BILLING AND INSURANCE
The following are frequency asked questions about how billing and insurance work at Sacred Roots Midwifery and Birth Center (SRMBC)
ARE YOU IN-NETWORK WITH MY INSURANCE COMPANY?
SRMBC is only in-network with Anthem BCBS. We bill all other commercial payers at their out-of-network rates.
WHO ARE COMMERCIAL PAYERS?
Commercial payers are insurance plans that are typically offered by an employer. For self employed individuals; it is an insurance policy that you pay a premium for. The most common commercial payers are United Healthcare, Aetna, Cigna and Anthem.
WHAT IF I HAVE MEDICAID, MEDICARE OR TRICARE? DO YOU NEED MY INSURANCE INFORMATION?
Medicaid, Medicare, and Tricare are all government payers. We do not have any contracts with any government payers. This means our services are not covered by these insurance agencies. We do still need your insurance card and information for a couple of reasons. First, the services you will receive outside of our office (i.e. labs and ultrasounds) likely take your insurance. We will submit the insurance to those facilities along with our orders. Second, all services will be submitted to the payer so we are not fraudulently billing. All clients sign a waiver with understanding that government payers do not pay and allowing us to collect for those services.
WHAT SERVICES ARE NOT COVERED BY GLOBAL MATERNITY OR BIRTH FACILITY FEES?
Excluded services from the Global Maternity Care fee include labs, ultrasounds, Rhophylac, non-stress tests (NSTs), labor checks outside of normal clinic hours, and problem visits unrelated to pregnancy. Excluded services from the Birth Center Facility fee include non-routine medications, such as antibiotics for GBS+ clients or IV fluids for dehydration.
HOW CAN I DETERMINE WHAT I WILL OWE TO SRMBC?
You may call your insurance company to discuss your benefits. SRMBC will also research your benefits and will discuss all findings at your second prenatal visit. When creating payment plans for a client’s portion of costs, relevant considerations include in-network versus out-of-network benefits, individual deductible, coinsurance, exclusions, and prior authorization requirements.
WHAT HAPPENS WITH BILLING IF I TRANSFER CARE BEFORE BIRTH?
SRMBC will bill only for services that were performed.
WILL I BE RESPONSIBLE FOR MEETING TWO DIFFERENT DEDUCTIBLES IF I RECEIVE SERVICES ACROSS MULTIPLE YEARS?
SRMBC collects in advance for two services--Global Maternity Care and Birth Center Facility. These services are billed to your insurance company after birth. Therefore, those claims contribute to the deductible for the year of birth ONLY. Any services rendered outside of the global fees are subject to billing under a different year’s deductible.
DO YOU NEED MY INSURANCE INFORMATION IF YOU ARE NOT GOING TO BILL MY INSURANCE COMPANY?
Yes, we need to keep your insurance on file for multiple reasons. For example, our providers are required to include your insurance information with orders for lab testing, ultrasounds, and referrals to other medical professionals.