Key Takeaways
- PAS delivery costs $200K–$350K+ in hospital charges, but insurance caps your out-of-pocket exposure
- Most major Aetna plans cover care at Tier 1 PAS centers (all are major academic hospitals)
- Aetna CPB 0327 covers fertility preservation when surgery could cause infertility
- Precertification is essential — start the process as early as possible
This guide provides general information based on research conducted in March 2026. Insurance coverage varies by plan, employer, and state. Always verify coverage directly with your insurance company before making care decisions. This page is not a guarantee of coverage and should not be used as a substitute for contacting your insurer directly.
Understanding PAS Delivery Costs
Placenta Accreta Spectrum is one of the most expensive obstetric events in modern medicine. Unlike a routine cesarean delivery, PAS care involves large multidisciplinary surgical teams, extended hospital stays, intensive monitoring, and frequently requires massive blood transfusion protocols and ICU-level care.
Typical total hospital charges for a PAS delivery range from $200,000 to $350,000 or more, combining both maternal and neonatal care. These charges reflect the complexity and resource intensity of the procedure, not what you will pay out of pocket.
Where the Costs Come From
- Surgical team: Maternal-fetal medicine specialist, gynecologic oncologist or pelvic surgeon, interventional radiologist, anesthesiologist, urologist (if bladder involvement)
- Operating room time: PAS surgeries can last 3–6+ hours, far longer than a standard cesarean
- Blood products: Many PAS deliveries require multiple units of packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate
- ICU stay: Maternal ICU monitoring is common for 1–3 days post-delivery
- Extended hospitalization: Typical maternal stay is 5–14 days (compared to 2–4 days for standard cesarean)
- Neonatal care: PAS deliveries are often scheduled at 34–36 weeks, meaning the baby may require NICU (neonatal intensive care unit) time
While hospital charges are staggering, your insurance plan's out-of-pocket maximum caps your financial exposure. Once you hit your OOP max, the plan pays 100% of covered charges. With PAS charges easily exceeding $200K, you will reach this cap very early in the hospital stay. The key is making sure your care is in-network and preauthorized.
Source: Matsuo K, et al. "Hospital resources utilization for placenta accreta spectrum." Am J Obstet Gynecol. 2021.1
Aetna Coverage Guide
This section provides detailed coverage information for patients with Aetna insurance, specifically the Aetna OA Managed Choice POS HDHP plan administered through Rippling PEO. While the specific dollar amounts below apply to this plan, the general strategies for verification, preauthorization, and appeals apply to most Aetna plans.
Your Plan at a Glance
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Deductible (Individual) | $3,300 | $6,000 |
| Deductible (Family) | $6,600 | $12,000 |
| OOP Max (Individual) | $5,500 | $12,000 |
| OOP Max (Family) | $11,000 | $24,000 |
Network type: Open Access (no PCP referral needed, national network) · Complementary network: First Health Network
Key: After hitting OOP max, the plan pays 100% of covered charges. With PAS charges easily exceeding $200K, you will hit the OOP max very early in the stay.
In-Network vs. Out-of-Network
The difference between in-network and out-of-network care is significant — potentially $5,500 vs. $12,000+ in individual out-of-pocket costs. For a family scenario (mother and baby both receiving care), the gap widens to $11,000 vs. $24,000.
Key Features of Open Access Managed Choice POS
- No referrals required: You can contact specialists directly without a primary care physician referral
- Broadest Aetna national network: Open Access Managed Choice uses one of Aetna's most extensive provider networks
- Out-of-state coverage: POS (Point of Service) plans cover out-of-state care at in-network rates when the provider is in Aetna's network — critical if you need to travel to a PAS center
- Self-referral to specialists: You do not need to go through a gatekeeper for MFM or surgical specialists
How to verify: Use Aetna DocFind at aetna.com/docfind → select "Managed Choice POS (Open Access)" as your plan type to see in-network providers and facilities.
Tier 1 PAS Center Network Status
All of the top PAS treatment centers in the US are major academic medical centers, which means they are likely in most major commercial insurance networks. Below is the current research on Aetna network status at each Tier 1 center.
| Center | Location | Aetna Status | Confidence | How to Verify |
|---|---|---|---|---|
| University of Utah Health | Salt Lake City, UT | ✅ In-network (multi-year contract renewed Jan 2024) | High | DocFind or call 801-587-6303 |
| Penn Medicine | Philadelphia, PA | ✅ Very likely (Penn uses Aetna for own employees) | High | Call 215-614-0581 |
| Beth Israel Deaconess | Boston, MA | ⚠️ Likely but unconfirmed online | Medium | Call 617-667-3700 |
| Texas Children's / Baylor | Houston, TX | ✅ Lists Aetna POS (verify narrow network exclusions) | High | texaschildrens.org or call |
| UTMB Galveston | Galveston, TX | ⚠️ Verify directly | Medium | doctors.utmbhealth.com |
Network status can change. Always verify directly before scheduling. The information above was researched in March 2026. Call both Aetna Member Services (1-800-704-7287) and the hospital's billing department to confirm network status for your specific plan.
First Health Network
Your Aetna card lists a complementary network: First Health Network. This is an additional safety net that may expand your in-network options.
- Approximately 1.67 million providers and 6,400+ hospitals participate in First Health
- If a provider is not in the Aetna Managed Choice network but is in First Health, care may be processed at in-network rates
- Search providers at providerlocator.firsthealth.com
Hospital-based physicians (anesthesiologists, radiologists, neonatologists) may not be in the First Health Network even if the hospital itself is. Always verify individual providers, not just the facility. The No Surprises Act provides some protection against surprise out-of-network bills from hospital-based providers, but proactive verification is always better.
Fertility Preservation Coverage
Aetna Clinical Policy Bulletin (CPB) 0327 covers egg and embryo cryopreservation (freezing) for patients facing iatrogenic infertility — meaning infertility caused by a necessary medical treatment. PAS patients who face hysterectomy as part of their delivery clearly qualify, since the surgery causing infertility is medically necessary.
- Coverage includes: Ovarian stimulation, egg retrieval, and cryopreservation of oocytes (eggs) or embryos
- Qualifying criteria: A medical condition or its treatment is expected to cause iatrogenic infertility
- Documentation needed: Have your MFM (maternal-fetal medicine specialist) document medical necessity, including the PAS diagnosis and the likelihood that hysterectomy may be required
- Policy reference: Aetna CPB 03272
This is one of the most important insurance benefits for PAS patients. If there is any chance your surgery will result in hysterectomy, ask about fertility preservation coverage before your delivery. Even if you are hoping for uterine preservation, having eggs or embryos frozen provides a backup path to future biological children through surrogacy. Time is limited — egg retrieval needs to happen before delivery, so start this conversation early.
Step-by-Step: Getting Preauthorized
Precertification (also called preauthorization) is the process of getting your insurance company to approve a procedure or hospital stay before it happens. For PAS, this is especially important because the care is complex, expensive, and may involve out-of-state travel. Follow these steps carefully.
Step 1: Verify Network Status
When: Weeks to months before delivery
- Call Aetna Member Services: 1-800-704-7287
- Ask specifically about your plan type (Managed Choice POS Open Access) and verify the hospital and key physicians are in-network
- Use DocFind online as a backup verification
- Get a reference number for every call — write down the date, time, representative name, and reference number
Step 2: Get Medical Necessity Documentation
From: Your MFM specialist
Have your maternal-fetal medicine specialist write a medical necessity letter that includes:
- PAS diagnosis with specific imaging findings (ultrasound and/or MRI results)
- Why a Tier 1 PAS center is medically necessary for your case
- Why local hospitals cannot provide equivalent care (lack of multidisciplinary PAS team, insufficient surgical volume)
- Specific expertise available at the chosen center (surgical volume, published outcomes, specialized team)
ICD-10 codes to include:
- O43.21x — Placenta accreta
- O43.22x — Placenta increta
- O43.23x — Placenta percreta
Step 3: Request Precertification
Call: Aetna Precertification at 1-888-632-3862
- Have the receiving hospital's team initiate the precertification when possible — they know the process and required clinical details
- Request authorization for all anticipated services:
- Extended inpatient stay (5–14 days, far exceeding the 96-hour auto-approval for standard cesarean)
- Cesarean delivery with possible hysterectomy
- Possible ICU admission
- Interventional radiology procedures (balloon catheter placement, embolization)
- Blood products (massive transfusion protocol)
- Penalty for skipping precertification: $400 per occurrence — a manageable penalty, but unnecessary when the process can be completed in advance
Step 4: Request Predetermination of Benefits
A predetermination is different from precertification — it provides a written estimate of what Aetna will cover for the anticipated services.
- Gives you clarity on expected out-of-pocket costs before the delivery
- Helps you plan financially and avoid surprises
- Request this from Aetna Member Services or through the hospital's financial counselor
Step 5: Verify ALL Providers
PAS surgery involves multiple specialists. Confirm that each of the following is in-network:
- Lead surgeon (MFM or gynecologic oncologist)
- Anesthesiologist
- Neonatologist
- Interventional radiologist
- Any consulting urologist or other specialist
The No Surprises Act (federal law effective January 2022) provides backup protection against surprise out-of-network bills from hospital-based providers you did not choose, but proactive verification is always better than relying on after-the-fact protections.
Ask the hospital's financial counselor to run a full benefits verification — this is a standard service at major academic medical centers.
Step 6: Get Everything in Writing
- Verbal approvals are not enough — always follow up to receive written confirmation
- Keep a file with all authorization numbers, reference numbers, dates and times of calls, and names of representatives
- Save all letters, emails, and documents from Aetna in a dedicated folder
- If a representative tells you something is covered, ask for it in writing or note the reference number
If Your Center Is Out-of-Network
If the PAS center you need is out-of-network with your Aetna plan, do not give up. There are established processes to request in-network exceptions when no comparable in-network provider exists.
In-Plan Exception / Network Deficiency Request
You can argue that no comparable in-network provider exists for your specific condition. PAS is rare and requires specialized multidisciplinary teams that most hospitals do not have. To make this case:
- Obtain your MFM's medical necessity letter (as described in Step 2 above)
- Reference ACOG and SMFM guidelines recommending delivery at centers with multidisciplinary PAS teams3
- Document that no in-network hospital in your area has an established PAS program with comparable surgical volume and outcomes
- Submit the request to Aetna's network deficiency team via Member Services
Appeals Process
If your initial request is denied, you have multiple levels of appeal:
- Peer-to-peer review: Your MFM or referring physician speaks directly with Aetna's medical director. This is often the most effective step — physician-to-physician conversations carry significant weight.
- Internal appeal: Submit a formal written appeal with comprehensive clinical documentation including imaging, diagnosis details, and the medical necessity letter.
- External independent review: If internal appeals are denied, you have the right to request an independent external review by a third party. This is mandated by the ACA (Affordable Care Act) and Aetna must comply.
Throughout the appeals process, keep copies of every letter, email, and phone call record. Note the date, time, representative name, and reference number for every interaction. Written documentation is your strongest tool in any insurance dispute.
Travel & Lodging
Many PAS patients must travel to reach a Tier 1 center. If no in-network PAS-specialized provider exists within approximately 100 miles of your home, Aetna may reimburse travel and lodging costs.
- Confirm eligibility: Call Aetna Member Services (1-800-704-7287) and ask about travel reimbursement for medically necessary out-of-area care
- Travel form submission: Aetna requires a specific travel expense form — request it from Member Services before your trip
- Keep all receipts: Airfare, mileage, hotel, and other travel expenses must be documented
Hospital-Affiliated Lodging
Most major academic medical centers have partnerships with nearby lodging for patients and families:
- Ronald McDonald House: Available near most major children's hospitals (relevant since your baby may be in the NICU)
- Hospital guest housing: Many academic centers have affiliated hotel-style accommodations at reduced rates
- Social work services: Contact the hospital's social work department early — they can help arrange lodging and connect you with local resources
The National Accreta Foundation (preventaccreta.org) may have additional resources and can connect you with other PAS patients who have navigated travel for care.
What to Expect: Out-of-Pocket Costs
Because PAS charges are so high, you will almost certainly hit your out-of-pocket maximum. The question is whether your care is processed as in-network or out-of-network.
HDHP and HSA Considerations
As an HDHP (High Deductible Health Plan) participant, you may be eligible for a Health Savings Account (HSA). Key points:
- HSA funds can be used for all qualified medical expenses, including deductibles, copays, and coinsurance
- Contributions are tax-deductible, and withdrawals for medical expenses are tax-free
- If you know a PAS delivery is coming, consider maximizing HSA contributions now
- HSA funds can also cover travel expenses for medical care if the travel is primarily for medical treatment
Financial Assistance Programs
All four Tier 1 PAS centers are nonprofit academic medical hospitals with established charity care and financial assistance programs. If out-of-pocket costs are a hardship:
- Contact the hospital's financial counseling department before your admission
- Ask about income-based payment plans, sliding scale programs, or charity care
- Nonprofit hospitals are required by law to have financial assistance policies — ask for the written policy
Key Phone Numbers & Resources
| Contact | Number | When to Call |
|---|---|---|
| Aetna Member Services | 1-800-704-7287 | Verify coverage, ask questions about your plan |
| Aetna Precertification | 1-888-632-3862 | Get preauthorization for procedures and hospital stay |
| U of U Health Scheduling | 801-213-2995 | Schedule PAS consultation at University of Utah |
| Penn Medicine MFM | 215-829-2345 | Schedule consultation at Penn Medicine |
| BIDMC Referrals | 617-667-2020 | Schedule consultation at Beth Israel Deaconess |
| Texas Children's PAS | 832-824-9322 | Schedule consultation at Texas Children's |
| National Accreta Foundation | preventaccreta.org | Patient advocacy, guidance, peer support |
Other Insurance Providers
We plan to expand this guide to cover additional insurance providers based on patient needs. Guides for the following are in development:
UnitedHealthcare
Coverage guide coming soon.
Blue Cross Blue Shield
Coverage guide coming soon.
Cigna
Coverage guide coming soon.
Medicaid / State Programs
Coverage guide coming soon.
If you have a different insurance provider and would like us to research coverage at PAS centers, please contact us through the National Accreta Foundation. We plan to expand these guides based on patient needs.
References
- Matsuo K, et al. "Hospital resources utilization for placenta accreta spectrum." Am J Obstet Gynecol. 2021;225(3):279.e1-279.e12. PMID: 33757730
- Aetna. "Clinical Policy Bulletin 0327: Fertility Preservation." Updated 2024. aetna.com/cpb/0327
- American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. "Obstetric Care Consensus No. 7: Placenta Accreta Spectrum." Obstet Gynecol. 2018;132(6):e259-e275. PMID: 30461695
- KSL.com. "University of Utah Health and Aetna reach multi-year agreement." January 2024.
- University of Utah Health. "Aetna Insurance FAQ." Accessed March 2026.
- Penn Medicine. "Accepted Insurance Plans." Accessed March 2026.
- Beth Israel Deaconess Medical Center. "Billing and Insurance Information." Accessed March 2026.
- Texas Children's Hospital. "Accepted Insurance Plans." Accessed March 2026.