Paying for Care

Paying for Care - Financial Planning During Pregnancy

Financial planning is an essential component of preparing for the birth of your baby. The Minnesota Birth Center (MBC) wants to be your partner in navigating insurance and planning your finances over the course of your pregnancy so that upon the arrival of your sweet baby, there are no financial surprises. At your first appointment, MBC will walk you through our financial policy and work with you to develop a plan that reflects the details of your insurance policy.

You are invited to review our Frequently Asked Financial Questions or to email billing@theminnesotabirthcenter.com with your insurance questions.

Insurance

There are three primary factors to consider when you have insurance:

1. Commercial Insurance: it is important to understand your policy’s maternity  care coverage and whether it is in- or out-of-network with MBC – these are two crucial factors in determining the family’s care coverage and financial responsibility. MBC has in-network contracts with the following insurance payers:

  • Medica
  • Health Partners
  • BCBS-MN
  • Aetna
  • Cigna
  • United
  • Preferred One – Effective June 1, 2016; please verify that your plan includes birth center care
  • For insurance plans that are out-of-network, MBC can provide an ‘in-network request letter’ to help you petition your insurance company for in-network coverage.

2. Public Programs and Medical Assistance

  • MBC prefers plans that are administered through a commercial payer
  • MBC accepts UCare & Medicaid-MN plans

MBC does not accept the following:

  • Out-of-state medical assistance programs
  • TriCare

3. Newborn Insurance Coverage: MBC must have insurance information for your newborn within 30 days of birth. Submitting insurance information to MBC in a timely manner protects you from assuming full financial responsibility for the newborn costs associated with birth.

Self-Pay

MBC accepts self-pay patients and medical cost-sharing groups such as Samaritan Ministries or Medishare. For these patients we will enter into a comprehensive contract that outlines the anticipated expenses and payment timeline.

Codes & Fees

Below is the estimated fee schedule for prenatal care, labor, delivery and newborn care. Please note, this does not include any necessary labs, problem appointments or hospital fees in the event of a transfer. Most labs that are drawn at MBC are processed and billed by Health East Medical Lab.  No lab costs are reflected in the costs below.

MBC’s providers (Certified Nurse-Midwives, RNs, Sonographer, Medical Director) are committed to practicing evidenced-based care and will only assess, test and treat when medically indicated. In the event that additional care is necessary MBC will submit bills accordingly.

If you are a patient with insurance, your bill will reflect Minnesota Birth Center’s and your insurance payer’s contracted rates and the terms of your insurance policy.

If you are a self-pay patient, Minnesota Birth Center will work with you to arrange a payment plan.

BirthBundle®

[table sort=”desc,asc”]
CPT,FEE FOR MOTHER,Price
99205,60min Initial Consultation,$381.55
59400,Maternity Care,”$4,500.00″
59409SG,Facility Fee,”$4,400.00″

A4450,Delivery Supply Kit,”$150.00″
99349,Home Visit,$225.00
76805,20wk Ultrasound,$398.22
,Mother Total,”$10,054.77″
CPT,FEE FOR NEWBORN,PRICE
99464,Initial Stabilization,$300.00
99463,Care and Discharge,$272.16
99348,24 Hr. Home visit,$156.00
92558,NB Hearing Screen,$150.00
J3430,Vitamin K Injection,$30.00
99463SG,Newborn Facility Fee,”$1,265.00″
,Newborn Total,”$2,173.16″
,TOTAL,”$12,227.93″
[/table]

Frequently Asked Financial Questions

For Clients With Insurance:

I have commercial insurance. Are you in network on my plan?
MBC is contracted with the following insurance companies:

  • Aetna
  • BCBS-MN (out of state BCBS plans are typically covered under this agreement)
  • Cigna
  • Health Partners
  • Medica
  • Preferred One – Effective June 1, 2016; please verify that your plan includes birth center care
  • United

This means that we have a contract with the company and may be considered in network. Each insurance company has many different plans, which all vary in what they do and do not cover and which providers are considered in network.  

It is your responsibility to call your insurance company and confirm MBC is in network for your particular plan. It is helpful to use the tax ID to look up our practice as searching by name does not always yield accurate results. Our Tax ID is 271689468.  

In our experience, we are usually in network, but we cannot guarantee we are always in network. If you learn we are out of network we encourage you to ask if you could receive a referral from an in network provider in order to have the birth center covered as in network.

If your insurance is through an employer, you could speak with the benefits coordinator at the place of employment to determine if the plan could be changed. If you have any questions please contact our billing office. 

I have Medical Assistance (MA). Do you accept this type of coverage?
Yes, MBC accepts MA plans from Minnesota. Please note we do not accept out-of-state MA plans.  

We prefer MA plans administered by a commercial carrier. When enrolling in MA, most people will be given the choice of commercial administrators of their MA plan. If you do not choose an administrator you will usually eventually be assigned to one. We ask that you choose a commercial plan as soon as you can to expedite claims processing. 

Will my insurance cover a birth center?
As freestanding birth centers become more common in the state of Minnesota and in the United States as a whole many plans do cover freestanding birth centers – however some plans do not. It is your responsibility to call your insurance company and ensure that prenatal care, labor, and delivery at a freestanding birth center is not an excluded service. 
What is your financial policy?
Our financial policy is that you prepay your deductible by 37 weeks’ gestation. If you are planning on birthing at Minnesota Birth Center we will also collect the deductible, or an estimate, for your baby’s care. You will be presented with a financial contract that reflects the amount you are expected to prepay; MBC will work with you to determine a prepayment schedule.  

Please note – your financial contract will reflect your deductible; it is not meant to be an estimate of your total responsibility. Your responsibility will vary depending upon your insurance plan, whether you have an out of pocket maximum that is higher than your deductible, and if you owe coinsurance and/or co-pays on services received.

Here is an example to illustrate our prepay plan in action:

Family Deductible $3,000
Prepayment made by 37 weeks $3,000
Total Billed Amount $12,227.93
Client Responsibility After Claims Processed $3,750
Portion covered by prepayment $3,000
Remaining Balance Due $750

Does my baby need insurance?
If you deliver at the Minnesota Birth Center your baby will receive care from our clinical team, therefore we will have claims for your baby. Many insurance companies have a set timeframe in which you can add a baby after their birth – we encourage our clients to find out prior to their delivery how long they have to insure baby on the intended plan so they are not at risk of being self-pay for services received.  

Once you have insured your baby, please provide MBC with their policy information. MBC requests to have baby’s insurance information no later than 30 days post-birth.  

It is your responsibility to insure your baby in a timely manner.  If you do not add your baby in the specified timeframe the coverage may not be backdated to their date of birth and the charges for their care will become your responsibility.

Once we know whether baby is self-pay or insured we will submit the claims appropriately.  

If you deliver at the hospital, MBC will likely not have claims for your baby, but you should still secure insurance for them and provide that information to the hospital where you delivered. 

How do I obtain insurance for my baby?
Contact your insurance company or your Human Resources Department if you receive insurance through your employer and tell them you are expecting a baby and would like to know how to add baby to your insurance plan.

You cannot enroll your baby until they are born, but it is worthwhile to call before your baby is born to learn what paperwork and documentation you will need in order to enroll them in the desired plan, and the timeframe you have to submit that documentation.  

It is your responsibility to insure your baby in a timely manner – some plans have a timeframe in which you can add a baby after they are born in order to have coverage backdated.  If you do not add your baby in the specified timeframe the coverage may not be backdated to their date of birth and the charges for their care will become your responsibility. 

How much does having a baby with MBC cost?
The amount you and/or your insurance company are charged is dependent upon services received. You can find a cost of care estimate on our Paying for Care page, this estimate assumes you begin and end your prenatal care with MBC.  Ultimately, the claims we submit will reflect the care you receive. 
Of the estimated costs listed, what will my responsibility be?
Your responsibility is based upon your contract with your insurance company. MBC will submit claims to the insurance company that you present at the time of care; they will process the claims and send MBC an explanation of benefits that explains what they paid, and what you owe. We apply that information to the claim and then send you a bill for the amount your insurance tells us is your responsibility or use your prepayments to cover the balance due. 
How does MBC compare to the cost of a hospital birth?
Birth centers are usually cheaper than hospitals – here’s a snapshot of the facility fee for local hospitals compared to MBC:  

Service Facility Vaginal Delivery w/o complications* Normal Newborn*
HCMC $13,127 $3,806
Abbott Northwestern $13,813 $4,748
United $14,062 $4,604
MN State Hospital Avg $10,747 $3,823
MBC $4,550 $1,265
Average Savings $6,197 $2,558

*These charges are an average of what the hospital charges for use of their facility. This price does not include charges for the provider or other professional fees, such as pharmacy, diagnostic imaging, or lab work. Source 

I am planning a birth at United hospital with your midwives. How will my costs change?
If you are planning to deliver at United you will not be charged by Minnesota Birth Center for baby care.  In addition, you will not be charged the facility fee that is listed on the BirthBundle estimate. Instead, you will be charged for these services by United Hospital.

Our financial policy for clients planning a United Hospital birth is to collect the individual deductible, rather than the family deductible, by 37 weeks. 

What happens if I need or want to transfer to the hospital in labor?
Your billing will reflect the care you received at Minnesota Birth Center, plus any care our Midwives provide at the hospital. If you transfer to the hospital in labor, you will not be charged by Minnesota Birth Center for baby care (the hospital and their providers will charge you for these services).

A Facility Fee would be charged by both MBC and the transferring hospital, but MBC’s fee would be less than the rate listed on our website. As with a birth center birth, we will wait for the claims to process and use your prepayment plan to satisfy your responsibility for the care you did receive, and refund you any excess prepayment. 

What happens if I transfer out of your practice prenatally?
Your billing will reflect the prenatal care you received at Minnesota Birth Center. We will wait for the claims to process and use your prepayment plan to satisfy your responsibility for the care you did receive, and refund you any excess prepayment. 
What happens if I'm planning on switching insurance during my pregnancy?
Let us know as soon as you have switched – we will need to know your new company name, your new ID and group number. We’ll also need to know the effective date of the change – this is extremely important to ensure claims are submitted to the correct company.

Once we have updated information from you we will update your financial contract to reflect your new coverage and deductible, and can adjust your prepayment plan as needed. 

What if I have two insurance policies?
Let us know as soon as possible.  We must know which plan is primary and which plan is secondary, and both plans must also know that you have dual coverage and which plan is primary and secondary.  

In dual coverage situations, claims must first be submitted to the primary company, processed (usually about 4-8 weeks), then submitted to the second company and processed (usually about another 4-8 weeks and, in our experience, many times it will take longer than 8 weeks).  

All told, for clients who have dual coverage we see that claims typically take 10-16 weeks to fully process – usually longer. For this reason, it is imperative that both companies know you have dual coverage, and both companies know whether they are first or second in line to pay claims. MBC must also have the correct order of the policies from you. Having this information in place helps the claims process more quickly.

Dual coverage is complex; we highly encourage any client considering dual coverage to talk to both plans they are considering to understand the benefits and potential impact on their responsibility. 

I have a dedicated account where I save money for health care expenses, and/or my employer contributes money. Can I use it?
Yes – sometimes these accounts have requirements that do not allow them to be used to prepay. Before using this type of account to prepay please verify the account can be used in that manner. 
I prepaid money to MBC, but it’s not reflected on my insurance website as already being paid towards my deductible. What’s up?
The money prepaid to MBC will be held in your MBC account until claims have processed and your insurance company determines you have responsibility on a claim. Once they’ve processed a claim with your responsibility they will reflect that you have met that portion of your deductible.

Usually at that time they will send you an Explanation of Benefits (EOB) that may show the amount that you will owe. The EOB is not a bill – please do not pay your insurance company!  

They also send this information to MBC; we apply it to the claim and, once your responsibility is known, we use your prepayment to cover that portion of the claim. Once your prepayments have been used up, we will send you a bill for any remaining responsibility.

If you have prepaid money or scheduled prepayments to MBC and end up meeting your deductible elsewhere (i.e. incur other medical expenses where you have responsibility with a different provider) let us know and we can adjust your prepayment plan as necessary. 

I’ve met a big portion of my deductible this year, but the financial contract you gave me shows my whole deductible amount. Why?
We prepare financial contracts using the deductible estimate for the year in which you deliver. Many insurance plans follow the calendar year and reset the accumulations towards your deductible back to $0 on January 1.  

If your delivery is expected in the next calendar year we will collect your full deductible, since accumulations made this calendar year won’t roll over.  If your plan follows a plan year we will prep your contract accordingly. 

You referred me to another provider - can I assume they are in network?
No – MBC providers may refer you to other providers for a variety of reasons – since they are separate clinics you must check with your insurance company to ensure the clinic is in network and the services you plan on receiving are covered. This includes but is not limited to referrals for non-invasive prenatal testing, external cephalic version, gestational diabetes counseling, massage, and physical therapy.  

If you receive a bill from another clinic or lab, please call the clinic or lab and/or your insurance company directly to discuss the balance and any questions related to claims processing. 

For Self-Pay Clients:

I do not have insurance, but I am a member of a medical cost sharing group. How will billing be handled?
We are happy to work with clients who use medical cost sharing groups.  We treat your account as self-pay, and provide you with a detailed estimate of the cost of care to provide to the cost sharing group. This estimate will reflect a 15% discount from the amount we typically bill for services. We will work with you to set up a prepayment plan to prepay the estimated costs by 37 weeks’ gestation.
How much does having a baby with MBC cost?
The amount you are charged is dependent upon services received. MBC will provide you with a detailed estimate which can be amended to include services specific to your care as you progress through your pregnancy, if you wish. Please refer to our Paying for Care page for the detailed cost estimate, as a self-pay client you will receive 15% off the posted rates.
Of the estimated costs listed, what will my responsibility be?
As a self-pay client, your responsibility will be the listed rates, less our 15% self-pay discount.
How does MBC compare to the cost of a hospital birth?
Birth centers are usually cheaper than hospitals – here’s a snapshot of the facility fee for local hospitals compared to MBC:

Service Facility Vaginal Delivery w/o complications* Normal Newborn*
HCMC $13,127 $3,806
Abbott Northwestern $13,813 $4,748
United $14,062 $4,604
MN State Hospital Avg $10,747 $3,823
MBC $4,550 $1,265
Average Savings $6,197 $2,558

*These charges are an average of what the hospital charges for use of their facility.  This price does not include charges for the provider or other professional fees, such as pharmacy, diagnostic imaging, or lab work. Source

What is your financial policy?
Our financial policy is that the cost of your initial visit is paid at the time of service, and your estimated responsibility for your birth is prepaid by 37 weeks’ gestation. We will present you with a detailed financial contract that reflects the estimate and work with you to find a payment plan that suits your family’s needs.
Does my baby need insurance?
If you deliver at the Minnesota Birth Center your baby will receive care from our clinical team, as such they will incur costs. We ask that families let us know how baby’s costs will be handled by 30 days after baby’s birth, or sooner if the information is available. Once we know whether baby is self-pay or insured we will handle the claims appropriately.
What happens if I need or want to transfer to the hospital in labor?
Your billing will reflect the care you received at Minnesota Birth Center, plus any care our Midwives provide at the hospital. If you transfer to the hospital in labor, you will not be charged by Minnesota Birth Center for baby care (the hospital and their providers will charge you for these services).

A Facility Fee would be charged by both MBC and the transferring hospital, but MBC’s fee would be less than the rate listed on our website.

What happens if I transfer out of your practice prenatally?
Your billing will reflect the prenatal care you received at Minnesota Birth Center. Once we finalize your billing, we will apply your prepayment to the balance due and refund you any excess prepayments.