Verification of benefits

$45

Gap exception guide

$20

Prenatal, birth, postpartum, global perinatal, or facility fee claim preparation and submission

$90

Well-person or lactation care claim preparation and submission

$45

FSA, HSA, or HRA invoice preparation

$90

Claim follow-up

$45/hour

Client payment plans and collections

Negotiable

Verifying benefits gives you and your clients a realistic expectation of coverage, which helps to determine the best options for payment.

When we call insurance companies to verify benefits, we know the right questions to ask to find out:

• Which services, places of service, and provider types are covered and excluded;
• Deductible, coinsurance, copayment, and out-of-pocket maximum amounts, and whether there are different deductible and coinsurance amounts for in- and out-of-network providers;
• Whether a prior authorization, referral, or gap exception is required;
• The beginning and ending dates of the benefit year; and
• The process by which a newborn can be added to the policy.

After your client completes the client information form and submits payment, we’ll verify their benefits and send a report that clearly explains their coverage.

If your client is covered by two or more insurance plans, they’ll specify in the client information form which plan is primary and which plan is secondary/tertiary/etc. Coordination of benefits between multiple insurance companies often lengthens the claim processing time.

A gap exception allows a client with exclusive provider organization (EPO), health maintenance organization (HMO), or preferred provider organization (PPO) insurance to receive services from an out-of-network provider at an in-network rate.

We provide a guide that includes the information you'll need to request a gap exception: procedure and diagnosis codes, your provider's tax ID and NPI numbers, and rationales that can help to prove your request is medically necessary.

Whether you’re submitting a claim for birth center facility charges or for prenatal, birth, postpartum, or global perinatal care, we charge the same fee ($90) to prepare a claim, scrub it for errors, and submit it for payment. Please keep in mind that a home birth can create two claims (one for the birthing person's care and one for the baby's care), and a birth center birth can create up to four claims (one for the birthing person's care, one for the baby's care, one for the birthing person's facility fee, and one for the baby's facility fee).

We charge a flat $45 claim preparation and submission fee for well-person or lactation care.

We submit provider and subscriber claims to insurance companies, healthcare sharing ministries, Medicaid, and TRICARE.

Midwives and birth centers share the clinical information for claims by giving us access to their electronic health record system, or by completing a superbill we customize for their practice. When you fill out the provider and practice information form, you can tell us which option works best for you.

We also prepare detailed invoices for clients’ flexible spending accounts (FSAs), health savings accounts (HSAs), and health reimbursement arrangements (HRAs). As with insurance claims, invoices are prepared within three business days of the date we receive the $90 preparation fee and necessary information, which is shared via electronic health record system access or completion of a customized superbill.

Setup fees

Approximately half of the midwifery billing services we surveyed charge $200 to $500 to “set up” your practice with their clearinghouse. Our fees accurately reflect our cost of doing business, so there’s no need to tack on additional fees.

Monthly minimums

Some billers charge a monthly minimum fee to cover the times their clients’ practices experience a lull. If your practice isn’t making money, we aren’t either. We only charge for the services we provide, never more.