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Insurance Coverage and Billing

In-Network Insurance Coverage

River Valley Birth Center and the providers are in-network with many insurance plans!

Here are some of the companies we are contracted with or participate in their networks:

  • Blue Cross Blue Shield
  • Medica
  • Health Partners
  • PreferredOne
  • Cigna
  • UCare
  • South Country Health Alliance
  • Aetna
  • United Healthcare
  • VA Community Care
  • Any insurance company that uses the established networks of the above companies.

If you are uncertain if we are in-network with your insurance company, give them a call and ask.

If we are in-network with your plan, after care is provided, you will be responsible for co-insurance, co-payments, and/or deductible amounts, as determined by your insurance plan.

Plan specific information:

Even when we are in-network with an insurance company, it is important to understand what your individual plan covers. Some plans use a smaller network or exclude certain types of care or only specific facilities, so checking in with your insurance plan is crucial for understanding what your plan specifically covers.

If your plan requires a prior authorization for care, a referral, or additional paperwork prior to coverage, this is your responsibility to find out and collect. To make this process easier, we have a Verification of Benefits form to assist you with the right questions to ask. We recommend that you complete this form and bring it with to your first prenatal visit. The form can be printed off right here: River Valley Birth Center VOB

Medicaid Specific Information:

Medicaid and plans offered through the Minnesota Health Care Programs only covers care offered by in-network providers. We are covered by the majority of MA plans in the state of Minnesota, but with a few exceptions including Prime West Health. If you have a medicaid plan that does not cover River Valley Birth Center, we can request an exception or a prior authorization for approval. There is no need to conduct a verification of benefits for a medicaid plan as the services covered are the same for all members.

Medicaid as secondary payer:

We understand this can be confusing, but we aim to try to simplify the information as much as possible. Many pregnant women qualify for medicaid as a primary or secondary insurance. Secondary insurance means that you have insurance already (maybe through your work, your partner’s employer, or a parent), but that you qualify to have a second form of insurance. The most common form of this is having an insurance plan through an employer and then having medicaid in addition. How this billing works is that we drop the claims to your primary insurance plan and they apply deductibles and co-insurances to that claim and then send it to the secondary insurance for processing. If the primary insurance plan did not pay us at least what the medicaid rates are, then medicaid pays us that remaining amount of money and you are not billed any out-of-pocket expenses.

To see if you qualify for Medicaid as primary or secondary insurance, check the income guidelines here (be sure to count the pregnant woman as 2 members of the family): MNsure Income Guidelines

You will need to apply for MA as soon as possible as they will only backdate for a short period of time.

Homebirth Specific Information:

In the state of Minnesota, it is exceptionally rare for an insurance plan to cover homebirth. Most plans will cover prenatal care and postpartum care, regardless of birth location. If you are planning to have a homebirth, you will need to pay the fee for a homebirth and newborn care out-of-pocket. When a service is excluded from insurance coverage, it will not apply to your deductible or co-insurance either. This is an important matter to consider when deciding on birth location. If you are planning a homebirth with our team, we will still bill your prenatal and postpartum care to your insurance plan and then you will need to pay for the homebirth and immediate newborn care to River Valley Birth Center by 36 weeks gestation.

HealthShare Program Information:

Health Share Programs are a little different from health insurance programs. Starting January 1, 2020, families utilizing a health share program vs insurance will need to pay for the global maternity care and birth center facility fee in advance. We will provide you with invoices and documentation so that you may get reimbursed from your health sharing plan directly. Some health share programs will allow reimbursement in advance. This payment does not have to occur in one lump sum and payments can be made through the entire pregnancy. Newborn care will be billed after your baby is born. Again, we will ask for families who have health sharing programs for coverage to pay the newborn bill and then seek reimbursement from their health plan. If you have questions or concerns about this, please find out details from your health sharing program and then also discuss it with us.

Out-of-network Coverage:

If we are not in network, we will still happily bill your health insurance for care and it should be covered at your out-of-network rates.

Tricare:

Unfortunately, River Valley Birth Center is not covered by Tricare. Tricare has requirements for participation in their network that River Valley Birth Center does not meet.

Self-pay/Cash pay:

If you do not have health insurance or a health sharing plan and need to pay cash for your care, please discuss this with us early in your care. You may be eligible for a sliding fee scale or other discounts.

Newborn Insurance Coverage:

While typically calling family and friends with the good news of a healthy baby is on people’s minds after giving birth, it is important that you also call your insurance as soon as possible! Often there is a short window of time to get a newborn added to a policy and you do NOT want to miss that window or your child will be without insurance until the next open enrollment time. Your newborn does have their own health bills starting at birth: newborn exam and stabilization, any medications administered, newborn screenings, and newborn checks and weight checks as well as a visit to the pediatrician. Your insurance will not automatically enroll a newborn nor is the newborn automatically covered by medical assistance/medicaid without you placing those important phone calls to let them know of your child’s birth. Should a family not enroll their child in a health plan, the family will be responsible for the bill as self-pay.

As soon as you have confirmed that your child is enrolled in health care coverage, you must let our office know that information. They will not automatically appear in our system as having valid coverage.