Coverage varies from insurance company to insurance company, and even from plan to plan within each company. It's complicated, so it’s best to do the Verification of Benefits to find out about your coverage so that there are no surprises. All clients billing insurance are required to verify their commercial insurance coverage with Larsen Billing Service prior to their first visit with us. Some plans have requirements for prior authorizations or other provisions, and the only way for us to be certain of the best way to cover your care is for you to register with Larsen Billing prior to coming into our care.

 

If you do not register with Larsen Billing before your first visit, your visits will be self-pay and due at the time of service (non-refundable fee of $250 for the initial visit and $150 for each subsequent visit until you complete your VOB with Larsen Billing). Once you register with Larsen Billing, they will send you a payment plan with an estimate of your financial responsibility for your care. Our billing representative is Ginger Burkett and she can be reached via email at ginger.burkett@larsenbilling.com or by phone at (801) 396-5185 Ext. 144. Ginger is happy to answer your questions.

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Registration Fee

All clients are required to pay a non-refundable registration fee to hold their spot on our calendar. This fee is $500 and is due at the first visit.

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Commercial Insurance

Birth center care involves two types of fees: Provider fees and Facility fees. Provider fees include all of your prenatal, birth, postpartum, and baby care provided by our midwives. Facility fees cover the use of the facility for your baby's birth. Costs have increased significantly for us over the past few years, but insurance reimbursement from Anthem/BCBS and Aetna has not. Due to inadequate reimbursement from these carriers for our professional services, we have unfortunately decided to terminate our contracts and are only billing out-of-network to these carriers. We will continue to be in-network with United Healthcare and Aetna for facility fees.

 

Provider Fees

Premier Birth Center's midwifery care is currently in-network with Aetna, United Healthcare, and Anthem/Blue Cross Blue Shield. CareFirst processes provider claims through Anthem BCBS. CareFirst is generally in-network for non-HMO plans. Effective 8/1/2023, Premier Birth Center will no longer be in-network for provider fees for Anthem/BCBS and Aetna. All provider fee claims for people with those insurance plans will be filed as out-of-network claims with all insurance carriers. There are some costs not covered by insurance. Contact us to learn more about that.

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Facility Fees

Both facilities are in-network with Aetna and United Healthcare. The Chantilly birth center is also in-network with CareFirst HMO and PPO/POS plans. We are not contracted with CareFirst for Facility Fees at our Winchester location. Other plans may cover the facility fee according to your insurance plan's out-of-network rate. If you have out-of-network coverage for facility fees, we will attempt to bill your insurance for facility services so that it will apply to your out-of-network deductible, and you may receive a refund of your facility fee deposit if they pay those claims. We do not guarantee facility fee reimbursement for out-of-network plans.

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Home Birth Fee

All clients planning a home birth are required to pay $1500 as a home birth fee. This is not reimbursable by insurance. The home birth fee covers the cost of the RN Birth Assistant and the use of our equipment for your birth. You will also need to purchase a home birth kit that contains all of the disposable supplies for your birth, and you may need to rent a birth pool if you plan a water birth and do not have a tub that will work well for that. Birth pool rentals vary, but are typically between $150 and $250, depending on the pool you use.

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Other Fees

Labs are billed directly to your insurance. You may receive a bill from Quest or LabCorp for any copay required by your insurance plan. Ultrasounds are in-network with insurance or are available for $185 as a self-pay option at the Chantilly location. However, if you prefer to use an imaging center or maternal-fetal medicine practice, we can give you a referral to the provider of your choice.

 

Medicaid

We are Medicaid providers, and our midwifery services are covered by some United Healthcare Community Plan. There are some fees not covered by Medicaid plans, so those would be an out-of-pocket expense. This would include either a $1500 facility fee or home birth fee. Contact us to learn more. You are required to register with Larsen Billing prior to coming into our care. There is no fee to register with Larsen Billing for people with Medicaid.

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Tricare

Tricare Select pays for much of your midwifery care with Premier Birth Center. People with Tricare Prime may be covered with a referral from their PCP.  Tricare will no longer guarantee facility fee coverage, so there will be some out-of-pocket expenses. Contact us to learn more.

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Aetna
Aetna does cover birth center care and is in-network for facility fees. However, Aetna has a very strong anti-homebirth policy. Aetna considers "planned deliveries at home and associated services not medically appropriate," so they will not cover any prenatal, birth, postpartum, or baby care if you choose to give birth at home. With this in mind, if you are planning a home birth, our services will be 100% out of pocket for you. 

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Share Plans

Christian sharing plans like Samaritan Ministries (Classic), Liberty HealthShare, Medi-Share, and Christian Healthcare Ministries (Gold) generally cover our care almost 100%. We do not require any prepayment for Samaritan Ministries Classic or Christian Healthcare Ministries Gold plans. For other Christian sharing plans, we may require paying a portion based on your sharing plan's requirements. 

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Uninsured

Not covered by any of these plans? We also have affordable self-pay plans and income-based discounts. Contact us and we will find the best solution to suit you.