Private Insurance Coverage
Many of our patients are covered by private insurance. If you have private insurance, this page is for you. (Private insurance is different from Medicaid. If you have Medicaid, please follow the Medicaid link from the menu under cost.)
It is always our goal to help you get the best possible coverage for your midwifery care and to keep your actual out-of-pocket expenses to a minimum.
Out-of-pocket expenses with the Corpus Christi Birth Center are almost always much less than the out-of-pocket expenses for a planned hospital delivery with an OB. There are a few exceptions, but most people discover that they will save a lot of money by choosing midwifery care and a birthing center over a hospital delivery with an OB. This includes those who are considered “out-of-network” with us. Before we can explain why this is the case, we need to first explain more fully how insurance works.
So lets begin by explaining exactly what we mean by “out-of-pocket expenses.” The out-of pocket expenses are the portion of your bill(s) that your insurance company requires you to cover personally or “out of your own pocket”. With maternity care especially, some of these expenses may come prior to the birth but some may be billed later, after the claims are processed. At CCBC, we rarely need to bill our patients after a claim is finished being processed because we are very careful to figure out what is needed in advance and to negotiate with the patient prior to the birth rather than have unfinished business afterwards. We want you to know in advance what all of your out-of-pocket expenses with us will be and to give you a bottom line as soon as possible.
What follows are the out-of-pocket expenses you can expect when you use insurance for anything. This is how insurance works:
- You are always required to cover the cost of your deductible. This is an amount determined by your individual policy. A low deductible might be $500 (rarely less). A more typical deductible will fall in the range of $1000-$2500. But some can be as high as $5000 or more. It is important to understand that the deductible MUST be paid directly to your provider(s) before your insurance company for the remaining portion of the bill. If a patient still owes anything on their deductible and a care provider does not first collect what is considered the deductible portion of their bill directly from the patient, it would be considered insurance fraud. That is why we require that you meet your deducible prior to the birth of your baby if you want us to bill your insurance. It is also important to understand that deductibles reset each year (usually in January) and that sometimes there are individual deductibles and sometimes there are family deductibles. Our billing expert can help determine all the details for you in advance
- When a policy does not cover 100% of the charges after the deductible, that portion of the bill is considered your “co-insurance” amount. For example if your insurance policy only covers 80% after you pay your deductible, your insurance company will expect you to pay the remaining 20% directly to your provider. In the case of a pregnancy, where there is a predictable expected amount to be due after the birth, a provider might also require you to pay a portion of your estimated co-insurance prior to the birth. It is good to know that unlike the deductible, the co-insurance amounts can sometimes be negotiated with your provider. At CCBC, we are willing to negotiate some (but not all) of the expected co-insurance amount. You will most likely find us much more willing to negotiate than all combined parties involved in a typical hospital delivery (the facility, the doctor, the anesthesiologist, the baby’s doctor, etc.)
- Finally, it is important to understand that most likely not every expense will be covered under your policy. Ask anyone who has ever had any length of stay in the hospital and you will almost always hear that something or someone was not covered by their insurance. When this happens, the patient is still responsible to cover any expenses not covered by insurance. Health care must be coded every time a claim is sent to an insurance company for payment. Codes are based on the procedure, the care provider and even the location of the care. Sometimes some codes are not covered under a policy. The more time, the more people and the more locations involved in your care, the more likely this is to happen. For example, my husband had heart surgery a few years ago. His surgeon (who was covered) brought in a team of surgical assistants who were not covered under our policy. Of course we did not know this until after we started getting the bills after the surgery.
At CCBC, we have absolutely no hidden fees for anything! Our billing expert will help explain exactly what to expect when it comes to your out-of-pocket expenses with us. We will always tell you right up front whether or not we expect a charge to be covered by your insurance. We will let you know before we bill exactly which parts of the bill we are willing (or able) to negotiate with you on and this can help you know the bottom line before you have the baby.
We found a YouTube video done by a Registered Nurse who explains the cost of her own normal vaginal delivery without complications. She received her routine care from an OB/GYN and had an uncomplicated vaginal delivery at a hospital. So this makes an interesting case study for comparison when considering CCBC where the average out-of-pocket expense for a patient with insurance is almost always below $4500. This nurse does not say what her out-of-pocket expense was for her pregnancy and birth but we have been told by local nurses that the average out-of-pocket expense in our area for someone with typical insurance is more than $6000.
In-Network vs Out-of-Network
One more thing we should explain and that is the difference between “in-network” and “out-of-network.”
With insurance, 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.
There is a new federal law that just went into effect in January of 2018 which will require every insurance company offering maternity care to include at least one free standing birth center as in-network. Even though the law has been passed, time is allowed for each company to become complaint with the law. We hope to be included as in-network providers with this new law and will keep you informed on the progress towards that end.
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 currently considered out-of-network unless we are able to get an exemption and can then bill as if we were an in-network provider. Some policies do not allow for in-network exceptions or do not allow for out-of-network billing. If this is the case with your policy, please discuss other options with us before giving up. We have many options, including a greatly reduced self-pay rate.
As we said earlier, even if we bill as an out-of-network provider, we are almost always able to save you on out-of-pocket expenses. So please discuss the details with our billing expert if you still have concerns or questions about cost.