FAQ

Which Cohosh services do I need?

Do I have to verify my benefits before Cohosh will prepare and submit claims for me?

Nope! You know what you need, so our services are à la carte.

I already had my baby. Can Cohosh still verify my benefits?

We're happy to verify your benefits at any point in care. We recommend doing it as soon as possible so you’ll have more time to plan for your out-of-pocket expenses.

Why doesn’t the verification of benefits report include the amount I’ll be reimbursed?

Our crazy healthcare system allows insurers to give themselves a discount for each billed service and call it the "allowable" amount. Unfortunately, insurers won't reveal allowable amounts to out-of-network providers before a claim is submitted (they say it's proprietary information). Allowable amounts vary even within the same insurer, based on the specific structure of your individual policy.

Your reimbursement will also be impacted by the other covered medical care you receive during the year. Care that gets you closer toward meeting your deductible and out-of-pocket maximum will increase the amount of reimbursement you receive.

These factors make it very difficult to accurately estimate the amount you'll be reimbursed. We’d hate to give you inaccurate information, so we don’t include a reimbursement amount in the verification of benefits report.

Why should I file two claims -- one for myself and one for my baby -- instead of just one for myself?

It’s a rule in the insurance industry that care for only one “patient” can be on a claim. Your baby received care specific to their health, so they’ll have a claim that’s separate from yours. Most people choose to submit two claims: one for their care and one for their baby's care. The billed amount for a newborn's care usually totals several hundred to a thousand dollars, so the potential reimbursement often exceeds the additional claim prep fee we charge. It’s up to you whether you file one or two claims!

Which insurance plan should I choose?

Our general advice is to pick a preferred provider organization (PPO) plan over exclusive provider organization (EPO) and health maintenance organization (HMO) plans, and to choose the plan with the lowest deductible you can afford. Calling to make sure home birth is a covered service is also a great idea!

My plan doesn't cover midwives. Is that legal?

If midwives are licensed in your state but aren't covered providers, your plan may be in violation of the Affordable Care Act, which forces insurers to cover all providers licensed in the state in which the services were provided and acting within the scope of their license. Grandfathered plans (those that were in place before March 23, 2010) and self-funded plans are exempt from this provision of the Affordable Care Act.

My plan doesn't cover home birth. Is that legal?

Unfortunately, insurance companies are allowed to exclude home birth from coverage -- except in New Hampshire, New Mexico, New York, and Vermont, where insurers are required to cover home birth.

My plan doesn't cover out-of-network providers. Is there anything I can do?

Some plans let their members apply for a gap exception, a waiver that allows services you receive from an out-of-network provider to be priced and paid as though they were from an in-network provider.

For a gap exception to be approved, you must demonstrate that the services you’re seeking are covered by your plan and medically necessary, and that in-network providers are unable or unwilling to provide them. Successful arguments we’ve used include a lack of in-network providers who attend home births, hospital-induced anxiety from the trauma of previous births, and a history of fast labors, among others.

Why did my insurer reimburse less than my midwife charged?

We know the compassionate, individualized care you received from your midwife was priceless! Your insurance company doesn’t agree, sadly. As we wrote in an answer to another question above, our crazy healthcare system allows insurers to give themselves a discount for each billed service and call it the ‘allowable’ amount.

Another reason clients may receive less reimbursement is that they have some or all of their deductible and out-of-pocket maximum left to satisfy. You’re responsible for 100% of costs until you meet your deductible, and a portion of costs (your coinsurance portion) until you meet your out-of-pocket maximum.

Why did my insurance reimbursement get mailed to my midwife instead of me?

Who receives the payment (provider vs. client) depends on the policies of the insurer -- there's no way to specify on the claim form who the check should go to, and every insurer handles it differently.

Can I still submit a claim for reimbursement if I used HSA funds to pay for midwifery care?

It's our understanding that because an HSA is funded from an employee's pre-tax earnings (as opposed to an HRA, which is funded by an employer and thus remains the employer's property), it's fine to use HSA funds for midwifery care and then submit an insurance claim for that care. It would be the same as a client paying by cash/check/credit card and then submitting a claim to receive insurance reimbursement.

What do I need to do to start working with Cohosh?

Just three things: complete this form to tell us more about your practice, sign and return the service agreement we’ll email to you, and complete and return the fee schedule we’ll email to you.

What fees should I charge insurance companies and my clients?

This is one of the most common questions we hear from midwives! Many of us receive excellent clinical training but not much support in starting a small business: our practice.

We suggest three strategies to midwives who aren’t sure what to charge, especially for the specific services that can be billed in addition to your global perinatal fee or when care has to be itemized:

• Talk to fellow midwives in your area to get an idea of the going rates for perinatal care.
• Find out your state’s Medicaid rates for perinatal services and triple them -- some providers use tripled Medicaid rates as a rough estimate of insurers’ allowable amounts.
• Keep detailed records of the amount of time you spend caring for a few clients. Be sure to include charting, reviewing labs, answering care-related texts and phone calls, consulting with other providers, restocking your birth bag… the many things you do in addition to attending births and prenatal and postpartum visits. Finding an hourly rate that would allow you to cover your salary, supplies, marketing, health insurance, retirement savings, and all the other costs of operating your practice can help you fine tune your fees.

We’re happy to think through the process of setting fees with you!

Which Cohosh services do my clients need?

Where should I direct my clients when they need services from Cohosh?

Please send clients to our website, specifically this FAQ, the Services & Fees page, and our client information form.

Who should pay Cohosh fees: me or my clients?

Most of the midwives with whom we work pass our fees along to their clients. If paying billing fees is the standard among the midwives in your community, however, then it might be wise to do the same. We’re happy to do whatever you think is best!

Why did my insurance payment get mailed to my client instead of me?

Who receives the payment (provider vs. client) depends on the policies of the insurer -- there's no way to specify on the claim form who the check should go to, and every insurer handles it differently.

Why is an insurer requesting a W9 from me?

Nothing to worry about! An insurance company requests a W9 when they don’t have a provider in their vendor system, so this is probably the first time you’ve billed this insurer.

Why is an insurer requesting medical records from me?

Also nothing to worry about! A charitable answer is that they’re just confirming the information we submitted in the claim and clarifying anything that looks questionable. A cynical answer is that they’re expecting out-of-hospital midwives to provide a lower standard of care and/or to document care improperly, so the insurer can deny payment.

I don't have an electronic health record. Can I send you my paper charts?

Ask us for the link to our online superbill! It’s a Choose Your Own Adventure-style path through all of the possible services we could bill, and it only takes about 10 minutes to complete.