Frequently Asked Questions
1. I'm a new midwife and don’t know anything about insurance billing. Can you help me?
Yes! We are here to serve you and can certainly help you understand the insurance cycle. We will create customized insurance forms for your practice and work with you and your clients for maximum reimbursement.
2. Do you verify insurance eligibility and coverage?
Yes, we can verify benefits for anyone seeking midwifery care, regardless of whether their midwife uses our service. Verification includes obtaining any necessary referrals or pre-authorizations and requesting in-network exceptions.
3. Is there a fee for this service?
Yes, there is a $20 fee to the member (not the midwife) for this service.
4. How often do you send claims?
At least three times for a normal course of maternity care. We send a claim after the initial visit (now called the pregnancy confirmation visit), after the birth and again after the six-week visit (or final visit). You can bill for anything outside of “normal” as they occur. For example, extra visits for hyperemisis, UTI, false labor, threatened SAB, and others.
5. Do you bill the global maternity code (59400)?
We bill globally whenever possible. Some companies prefer each visit billed separately, and other times it is necessary to bill each visit separately due to the circumstances.
6. Do you bill for services other than midwifery care?
We only bill for midwives, but some midwives offer additional services. We can bill for well-woman care, naturopathic care, family panning, lactation consulting, doula services, massage therapy, acupuncture and childbirth education. We also bill for ultrasounds, non-stress tests and lab work.
7. Which insurance companies reimburse direct-entry midwives?
Every insurance company has several plans, but we have seen reimbursement from the following companies: Blue Cross/Blue Shield of Washington, Oregon, California, Idaho, Utah, Nevada, Arizona, Colorado, Kansas, Minnesota, Iowa, Missouri, Tennessee, New York, New Jersey, Central States (Indiana, Ohio, Kentucky, Connecticut), Illinois, Rhode Island, Maine and Pennsylvania. Blue Cross/Blue Shield of Texas and South Carolina require the cooperation of the member, but reimbursement from these companies can usually be obtained. Other major payers who routinely reimburse direct-entry midwives are United Health Care, Cigna, Aetna US Healthcare, Principal Financial Group, Christian Care Medi-Share, Adventist Risk Management, Mega Life and Health Insurance Company, Great West Life and Annuity, AVMA Group Health, Cooperative Benefit Administration, Central Benefits, Premier Health Systems, Fortis Insurance Company, Mamsi Life and Health Insurance, Principal Financial Group, Unicare Health and Life and Nationwide Health Plans.
8. Do you bill Medicaid and their HMO plans?
Yes, we bill claims to Medicaid and work with the various HMO plans to obtain reimbursement for our clients.
9. Do you bill facility fees for birth centers?
Yes, we have received additional training in how to effectively bill for free-standing birth centers. We have had very good results obtaining reimbursement for facility fees.
10. Where did you get your certification?
All of our billers are certified through the Professional Medical Billers Association. Some of us are also working on becoming certified coders through the American Academy of Professional Coders. Both of these associations require yearly continuing education credits in order to remain certified.
11. How do I sign up for your service?
Please give us a call or email us and we will be happy to speak with you about your practice and get the registration process started. Or, if you like, please fill out our Registration Form and we will call you.