Insurance & Payment

Insurance & Payment


 

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The cost of maternity care at Dar a Luz

We are happy to 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. 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. Your estimate will include:

  • a non-refundable registration fee (due at your first prenatal visit), $500.
  • your portion of the professional fees (based on your insurance coverage), usually your deductible plus co-insurance.
  • your portion of our birth center services fees (in some cases you will pay these facility fees directly to us and you may request your insurance company to reimburse you).
  • your portion of newborn care -- with the Affordable Care Act, routine visits are usually covered 100%, but it depends on your insurance. Usually you will pay a copay or a portion of the baby's deductible.

Depending on insurance, your estimate will likely be between $500 and $3500. We can only provide an estimate, and we will settle your final bill with you several weeks to months after your baby comes.  It depends on how much and how quickly your insurance company pays its portion.

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, if you have a special situation.

 

Insurance we accept:

"Dar a Luz Birth Center is currently working on becoming a licensed birth center.  Until we are fully licensed and have received a facility contract with Presbyterian, all facility fees will be 100% out of pocket to Presbyterian Members. Professional fees will continue to be paid at the in-network level, subject to your specific benefits. Please check back here for any updates or email our billing specialist (see our Staff Directory here) to learn more."

  • 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)
  • BCBS Medicaid/Centennial Care (covers professional fees only)
  • Cigna
  • GEHA/PPO-USA (covers professional fees only)
  • Great West
  • Health West
  • Molina's Centennial Care/Medicaid
  • Molina's Healthcare Marketplace/Exchange Plans
  • MultiPlan/PHCS national network (covers professional fees only)
  • New Mexico Health Connections
  • Presbyterian (covers professional fees only)
  • Presbyterian Centennial Care (covers professional fees only)
  • 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 Medicaid/Centennial Care (covers professional fees only)
  • Note: As of 3/17/15, we are no longer accepting NEW Aetna clients due to Aetna's refusal to negotiate a fair contract with us. If you are an established client with Aetna, we will continue to bill them for your care through 12/31/15.

*Note: As we near the end of the calendar year, policy changes are common. Please notify us as soon as you know of a change to your insurance.

If your insurance company is not listed, contact us and we will attempt to obtain a contract with them.

If you are a woman who is 30 years of age or older and have no insurance, Casa de Salud, with the assistance of the Breast & Cervical Cancer Early Detection Program, is providing free pap smears and mammograms. Email cds.admn@gmail.com to make an appointment.

 

 

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.

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. In most cases, 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 in the "Insurance we accept" section.

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 his or her first month of care is included.

Our birth center service fees (also known as Facility Fees) are out-of-network with some insurance carriers. See the list above, "Insurance we accept." If your insurance company is listed as one that covers professional fees only, then your facility fees will be out of network.  See "Out-of-Network" below for more information on that.

 

Out-of-Network:

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

We have two fees for prenatal care that usually are considered out-of-network: Registration Fees and Birth Center Service Fees (also known as Facility Fees).  These two fees together are usually the largest part of your out-of-pocket expense at Dar a Luz.

No matter what insurance coverage you have, at minimum, you will pay our registration fee at your first prenatal visit.  The registration fee is a non-refundable fee that goes to pay for the hard costs of running Dar a Luz. It is not an insured cost and cannot submitted to insurance for reimbursement.  You may, however, use a health care savings account Visa card to pay this fee if your plan allows it.

Our birth center service fees (also known as Facility Fees) are out-of-network with some insurance carriers. See the list above, "Insurance we accept." If your insurance company is listed as one that covers professional fees only, then your facility fees will be out of network.

Because insurance companies ignore, lose, short-pay or deny out-of-network claims so often, we must collect them from our clients directly.  This is true even if you have out-of-network benefits.  We do not submit out-of-network claims, but we can provide the documentation you may need to seek reimbursement from your insurance company.

Our Birth Center Services fees cover such services as your due-date reservation, the midwives being on-call to support you, birth classes, bonus classes, 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, a transfer doula if needed, and home visit travel.  These services are bundled into the birth center service fee.

Come to one of our orientations to find out more about these fees. If you need to know before coming to an orientation, email our billing specialist.

 
 

Contacting your insurance company

There are many reasons to get in touch with your insurance company when you find out that you are pregnant.

First, if your insurance company has not yet given us a facility contract, it is always helpful to call and write letters to your insurance company telling them why covering our services is important to you, explaining to them how much money Dar a Luz will save them over a hospital, and asking them to bring our facility into their network.  This is a grass-roots effort we've been working on for several years and we need all the help we can get!

Second, 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 insurance company may need to know our previous name, Full Circle Midwifery. Some insurance companies still have our old name and may not be able to find us if they are searching for Dar a Luz.
  • The provider's 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 weeks 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.

 

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 un-insured) 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.