Frequently Asked Questions
I’ve heard you can’t bill insurance for a homebirth?
Not true! It depends on your insurance. When I do a verification of benefits I look into the language in your policy. The only people who can say for sure if you can or can't is your insurance - and THAT'S who I talk to.
My Midwife is out of network, and the out of network coverage from my insurance is so terrible!
When I verify your benefits I also see if we can apply for a Prior Authorization/Gap Exception/Pre-Certification - this can result in the out of network provider being covered as if they were in network, for this single case. It can be very effective, and result in reimbursement for you. It’s always worth looking into, and I don’t charge anything to do this!
What is a GAP exception?
If your health plan approves a network gap exception, it means they'll agree to treat that particular service from that particular provider as if it's in-network. That means you'll be responsible for your in-network deductible, copays, and coinsurance, rather than the plan's out-of-network cost-sharing. I will always apply for one of these as part of the Verification of Benefits if it is allowed by your insurance.
Does billing my insurance affect the fee my midwife collects from me?
No. You will still pay the fee on the schedule that you agree to with your midwife, according to her financial agreements. Any reimbursement collected from the insurance will pay you back.
I’m due tomorrow - Is it too late to decide I want to bill insurance?
Not at all! You typically have 6 months to a year after baby is born to submit a claim for Pregnancy and birth. It’s better to begin the process earlier in pregnancy, so we have time to request a GAP exception for out of network care, and get you better coverage, but it’s not too late to try!
Will I know exactly how much insurance will pay?
No. We can know how much of your deductible is due, and how the billed amounts will be divided between you and your insurance company (example 40/ 60%, or 20/80%). The one thing we won't know until after billing is the allowed amount the insurance company will pay. It sounds strange, but this is how insurance deals with out of network providers. We will have to work with estimates. But we can have a good idea of whether they will cover your care or not.
When do you submit the bill to insurance?
After baby is born, and you have paid the fee for billing.
How much does it cost?
A verification of benefits costs $25. I will find out what insurance will cover, and submit any applications for Gap exceptions or Prior Authorizations. Once we know if/how your insurance will cover the kind of birth you want, then you can decide if it's worth billing. If you want to bill, and paid for a verification, it's $125, and I will submit all the billing and take care of any follow up too.
If you want to skip the verification it's $150 for billing.
Billing includes claims for pregnant person and newborn, as well as any follow up or appeals.