In-Network and Out-of-Network Coverage
Most insurance companies today will contract with healthcare providers in what are called preferred provider organizations or a PPO. Healthcare providers will agree toaccept a reduced payment from the insurance company as payment in full. I am notwilling to enter into a reduced payment contract with insurance companies. Most policies are set up so that you have coverage under either in-network for preferred providers, or out-of-network for providers who are not contracted with your insurance company. In addition, the majority of policies will provide in-network reimbursement for an out-of-network provider if there are no contracted providers, in the same service category,within a fifty-mile radius of where you live. There are no contracted midwives within a fifty-mile radius of Redding.
Once you have made a decision for midwifery care, you will need to contact your insurance company to obtain authorization for in-network reimbursement for an out-of-network provider. This will typically result in a twenty percent increase in coverage. In addition, many policies now have a separate deductible portion for out-of-networkservices. If that is the case with your policy, you will experience an additional savings because any portion of your in-network deductible that has already been paid by you forother healthcare during the same calendar year will be applied toward the birth care.
It is important to obtain this authorization as early in your pregnancy as possible.
In the unusual event that your care must be transferred to a hospital and physician, onlypreauthorized care can be billed at the in-network rate. When you are followed foryour entire pregnancy and birth, then the insurance is billed for a flat rate for servicesrendered, once the baby is born. If care is transferred for any reason during pregnancy or birth, then each visit is billed individually. Only preauthorized visits can be billed at the in-network rate.
