Insurance & Payment


 

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We know this can be confusing! Birth centers may be a new concept for you... and figuring out the best way to bring your baby into the world is a big decision for your family, in the realms of hopes and dreams AND finances. The best way to navigate these decisions is to come to an orientation. Afterward, you will receive your estimate from our billing specialist, so you have the information you need to make an informed decision. We are here to help! Read more below.

 

The cost of maternity care at Dar a Luz

We provide an estimate of your out-of-pocket costs for maternity, birth and newborn care at Dar a Luz after you have attended an orientation. We do this for everyone, prior to your first appointment with a midwife, so that you can make an educated decision about your care. Every policy with every insurance company may have different rules. We can estimate your out-of-pocket expenses based on your insurance coverage only by checking your specific policy.

We have four things that we charge for:

  • Registration fee
  • Professional fee (this is one-on-one time with the midwives)
  • Facility fee (this is the use of the birth room and the birth assistant present at your birth)
  • Newborn care for the first month

If you sign up with us, we will collect your portion from you by week 36 in your pregnancy. You can make payments or pay it all at once. We are flexible in our payment plans, so email our billing specialist, Erica, if you have a special situation.

 

Insurance we accept:

Aetna

Aetna

AIG's UNM student coverage (covers professional fees only)

AIG's UNM student coverage (covers professional fees only)

Blue Cross Blue Shield commercial plans, any state (however, no BCBS Marketplace plans are accepted at this time)

Blue Cross Blue Shield commercial plans, any state
(however, no BCBS Marketplace plans are accepted at this time)

BCBS Medicaid/Centennial Care (covers professional fees only), Molina's Centennial Care, Presbyterian Centennial Care (covers professional fees only), United HealthCare Medicaid/Centennial Care (covers professional fees only)

BCBS Medicaid/Centennial Care (covers professional fees only), Molina's Centennial Care, Presbyterian Centennial Care (covers professional fees only), United HealthCare Medicaid/Centennial Care (covers professional fees only)

 
Christian Care Ministry

Christian Care Ministry

Cigna

Cigna

GEHA/PPO-USA (covers professional fees only)

GEHA/PPO-USA (covers professional fees only)


 
Great-West

Great-West

HealthWest

HealthWest

Medicaid

Medicaid

Molina's Healthcare Marketplace/Exchange Plans

Molina's Healthcare Marketplace/Exchange Plans

MultiPlan/PHCS national network (covers professional fees only)

MultiPlan/PHCS national network
(covers professional fees only)

New Mexico Health Connections

New Mexico Health Connections


Presbyterian (covers professional fees only)

Presbyterian (covers professional fees only)

TriCare / United HealthCare Military & Veterans

TriCare / United HealthCare Military & Veterans

United Healthcare commercial plans (most will cover professional fees only, but Sandia National Labs employees have facility coverage)

United Healthcare commercial plans
(most will cover professional fees only, but Sandia National Labs employees have facility coverage)

 

Getting Medicaid/Centennial Care to help cover your costs

We have a lot of information about getting Medicaid! Many families are eligible for assistance -- is yours?

 

More about insurance networks, our fees, and your estimate

If you feel bewildered by insurance, you're not alone. We are here to help you understand your coverage.

Start by reading this easy guide to understanding insurance terms and rules. Don't let insurance companies intimidate you! Be armed with knowledge.

 
Guide from medicalbillingandcoding.org

Guide from medicalbillingandcoding.org

 

 

Also check out our page on the Affordable Care Act and the way it's changing the insurance landscape.

Below is a brief description of how insurance payments and your payments work together to cover our fees. For detailed and customized information, please come to one of our maternity orientations and request a verification of your insurance benefits. After you attend an orientation, we can help you understand your insurance situation! 

 

The first thing to know is that our fees fall into two categories with most insurance companies: In-Network and Out-of-Network. Keep reading to learn more about this.

 

In-Network:

Our professional fees are in-network with most insurers and your out-of-pocket portion of these fees is determined by your insurance coverage. This means you'll receive the same insurance coverage you would receive with other in-network providers, such as doctors. Professional fees are one-on-one midwifery fees for obstetric, newborn and gynecology care.

If you are getting gynecology services with us, you can expect to pay the same as you would with any doctor. All of our gynecology services are in-network with the insurance companies listed above.

If you are getting maternity services with us, in many cases you will pay less for the part of your care that is in-network, because our fees are lower, and all of our services are out-patient, meaning you don't have to pay a special hospital admission copayment and other admission fees. Your baby won't have hospital admission fees or nursery care fees at Dar a Luz, and their first month of care is included.

Out-of-Network:

Note: Gynecology services are almost always in-network. This section is for maternity clients only.

Our Facility fee is out-of-network with some insurance carriers. Our Facility fee covers such services as the midwives being on-call to support you, birth classes, other education classes (such as your Carseat class), educational materials, support groups, 24/7 midwife access, administrative research and review, data entry, physician consultations, birth supplies, your RN birth assistant, room & board during labor and birth, the majority of the fee for a transfer doula if needed, and home visit travel. 

We know this is a lot of information! We will detail all of your out-of-pocket costs in your personalized estimate after you attend an orientation. If you have any questions about how our midwives and birth center are covered by your insurance, please email our billing specialist, Erica.

 
 

Contacting your insurance company

There are many reasons to get in touch with your insurance company when you find out that you are pregnant. You should know what your insurance does and doesn't cover, what they need from you and what you can expect to pay.

When contacting your insurance company about your coverage at Dar a Luz, keep these important points in mind:

  • The providers' names, if required, can be found on our staff page. All are Certified Nurse Midwives.
  • All of our services are out-patient. We do not provide in-patient services, admissions, or "stays."
  • We file our insurance claims for global maternity services after your baby is born. No maternity claims will be filed before your baby comes (unless you transfer to another provider before then). If you receive care that is outside of the maternity umbrella, separate charges are generated.
  • We file insurance claims for in-network services only. Out-of-network services are charged to you, and after our services are complete you can ask your insurer to reimburse you. Find out what documents they need to reimburse you. Remember that your reimbursement will be subject to your out-of-network benefits, if any.
  • If your insurance company denies or under-pays our claims, you will be responsible for the remainder -- and if they pay more than expected, we will refund you. We will make every reasonable attempt to collect these fees from your insurance company. However, anytime between two months and six months after your baby is born, we may conclude that your insurance company is not going to pay, and then you will be billed. You may be able to file for reimbursement from your insurance company after you have paid us. Ask them what kind of documentation is required. We will provide any documentation we can to assist you in your claim.
  • If our facility is out of your network, ask your insurance company if they can grant you an in-network exception, gap exception or transition of care agreement to cover birth center service fees. If they grant it, this can increase your reimbursement after the birth (we will still collect the fee from you). Get any agreements in writing, including the name, title and contact info of the person who granted the exception; authorization number; and the terms agreed upon.
  • If your insurance renews during your pregnancy, you may be subject to new terms, such as a change in co-payments, deductibles or co-insurance. Ask your insurance company about the renewal date and any upcoming changes (and be sure to let Dar a Luz know of any changes promptly -- the insurance company will not notify us).
  • Ask about the rules for adding your new baby to your insurance, and then remember to call them and enroll the baby before the deadline. Otherwise our claims will be denied and you will be responsible for all baby costs. Ask whether your baby's care will be subject to her or his own deductible, copays and co-insurance.
  • Ask if you are required to notify your insurance company that you are pregnant, to enroll in any of their special pregnancy programs, or to get pre-authorizations for any part of your care. Remind them that your labor and birth at the birth center will be an out-patient service, not a hospital admission.
  • Find out if there are special pre-authorization requirements in case you decide to go to a hospital. However, remember that all insurance companies are required to pay for emergency care, no matter which hospital you go to.
  • You can file a complaint about your insurance company if you don't agree with the way they are handling your claims. The NM Superintendent of Insurance has a Managed Health Care department that processes all complaints involving HMO and PPO plans licensed to conduct business within New Mexico. The Managed Health Care Bureau may be reached at 855-427-5674. File a Managed Healthcare Complaint here.

Please contact us with any questions or concerns. We're here to help!

 

About payments:

We accept payments by cash, credit card, FSA/HCA/HRA spending account card (usually Visa), and check.

Gynecology clients who are self-paying (completely uninsured) receive a discount if the bill is paid at the time of the visit.

Prenatal care and birth services clients: Full payment is due by the 36th week of pregnancy, unless other arrangements have been made with the office manager.

We offer discounted fees to our clients who have been approved for Medicaid maternity coverage (see our Medicaid page).

Payment plans are available and we will work with you on an individual basis to the best of our ability. Find out more about our fees by emailing our billing specialist, Erica.

Did you find the information on this page helpful? We hope so! Our model of care involves educating our clients as well as supporting them in their choices. If this appeals to you, come to an orientation to learn more!


Medicaid: Is it right for You?

Medicaid is a government-sponsored health care insurance, paid for by taxpayers.

New Mexico's Medicaid program is called Centennial Care.  Its services include physical health, behavioral health, long-term care and community benefits.  Centennial Care uses four existing insurance companies to provide this coverage.

Frequently Asked Questions and answers about Centennial Care are here.

Medicaid's mission is to provide no-cost or low-cost health insurance coverage to financially eligible citizens. Even if you didn't qualify before getting pregnant, you may qualify for maternity coverage now. Medicaid is expanding to cover more people.

Confused about Medicaid?

Many people are!  But it's easy once you get into it. You only need to know if you qualify, and then complete an application.  You can do both from this page.

Just add up the gross pay on your household's paychecks (the amount before taxes, insurance and everything else is taken out), and come up with the total for an average month.

If it's less than the numbers below*, you can qualify for Medicaid.

  • Up to $3,384 for a pregnant woman and her unborn baby (family of 2)
  • Up to $4,255 for a pregnant woman and unborn baby plus one (family of 3)
  • Up to $5,125 for a pregnant woman and unborn baby plus two (family of 4)
  • Add $871 for each additional family member

*These numbers are good through the end of March 2018.

Start the application process immediately if you think you may qualify for Medicaid.  See below.  It can take 45 days for coverage to be set up, and while you wait, your appointments may or may not be covered by Medicaid.

    Find out for sure if you can get Medicaid, and apply today

    You can find out for sure whether you qualify for any Medicaid program in New Mexico several ways. Choose the option that's easiest for you:

    Before you go for Medicaid ... 5 things to know

    1. Before you start an application, gather these:

    • Social security numbers of the family members to enroll
    • Employment and income information -- paystubs, tax return, W2 forms
    • Policy numbers, if you currently have health insurance (this doesn't affect your eligibility)
    • The first date of your last menstrual period
    • Though they are not supposed to require it anymore, they may ask for a "proof of pregnancy" letter from your midwife or doctor

     

    2. If you qualify for Medicaid, you will be asked to select a Managed Care Organization (MCO) to administer your care.  We accept all four MCOs (BCBS, United, Molina, Presbyterian), but you get the best deal with Molina.

    If you choose Molina, you will pay the least at Dar a Luz.  Molina Centennial Care covers almost all of our fees. The others do not cover our birth center services fee.

    Each MCO has the same coverage for most things: certified nurse-midwife fees related to maternity, lab work, ultrasounds, hospital admission, doctor visits, specialist visits, other medical care, behavioral health, long-term care, prescriptions, emergencies, vision, dental, certain kinds of rehabilitation, and x-rays.

    However, not all providers accept all MCOs. Call your favorite providers and find out if your choice will matter to them.

    What else makes the MCOs different?  They may have different value-added services, such as free carseats, cribs, and mileage reimbursement for trips to provider offices.  And only Molina covers our facility fees. Visit their websites to find out what else they offer:

    - BCBS
    - Molina
    - Presbyterian
    - United HealthCare

    You can request an MCO change by calling the Insure New Mexico! Solutions Center at (888) 997-2583 or (800) 283-4465, or by contacting the MCO you want. For example, Molina makes it easy to switch: Request a callback here or call (877) 373-8986.

     

    3. If you have other health insurance, don't be afraid to report that to Medicaid. They don't use that information when determining your eligibility for pregnancy coverage.  And if you fail to report it to them, it could mean big trouble later ... insurance fraud.  You could also be stuck paying your own medical bills plus fines for the extra handling of claims.

     

    4. Pregnancy Medicaid is usually back-dated to the beginning of your pregnancy.  So if you've been told that you are eligible, your prenatal care at Dar a Luz will likely be covered no matter when you start seeing us.  We can hold our claims for a short time while you wait for your coverage to be ready, but you must keep us informed of the progress.

    And it's important to know that even with insurance or Medicaid, you could be billed for your visits if your coverage falls through (this is rare).

     

    5. Whatever you decide to do, please keep us informed. Tell us about all of your insurance policies.  Tell us whenever anything changes.  After your baby is born, add him or her to your Medicaid coverage within 30 days and tell us when it's done.

    If you have questions about how Medicaid works at Dar a Luz, send an email to our billing specialist, Erica at erica@daraluzbirthcenter.org.

    To file a complaint about Medicaid or any insurance, call the NM Superintendent of Insurance at (505) 827-4601.  Phone numbers for other states' Departments of Insurance can be found online.