What to expect if you have insurance coverage and how that works with Corpus Christi Birth Center
Many of our clients have insurance coverage. If you have insurance, we would like to help you get the best possible coverage for your midwifery care and out-of-hospital birth.
The purpose of this webpage is to provide basic education about how insurance works. We will also explain what you can expect when you want to use your insurance to help cover the cost of care at CCBC.
Before we start, we thought we would begin with a YouTube video done by a Registered Nurse who explains the cost of her normal vaginal delivery without complications. She received her routine care from an OB/GYN and then had a typical vaginal delivery in the hospital. You might find this information helpful as you consider the cost of care for a birth at CCBC, which is considerably less expensive whether you use insurance or take advantage of one of our self-pay discounts.
In order to talk about insurance, let’s start by defining some common words and phrases used by the insurance industry. The following YouTube video will help explain Deductibles, Copays, Coinsurance and Maximums.
Here is another helpful video explaining co-insurance.
The next thing you need to understand is the difference between “in-network” and “out-of-network.”
When you have an insurance policy, the “in-network” providers are those providers who have: signed an agreement with your insurance company; and agreed to set prices of care, which are negotiated between the provider and the insurance company. These prices are usually (not always) lower than what your provider might charge on his or her own.
If you choose a provider who is not under contract (or “in-network”) with your insurance company, then that provider is considered “out-of-network”. At CCBC we are always considered out-of-network unless we are able to get an exemption and bill as if we were an in-network provider. The reason we are usually able to get this exemption is because there are no other providers who are in-network with any insurance companies within 100 miles of us that offer midwifery care and/or out-of-hospital delivery. That is why most insurance companies will grant us an exemption letter allowing us to bill in-network. Please discuss this option with our billing specialist; she can help you file for the exception letter on your behalf.
Some insurance policies will not provide any coverage for out-of-network providers and do not allow for in-network exemptions. If this happens to you, please discuss all self-pay options with us before giving up on being able to use our services. Even at the self-pay rate, the out-of-pocket cost at the birth center is many times cheaper than the co-insurance amount for a routine hospital delivery with a doctor.
When we cannot get an in-network exemption most of the time we can still file claims as an out-of-network provider. The down side about filing out-of-network is that it usually means you pay a higher deductible or a higher co-insurance amount, or both. The benefit to filing even if you have to pay at the out-of-network rate is that you will still meet your deductible for the year, which can be extremely helpful if you need any other health care during the remainder of that same year.
When we provide out-of-network services, it important to remember that we have the right to set our own fees and that your insurance company may not always accept the amount we billed. They usually set an “allowed” amount and then pay based on the amount they allow. So for example, if they cover 50% and expect you to pay 50% co-insurance on a $100 fee but only allow $80 on that service, then they will pay us $40 and expect you to cover the remainder which would be $60. As our client and the policy owner, you have the right to negotiate with either the insurance company or us concerning your bill. So if you believe the fee we charged was fair and reasonable (meaning it is comparable to what another provider would have charged) then you can let your insurance company know you want them to pay more. Likewise, if you would want to negotiate with us about the amount we initially charged, we want you to let us know. We will consider negotiating any reasonable request after your claim has been filed and you are ready to either pay off your balance or set up a payment plan with us to settle a balance.
When claims are filed, your insurance company will provide you with an Explanation of Benefits or EOB. Here is a video explaining how to read the EOB. This video is by United Health Care but all EOBs have similar layouts.