Private Insurance Billing

We work with a third-party billing service specializing in out-of-hospital midwifery care. This service helps families navigate private insurance reimbursement for midwifery services.

How Insurance Billing Works

  • Pay Flat Fee Upfront: To begin care, all clients must pay our flat cash pay rate in full. This ensures transparent pricing and eliminates hidden costs.

  • Insurance for Reimbursement Only: Once services are complete, our biller files claims with your insurance provider. Reimbursement depends on your insurance policy and is not guaranteed.

  • Billing Fee: A 10% fee is charged by the billing company on any payments received from your insurance provider. This fee is deducted from your reimbursement.

What is the Flat Fee?

Our flat fee is an all-inclusive package price covering midwifery care. It:

  • Reflects the comprehensive care we provide.

  • Does not correspond directly to insurance billing rates, which vary based on services rendered.

  • Counts as a retainer toward your patient responsibility, such as your deductible or co-insurance.

If your patient responsibility is less than the flat fee, you will be reimbursed the difference (minus the billing fee).

Maximizing Reimbursement

  • Request a Gap Exception: If there are no in-network providers offering comparable services, requesting a gap exception may increase reimbursement.

  • Appeal Denied Claims: You can work with your insurance company to appeal if reimbursement is lower than expected.

Frequently Asked Questions

  • If insurance denies reimbursement, you are still responsible for the flat fee. We can work with you to explore payment plans or other options to make care more accessible.

  • Yes! Many families use HSA or FSA funds to cover midwifery care.

  • A gap exception is a request for your insurance to treat our services as in-network because no in-network providers offer comparable care. If approved, reimbursement rates may improve.

  • Our billers specialize in midwifery care billing. They handle claim submissions and communicate with your insurance provider on your behalf.