Billing FAQ
First Step: Your Insurance Card and a Verification of Benefits
We will take a picture of your insurance card and call your insurance company and have an in-depth conversation about your maternity benefits. We will discuss this during a subsequent prenatal visit and provide you with a summary of your benefits.
Second Step: Claims Submission
Geneabirth will submit claims on your behalf. Claims for prenatal care or a claim for global care (if homebirth is covered) are submitted after shortly after your baby is born. Claims for postpartum visits and baby care visits are submitted shortly after the 6-week postpartum visit. We will repair any errors on your claims. We will follow up with insurance companies who we believe have processed your claim in error or in a way that deviates from the benefits quoted. We do not appeal claims. We encourage families who feel their claims were rejected in error to file an appeal with their insurance company. The squeaky wheel gets the grease! We do not file for authorization or network exceptions. Some clients complete the process of out-of-network exceptions or pre-authorizations and are able to get good coverage that way. We are not insurance billing specialists. We offer this service as a courtesy to our clients.
Will you get coverage and reimbursement?
Does your policy cover Licensed Midwives? Most of our clients have private insurance that covers licensed midwives. If your policy does not cover licensed midwives, perhaps, for example they only cover “Certified Nurse Midwives working under the supervision of a physician in a licensed facility” then you are highly unlikely to receive any coverage. Although we will try submitting a claim anyway!
Does your policy cover or exclude homebirth?
About a third of the insurance policies we come across cover homebirth. These are usually policies administered in another state. Don’t worry if your policy excludes coverage for homebirth. We can still submit claims for prenatal care, postpartum and baby care.
How much will I get reimbursed?
This depends on a lot of factors, including your plan’s deductible, co-pays or coinsurance and your out-of-pocket max. Homebirth midwives in Minnesota are out-of-network providers. Often out of network care is reimbursed at a lower rate than in-network care and deductibles are typically higher. In our practice 76% of our privately insured clients received some reimbursement. The range of reimbursement is pretty dramatic from $200 to $4500! Even if you don’t receive reimbursement, when we submit claims to your insurance that are accepted, that amount may be applied to your deductible or out-of-pocket max. This means it’s possible that other health care you access for yourself, your baby or other members of your family during the calendar year may cost you less in out-of-pocket expenses.
What about Medical Assistance or Medicaid?
Minnesota’s Medical Assistance program does not recognize licensed midwives as a covered provider in the homebirth setting and our services are ineligible for coverage. This is a shame because homebirth midwifery care is a very cost effective option. Legislative action is needed to address this issue. Consider contacting your state senator or representative to let them know you think licensed midwives should be covered.
What about TriCare?
The U.S. Military insurance, TriCare, also does not cover licensed or traditional midwives.
What about health sharing ministries?
Health sharing ministries generally cover 100% of the costs of a homebirth. We are happy to fill out any paperwork you need submitted to your health ministry plan.
What if….?
What if I have a miscarriage?
If you have a miscarriage and you have already paid in full, we refund your payment, minus a prorated amount for prenatal services already provided.
If you have a miscarriage and have not yet paid for any care, you may be billed for prenatal services provided.
What if I move out of your service area or I decide I want to switch to a different clinic or provider during pregnancy?
If you choose to transfer care during the course of your pregnancy, you are responsible for payment for prenatal services already provided. This amount will be prorated based on the number of appointments that have taken place. If you have already paid in full at the time of transfer of care, we will issue you a refund, also prorated based on number of appointments. Unpaid balances must be resolved and refunds will be determined prior to transfer of care. We will also assist in a smooth transfer of care and will release your prenatal and health records promptly to your new caregivers. No refunds are issued after 38 weeks of pregnancy.
What if something goes wrong when I am pregnant and I need to transfer care to an OB?
Because most women who choose homebirth are health conscious and low-risk, this is very uncommon in our practice. If such a condition develops or is discovered during the course of your pregnancy, it is up to you and your partner as to how you want to proceed. If it is early in pregnancy, you may choose to transfer care and you will either be billed a prorated amount for prenatal care provided or you may be refunded a prorated amount if you have paid in full. If it is late in your pregnancy, you may choose to discontinue care as described above or to continue working with us and seeing the specialist in anticipation of a hospital birth. In which case, we would plan on attending your birth for physical and emotional support and advocacy and continue to provide midwifery style postpartum care upon discharge from the hospital. No refunds are issued after 38 weeks of pregnancy.
What if I need to go to the hospital in labor or during the first few hours postpartum?
Our transport rate is extremely low. However, sometimes for the health of the mother and baby we do make the decision that additional medical help is necessary. No refund is given in the case of hospital transport during labor or the immediate postpartum. We will call ahead so the hospital is ready to receive you, transfer your records and typically one midwife will accompany you to the hospital where we will help facilitate a smooth transfer of care. One midwife will remain behind to clean up your home and often meet us at the hospital later. We will stay with you in the hospital providing physical and emotional support and advocacy. Upon discharge we will provide to you and your baby our six weeks of midwifery-style mother/baby postpartum care.