, okay, can I have your member number?

Me: SP@$%ASD44398223.

CSR: And what do you need covered?

Me: None of your providers offer homebirth services. I'd like you to cover a certified nurse-midwife blah blah blah boring.

CSR: Um. I don't think? We do that?

Me: Would you mind checking on that?

~~~~~hold music~~~~~

CSR: It says here...(flipflipflip)...that it's covered in some states. Washington, Oregon...not Pennsylvania.

Me: Well, I'd like you to make an exception. CNM-attended homebirth blah blah save you thousands of dollars blah.

CSR: But there might be...um, complications?

Me: In Pennsylvania, but not Washington?

CSR: Um.

Me: I'd like your supervisor to call me. My home number is 777-888-9999.

CSR: 777-888-9999?

Me: Yes. 777-888-9999.

CSR: It'll be 24 to 48 hours.

***END SCENE***

48 hours pass, with no call.

* * * * * * * * * * * * *

Scene Two: The Email Exchange

Me: Dear Aetna, blah blah expecting call blah blah cover homebirth.

Email CSR: Dear Ms. Leerypolyp, We called you at 777-183-9125 and it rang like a fax machine. So it is totally like not our fault. Our telephone service representative has advised us to inform you that Aetna does not cover paternity testing. So good luck with that, whoresack. P.S. Call Precertification about the homebirth thingy.

Me: Dear You: Not my phone number, you jackasses.

END SCENE.

* * * * * * * * * * * * *

So. In addition to contacting Precert about the actual reason for my call, my next plan is to work my way up the ladder of complaint. Because my husband was mortally offended and my marriage irreparably damaged by their insinuations of the uncertain origin of my pelvic tadpole.

On the upside, if they're this shoddy about all their operations, sooner or later someone will be fool enough to put my homebirth coverage in writing for me. Ha ha.

Comments

[Hazy]

Having worked in Customer Service call centres, I can say that that can sometimes be an absolutely accurate description. Its just luck who you get through to. I hope you get some answers soon!

[Amy]

My homebirth was covered accidentally. One rep said it was covered and put it through. When I called after we got our money to ask why they didn't cover my stitches, they said I should have gone to one of their in-network doctors for that. Um... leave my bedroom, where I had just given birth, to drive to the ER in the middle of the night for 2 stitches? I don't think so. They also told me during that conversation that reimbursing me was a mistake--oops! But I could keep the money. What a racket they have going not covering homebirths. Stupid.

[Jen]

Sorry about your experience. I had Aetna for a bit over two years, from 2005-2007. I never had to call to request coverage or talk about precert stuff.

But I will say that when I was going through my miscarriage, and then hospital and doctor billed Aetna over $8000 for the er visit, labwork, and my d&c, I never saw a bill.

The insurance company I have now (Blue Cross) won't even cover my pre-natal bloodwork without looking at my doctor's records to make sure that I am, in fact, pregnant. Apparently they think he would order a pre-natal profile for fun.

[Jo]

Jen, I wonder if it's because I have the HMO version.

I used to have United PPO; they were WONDERFUL. Covered everything including homebirth without batting an institutional eye. I miss them.

[Brooke]

Wow, you're trying to get your HMO to cover homebirth? I'm impressed. I'm working on a gap exception for midwives, but I'm in a PPO (sorta) and all I'm looking for is in-network coverage.

Friends of ours did the gap exception thing for their homebirth and managed to get it-for the non-pregnant partner.

Before, when we had an HMO, they would cover getting me tested for cystic fibrosis (even though their is no way I could have been the biological father of the fetus) but not the donor. Although they would cover an amnio which was way expensive than a CF screen.

[Ruth]

I have an HMO and recently went through this whole charade of trying to get a gap exception, but they ended up telling us that even though they officially cover "midwives" in the policy, what that actually means is that they cover "nurse midwives who are in network," so CMs are no dice. One of the people I talked to on the phone told me, "We consider midwives to be a preference. You'll just have to go to an ob/gyn." Um, no. I will not. What I will have to do is pay for the damn midwife myself, despite the fact that you pocket thousands of dollars of our money every year, ostensibly to cover our health care costs. You bastards. Sigh.

[Jo]

Unofficial reports have led me to believe that sometimes you have better luck with an HMO -- IF you can get them to cover, they'll cover at 100%, because they can't try to say it's an out-of-network benefit. It's either in or it's not covered.

[Jen]

ewwww, HMO. My Aetna was the PPO, which maybe was why it was so great.
My current Blue Cross plan is PPO, and it still sucks, but I think that's because my employer is cheap.

[Chickenpig]

Frickin' insurance companies! I'm still mad at mine for covering viagra but not the pill! Right now we are fighting ours over them not covering a doctor recommended ultrasound. I have never checked, but I'm sure they wouldn't cover home deliveries either. It makes me want to move to Sweden...or Amsterdam...or Canada....

[katrin]

When I read this post I just went Yes!Yes!Yes!Yes!

Why? Because this is the kind of invisible shit us mothers spend waaaaay too much of our time dealing with.

I just wrote a book about Moms needing to take care of themselves and I should have included a chapter about how to get someone else -- anyone! your husband! The postman! Your neighbor! -- to deal with this kind of incredible and frustrating time sink. You watch the minutes and hours tick by, and you know your life is going down the drain one muzak-filled moment at a time.

Good luck!
Katrin
CO-Author, Mothers Need Time Outs Too
www.momstimeouts.com

[Sarah]

I honestly would never want to live in "Sweden...or Amsterdam...or Canada", if only for the simple fact that healthcare in those countries is not as good as it is in the U.S. And yes, I have worked and lived in a country with socialized healthcare (Netherlands). While everyone is always "covered", and it's all "paid for", waiting 2 weeks to see a Dr. for a urinary tract infection is not my idea of fun, especially when it results in hospitalization due to the UTI going into my kidneys. It's a hot debate, but to be totally frank, people in those countries don't even know how bad it is for them. I know two Canadian *doctors* who have come to the U.S. for various surgeries and medical treatments. What does that tell you?

[Jo]

Yes, Sarah, it's a far more complex picture than either side would have you believe. There are some things that US medicine does a good job on (emergent and specialty stuff, mostly) and some things that other countries do better jobs on (routine childbirth in the Netherlands, for example).

Although if you're poor in the US, it just sucks no matter what.

[Mary]

OMG, you have just encapsulated my entire customer experience with AETNA so far. Every ... single ... bill ... having to do with the birth of my 2nd child had to be disputed with them. Why? Because she wasn't on our policy! Because she hadn't been born yet! Despite the fact that we registered her as soon as she had been born! Seriously, literally every single charge related to her birth (and this was a hospital birth) was contested by them, just to play it out as long as they could and make it as painful as they could. Awful. Evil. I hate them. And then they wouldn't pay for my older daughter's autism eval bec. that is a "mental health diagnosis" so has to be in network--wha? Since when is a neurological condition a mental health issue? I ended up crying on the phone to them saying, this is the worst, most dysfunctional way to pay for health care in the world, and even the customer service representative agreed with me. I will be quiet now.

Sorry to sound bitter. There has to be a better way.

[emjaybee]

Odd how Sarah's experience is not borne out by any actual studies or evaluations of the Netherlands healthcare relative to our own...which generally show better outcomes and longer lifespans...anyway. I work for one of the Giant Companies mentioned, I won't say which, but your coverage can vary wildly depending on what your employer negotiates. So saying "Company X was great or horrible" really means "had a good or bad plan paid for by my employer." But the system overall is broken, and the very fact that you have to pay hundreds of dollars and still not know if you're actually going to get good coverage till it happens just sucks.

I am intrigued that it's even possible to get midwives paid for via exceptions. Hope it works for you.

[carabella]

I just had the same run around with Aetna PPO. I was finally told (after two hour long calls) that because California doesn't consider CNM's to be birth providers WTF?? that they cannot cover her services. Which means they do not pay for homebirths...sigh.

Anyway, hope you get someone to approve it for you! Let me know their name if you do!