Premier Birth Center: Insurance

Insurance

Insurance Snapshot

Insurance billing is complicated! Because of this, the Insurance Snapshot is required for all clients planning to use health insurance at Premier Birth Center. We charge $20 to have our professional billing company estimate your out-of-pocket expense and provide you with a personalized payment plan for your care. They will base this estimate on their experience in processing our claims with your insurance carrier and consulting with their payer portals as needed. This will give you a clear idea of your financial commitment if you receive care with Premier Birth Center's team.

Client Registration Form

Use this form to register with our insurance billing company and receive a quote for your estimated out of pocket expense for your care at Premier Birth Center. Cost of this service is $20.

Name

Address

Date of Birth

Estimated Due Date

Phone

Where do you plan to give birth? (If undecided, check the places of service you may consider)

Chantilly Birth Center

Home (with prenatal/postpartum care)

Insurance Information

Primary Insurance
(If you also have secondary insurance, complete a second insurance snapshot)

Primary Insurance Company

Insurance ID Number

Insurance Group

Insurance Address/City/State/Zip

Insurance Phone

Plan Name

Effective Date

Insurance Policy Holder Name

Policy Holder Birth Date

Covered By:

Medicare/Medicaid

Commercial Insurance

Tricare

Healthshare Program

Terms & Conditions

I certify that the information on this form is correct to the best of my knowledge. By signing this form, I authorize Larsen Billing Service (LBS) to confirm my primary insurance benefits and authorize Virginia Midwifery Group LLC charge me the fee of $20.. Once this form has been completed, LBS will begin the process of confirming your benefits and whether we are contracted with your insurance carrier. They will also pursue obtaining pre-authorization and in-network exception (if possible). LBS will send a copy of the insurance snapshot to the email address listed above on the Patient Registration Form and to your provider. Please note that Insurance Snapshot is not confirmation that the insurance company will pay what is stated when verifications were obtained. The insurance company has the right to make a final ruling on each claim submitted according to their latest policies and procedures. LBS is not responsible for deviations from the insurance coverage described within the Insurance Snapshot form, nor for incorrect information given by health plan representatives. Some insurance companies may be difficult to obtain benefits information from; if the benefits call exceeds two hours, we will contact you for assistance in obtaining a complete Insurance Snapshot. LBS will send the completed Insurance Snapshot form to both the patient and the provider from an email address and system that is appropriately encrypted according to HIPAA/HITECH regulations, but is not responsible for any breach that may occur due to the message being received by an unsecure email address. I understand that the purchase of the Insurance Snapshot services does not guarantee that my claims will be submitted and does not create a contract for billing services between myself and LBS Larsen Billing Service specifically DISCLAIMS LIABILITY FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES and assumes no responsibility or liability for any loss or damage suffered by any person as a result of the use or misuse of any of the information or content included in this Verification of Benefits report. Larsen Billing Service assumes or undertakes NO LIABILITY for any loss or damage suffered as a result of the use, misuse or reliance on the information and content on the Verification of Benefits report or findings. In the case of gross negligence or willful misconduct, the liability of Larsen Billing Service to any patient seeking Insurance Snapshot services is limited to the cost of the Insurance Snapshot ($20.00) under this agreement. Verifications that are performed at no cost to the patient carry zero liability.

I accept terms & conditions

Type your first and last name to electronically sign this form

Coverage varies from insurance company to insurance company and even from plan to plan within each company. It's complicated, so it’s best to do the Insurance Snapshot to find out about your coverage to avoid surprises. All clients billing insurance are required to complete the Insurance Snapshot with Larsen Billing Service before their first visit with us. Some plans have requirements for prior authorizations or other provisions, and the only way for us to be certain of the best way to cover your care is for you to register with Larsen Billing before coming into our care.

Keep in mind that we bill insurance as a courtesy to you. Your contract for insurance payment is between you and your health insurance company. We will do our best to help you understand your coverage, but you are responsible for verifying that your insurance will cover the care we provide. Ultimately, you are responsible for the cost of your care with us, as with any provider.

If you do not register with Larsen Billing before your first visit, your visits will be self-pay and due at the time of service (non-refundable fee of $250 for the initial visit and $150 for each subsequent visit until you complete your Insurance Snapshot with Larsen Billing). Once you register with Larsen Billing, they will send you a payment plan to estimate your financial responsibility for your care.

Registration Fee

All clients must pay a non-refundable registration fee to hold their spot on our calendar. This fee is $500 and is due at the first visit.

Commercial Insurance

Birth center care involves two types of fees: Provider fees and Facility fees. Provider fees include all of your prenatal, birth, postpartum, and baby care provided by our midwives. Facility fees cover the use of the facility for your baby's birth. Costs have increased significantly for us over the past few years, but insurance reimbursement has not. Due to inadequate reimbursement and restrictions that have resulted in unpleasant surprises from insurance companies, we have unfortunately needed to terminate some of our contracts and are only billing out-of-network to these carriers.

Provider Fees

Premier Birth Center's midwifery care is in-network with most CIGNA and United Healthcare insurance plans. We are currently out-of-network for provider fees for all other insurance carriers.

Facility Fees

Both facilities are in-network with Aetna, CIGNA (except EPO), and United Healthcare for birth center facility fees. The Chantilly birth center is also in-network with CareFirst HMO and PPO/POS plans. We are not contracted with CareFirst for birth center facility fees at our Winchester location.

Other plans may cover the facility fee according to your insurance plan's out-of-network rate or offer GAP Exceptions. If you have out-of-network coverage for facility fees, we will attempt to bill your insurance for facility services so it will apply to your out-of-network deductible, and you may receive a partial refund of your facility fee deposit if they pay those claims. We do not guarantee facility fee reimbursement for out-of-network plans.

Home Birth Fee

All clients planning a home birth must pay $1500 as a home birth fee. This is not reimbursable by insurance. The only exception to this is for clients who have CIGNA. CIGNA covers the home birth fee (except EPO plans). The home birth fee covers the cost of the RN Birth Assistant and the use of our equipment for your birth. You will also need to purchase a home birth kit that contains all of the disposable supplies for your birth, and you may need to rent a birth pool if you plan a water birth and do not have a tub that will work well for that. Birth pool rentals vary but are typically between $150 and $250, depending on the pool you use.

Other Fees

Labs are billed directly to your insurance. You may receive a bill from Quest or LabCorp for any copay required by your insurance plan. Ultrasounds are in-network with insurance or are available for $185 as a self-pay option at the Chantilly location. However, if you prefer to use an imaging center or maternal-fetal medicine practice, we can refer you to the provider of your choice.

Medicaid

We are Medicaid providers, and our midwifery services are covered by United Healthcare Community Plan (Medicaid MCO). There are some fees not covered by Medicaid plans, so those would be an out-of-pocket expense. This would include either a $2000 facility fee or home birth fee. Contact us to learn more. You are required to register with Larsen Billing before coming into our care.

Aetna
Aetna does cover midwifery care at the birth center (at the out-of-network rate) and is in-network for facility fees. However, Aetna has a very strong anti-homebirth policy. Aetna considers "planned deliveries at home and associated services not medically appropriate," so they will not cover any prenatal, birth, postpartum, or baby care if you choose to give birth at home. With this in mind, if you have Aetna and give birth at home, our services will be 100% out of pocket.

Healthshare Programs

Healthshare programs like Samaritan Ministries (Classic), Liberty HealthShare, Medi-Share, and Christian Healthcare Ministries (Gold) generally cover our care almost 100%. We often do not require any prepayment for Samaritan Ministries Classic or Christian Healthcare Ministries Gold plans. For other Christian sharing plans, we may require paying a portion based on your sharing plan's requirements.