Insurance FAQ's

Is Willow Midwives an “in network” provider with my plan? How does my policy cover the professional services at birth and the facility fee at an outpatient facility? Most policy information is available on your insurance plan’s website.

Our address is 3033 Excelsior Blvd, Suite 585, Minneapolis, MN 55416. Our NPI numbers are: Clinic and professional services-1801299128 and facility-1750771143. These are important identifiers.

Please explain my eligibility and benefits for pregnancy, birth postpartum and newborn care. What is my deductible? What is my co-insurance percentage?

The amount you pay for your pregnancy and birth is determined by these two amounts. Your deductible is the amount you will pay out of pocket before your insurance starts paying for anything and it resets every year. Your co-insurance amount is the percent AFTER meeting your deductible, that you will be responsible for. If your plan is not in-network with us, be sure to ask what your out-of-network benefits are. Typically, the out-of-network deductible and co-insurance numbers are higher if you are considered out of network to come to Willow. SOMETIMES THIS IS STILL A COST SAVINGS FOR YOU.

Are pregnancy labs, ultrasounds, and other pregnancy procedures covered under my plan? Are they subject to my deductible?

MN law requires health plans to cover routine prenatal labs. These charges MAY be applied to your deductible which will result in an out of pocket cost to you.

How does the pregnancy billing work?

Your initial visit is lengthy, detailed and extensive and therefore is charged after your visit. Your 2nd visit, and each prenatal visit thereafter, and your midwife care and postpartum care are billed as a bundle. One charge for all of those services. This is standard and all providers bill the same way.

Your baby's care will be billed separately because insurance sets them up on their own account and they are a separate person after they are born. Regardless of where your baby is born, this is also a standard billing practice.

Frequently
Used Terms

EOB:

Explanation of benefits. Not a bill, but looks like a bill. Insurance companies are required to explain the way they are covering your services. You won’t receive a bill from us until after your insurance has processed. If you have your baby at our birth center, there will be an EOB for your care, for your baby’s care and for the Birth Center facility.

Deductible:

The amount that you will pay out of pocket, each year, before insurance will pay for services.  Even though it is your expense, it is important that the charges get processed through insurance so they can track the use of your deductible. In most cases, you can expect to pay the amount of your deductible for both yourself and your baby regardless of your location of birth.

Contracted rate:

This is confusing stuff. The charges we send to insurance are different than the amount that applies to your deductible, coinsurance and final bill. Here’s why: Willow has established contracts with each insurance company. In creating a contract, we can be “in-network” providers in most cases. In the contract we agree on a reimbursement that is LOWER than the amount we bill. This reduces your expense and it gives more clients an opportunity to choose birth center care.

Co-insurance:

The percentage of your bill that you will be charged after you pay the deductible. If you have a high-deductible amount, there is sometimes NO co-insurance rate. In most cases, the Co-insurance is stated as a shared percentage: 80%/20% is most common and it means that after you have met your deductible of $X, you will also pay for 20% of the rest of the bill. Knowing these numbers can really help you budget!

On your parent’s insurance?

Be aware that a parent’s insurance will usually NOT cover pregnancy-related care nor grandchildren. If your parent’s policy is secondary, see below.

More than one insurance policy?

Some families are covered by more than one insurance. Make sure all insurance companies know about the other and they use the term COB or coordination of benefits to determine how your services are covered.

Out of Pocket Maximum:

This is the most you are obligated to pay for services rendered. This includes your deductible and co-insurance payments. Out of pocket maximums are different depending on whether you are receiving in-network or out-of-network care.

HERE’S WHY IT GETS COMPLICATED:

• You consume actual health care services. e.g.,

  • Drugs from pharmacy

  • Provider services in a clinic (Willow Midwife/doctor/PA/NP, etc)

  • Facility usage (Willow Birth Center/hospital/surgical center)

  • Procedure usage (Ultrasound, XRay, MRI’s, etc)

• Payment calculations begin:

  • The insurance company (or employer) uses the money they have been paid from your monthly premiums or taxes to pay their employees (and buy office buildings for them to work in) to do these things:

    • Hire negotiators to establish contracts with Willow providers to reduce the payouts to pay those who provide care (often commission-based)

    • Hire administrative employees who look at bills sent to insurance by Willow providers (who hire staff people to send them the bill) and compare billed rates to contracted rates (see above), then send you an EOB (explanation of benefits) to try to explain those items billed

  • 2-4 months pass while the bill works its way through these:

    • Adjudication (this is yet another system where claims get sent first to see if they are clean before passing to the insurance company)

    • Insurance company individual departments ascertaining contracted rates

    • Insurance company determination of appropriate billing practicing

    • Insurance company denial and appeal process of some claims including requesting your medical records to scrutinize the claim

    • Insurance determines their responsibility (from contracts they’ve negotiated) and pays Willow 2-14 months after you’ve received care.

    • Willow sends a bill to you for the remainder (your deductible, copay, coinsurance)