Frequently Asked Questions
THERE ARE MANY COMMON QUESTIONS FAMILIES ASK ABOUT OUR AMAZING WOMEN'S WELLNESS CENTER
Midwifery Care Common Questions
The American Association of Birth Centers defines a birth center as a home-like setting where care providers, usually midwives, provide family-centered care to healthy pregnant women. Most birth centers are located separately from hospitals, while a few are inside hospital buildings. In-hospital birth centers must meet specific standards for independence and be separate from the Labor and Delivery unit to be considered true birth centers.
Pregnancy and childbirth are healthy, everyday life events for most women and babies. In birth centers, midwives and staff hold to the “wellness” model of birth, which means that they provide continuous, supportive care, and interventions are used only when medically necessary.
Birth centers are universally committed to family-centered care. In birth centers, the childbearing woman’s right to be the decision-maker about the circumstances of her birth is fully respected. For example, at birth centers, women are encouraged to eat if they are hungry, move about and spend time in a tub as they wish, and push in whatever positions they find most comfortable. Birth centers recognize that the mother knows what her body needs to give birth. The midwives and staff attend to her needs while diligently watching for signs outside the wellness realm.
Since hospitals specialize in treating acute illness and injury, they are an obvious choice for women who have complications that require medical or surgical intervention or who choose to have high-intervention births. However, when normal, healthy pregnant women give birth in hospitals, their care often gets swept up into this same medical way of doing things. The philosophy is often “What if something bad happens?” instead of “What is happening right now?” Standard protocols, meant to prepare for problems that may never arise, can disrupt normal labor for healthy pregnant women.
As a result, many women in hospitals receive interventions, whether or not they need them. Almost all women (87%) who labor in hospitals undergo continuous electronic fetal monitoring, 80% receive intravenous fluids, 47% have labor artificially accelerated with medications, and 43% of first-time moms have labor artificially induced. In addition, 60% of women giving birth in hospitals are not allowed to eat or drink, 76% are restricted to bed, and 92% give birth lying on their backs. There is strong evidence that routine use of these practices, when carried out without medical indications, has few benefits and many potential harms for healthy mothers and babies.
Birth centers offer a more relaxed and personalized approach to childbirth compared to hospitals. Birth centers focus on natural childbirth and provide a homelike setting, while hospitals are equipped to handle high-risk pregnancies and offer medical interventions.
Midwives generally provide holistic, low-intervention care focused on natural childbirth and emotional support, while doctors typically offer more medicalized care, including interventions like epidurals and cesarean sections, and are trained to handle high-risk pregnancies and complications.
Yes, birth centers are a safe and evidence-based option for low-risk pregnancies. Our birth center is staffed by highly skilled midwives who provide comprehensive care and closely monitor the health of both mother and baby throughout the childbirth process.
Evidence confirms that 9 out of 10 women (94%) who entered labor planning a birth center birth achieved a vaginal birth. In other words, the C-section rate for low-risk women who chose to give birth at a birth center was only 6%—compared to the U.S. C-section rate of 27% for low-risk women. This means that the C-section rate for women in birth centers is more than four times lower than that among low-risk women in the U.S.
Pregnancy and childbirth are healthy, everyday life events for most women and babies. In birth centers, midwives and staff hold to the “wellness” model of birth, which means that they provide continuous, supportive care, and interventions are used only when medically necessary.
Low-risk pregnancies can typically give birth at a birth center. However, each individual’s eligibility will be assessed during the prenatal care process to ensure that a birth center is the appropriate setting for their childbirth experience.
In the U.S., 98.8% of births occur in hospital labor and delivery units, with physicians attending 86% of these births. In contrast, 0.3% of births occur in birth centers, where nurse-midwives and midwives provide most of the care. Among women who give birth in hospitals, approximately 85% are considered low-risk, while all women eligible for consideration at a birth center are healthy and low-risk.
There are times when additional collaboration and resources are needed during pregnancy, birth, and postpartum care. We value our highly skilled medical professionals and hospitals in our area to work closely together when additional care needs are present. This doesn’t happen too often, but some people do become higher risk during maternity care needing those medical resources available to create high quality outcomes for both mother and baby.
During labor, there may be times when transfers to the hospitals do arise. Based on the national birth center study, most women (84%) gave birth at the birth center. Out of the entire sample of 1,851, 4.5% were referred to a hospital before being admitted to the birth center, 11.9% transferred to the hospital during labor, 2.0% transferred after giving birth, and 2.2% had their babies transferred after birth. Most of the in-labor transfers were first-time moms (82%).
Out of the women who transferred to hospitals during labor, 54% ended up with a vaginal birth. Most in-labor transfers were done for non-emergency reasons, such as prolonged labor. Less than 1% of the study sample transferred to the hospital during labor for emergency reasons.
While birth centers focus on low-risk pregnancies, our staff is trained to recognize and manage potential complications. We have protocols in place for transferring care to a nearby hospital if necessary, ensuring a seamless transition to a higher level of medical care when needed.
Our birth center offers a variety of pain management options, including hydrotherapy (water immersion), relaxation techniques, massage, breathing exercises, and other natural methods. We prioritize providing a comfortable and empowering birth experience.
Yes, water birth is an option at our birth center. We have specially designed birthing tubs that provide a soothing and comfortable environment for labor and birth. Our midwives can guide you through the process and provide support during a water birth.
Our practice offers full scope midwifery services to our clients. We can provide preconception counseling, prenatal care, birth support, postpartum care, breastfeeding assistance, home visits, newborn care during the first month of life, well-women care, gynecological concerns, and primary care visits. Our independent midwives have in-house resources for lab work, ultrasounds, and routine screenings during pregnancy and women’s health care.
Financial Common Questions
Our services are on an out-of-network and cash basis to provide high-quality, personalized care. We can work closely with you to see if your insurance plan covers our services. Even if you only have in-network benefits, we can often get out-of-network exemption coverage since our care is so unique in the area. Many of our local businesses have set up special preferred provider contracts to help save money for families in the region compared to traditional hospital delivery costs. There is a wide variation of what each family pays for care since each person’s care needs are different and their insurance coverage details. The average family’s out of pocket responsibility costs after insurance processes is $2,500. If your insurance plan doesn’t cover out of hospital births, we have a cash bundled rate that can be discussed as well. Please call today and have our billing specialists verify benefits with your insurance plan to review options specific to your unique situation.
There are many different ways to pay for services with our team. You can use insurance coverage, cash, credit cards, flex spending accounts, health savings accounts, health reimbursement accounts, and payment plans. We will work with you and make the best option possible for paying for our care together.
There are many great insurance plans out there that cover our services. Anything with out of network benefits and doesn’t have a restrictive company policy against out of hospital births should cover our care. The more common plans we recommend families to choose during open enrollment include Blue Cross Blue Shield, Aetna, United Health Care, and UMR. Even if your current plan doesn’t have out of network benefits, we can many times get GAP exemption coverage since our services are so unique and there isn’t another in network provider in our area to see instead. We also can do a complimentary verification of benefits to see if your plan covers our services.
There are a few companies that have specific policies written to not cover home or birth center deliveries. They would cover the pregnancy visits and postpartum care, but not the actual community-based birth charges (most of the costs of the care are accrued during the birth itself). The following insurance plans in Michigan don’t pay for out-of-hospital births – Medicaid, Blue Care Network, Physician Care Network, and Priority Health.
Not necessarily. With our practice having far less interventions and charges compared to a hospital birthing experience (inductions, routine interventions, epidurals, much higher rate of cesarean sections – 34% versus 8%, complications, etc), the care cost is typically pretty similar to what a hospital birth would be. The only exception to that situation is when we can’t get any coverage by the insurance plan and the services are mostly covered by hospital care (like Medicaid, Blue Care Network, or HMO w/ no GAP exemption options). We will give you an estimated cost of care if you chose our practice or decided to go to the hospital after verification of benefits is done with your insurance plan.
It is so hard for families to call and speak with an insurance representative about this foreign world of billing and coding. Our services are so unique that most families AND insurance representatives don’t know the right questions to ask or how to answer them. We would love to do the verification of benefits and help you, BUT if you would like to call yourself directly, this is the wording you would have to say and make sure you ask for a reference number to have evidence of that conversation occurred. When you call your insurance plan to see if coverage is available, you will be asking about professional care with the midwives and facility coverage with the birth center. The question would be what are my out of network benefit details with maternity care. If you have out of network benefits, it is usually covered and counts towards the deductible (amount family owes for covered services before insurance plan starts contributing to payments as well), co-insurance or co-payments (splitting of cost for covered care after the deductible has been met), and out of pocket maximum (max level of cost-sharing amount each year the family has to contribute to before insurance pays 100% for covered services).
When asking about the facility fee coverage, the place of service code is 25 and revenue code 724 (birth center) and 171 (newborn portion of center services). Make sure you take lots of notes and ask lots of great questions. All insurance plans will never promise you anything for coverage until the claims have been submitted and processed. We will work as a team to get your insurance to pay claims promptly and maximum the coverage level so you owe the least amount possible directly out of pocket.
Our practice does all the insurance claim processing steps as a courtesy to you. We will work closely with you and the insurance plan to get all the professional and facility claims processed in a timely manner. Most of the claims go electronically to the insurance companies within 5 days of the services being rendered. Global maternity care (CPT code 59400) gets charged most of the time day of delivery (transfers the charges get broken up into separate codes versus one global care code). It takes up to 30 days for the insurance company to respond to our claim but either paying for the services based on your individual coverage level, request additional documentation, or deny claim based on the details of the plan and may warrant further investigation with insurance company representative to get issues resolved. It takes average 3-5 months after birth to get all the insurance claims processed and FINAL patient responsibility summaries to our families. There will be multiple claims sent out for the care provided to the mother and baby in the clinic, birth center, and home setting. We will try to make this complicated process as seamless and simple as possible and work as a team to resolve claim issues.
Insurance coverage is a complicated world to most people and really important to understand for care with us and all your future medical services. We want to truly help you advocate to have your insurance plan cover what you have legal rights to be owed from paying the monthly premiums each month. Our team of billing experts will work tirelessly on your behalf to get the insurance plans to pay for as much of our care as possible. Here are some common insurance terms that people need to understand:
- Covered services: items that your insurance plan determines with its policies is covered under your policy (most are private businesses and can determine what criteria is required to get coverage for care)
- Non-covered services: professional or facility charges that the insurance company has a policy stating their plan doesn’t cover that item and 100% responsibility of families
- HMO – only in network benefits and seeing providers that decided to take a significantly lower reimbursement rates in order to be a preferred provider on their insurance plan list (even if only out of network benefits, our providers can usually be still covered with GAP exemption on your insurance plan)
- PPO / POS: insurance plan has in and out of network benefits available
- Deductible: amount person has to pay out of pocket for covered services before insurance plan starts doing a portion of costs
- Co-payment: flat rate needing to be paid by patient (typically for office visits) and then insurance plan will pay remaining portion of those visit charges
- Co-insurance: percentage amount that patient and insurance share costs of covered services after deductible is met
- Out of pocket maximum: maximum amount each year that patient has to pay directly for covered services before insurance plan pays 100% of remaining charges
- Professional services: care provided that is processed by insurance companies with claim form CMS 1500
- Facility charges: covered facility services sent to the insurance company using claim processing form UB04
- Prior authorization: some insurance plans require for certain services and procedures that approval by insurance plan is required before care can be rendered (we can definitely help with this)
- GAP exemption: if your in network list of providers and facilities doesn’t offer your requested covered services with a preferred provider in the area, many insurance cover an out of network provider to make up for that “gap” in their options for your family (we can definitely help with this process)
- Physician referral: some insurance plans require your primary care provider to send a referral form for a specialist or out of network provider to be covered under your insurance plan (we can definitely help with this process)
- CPT codes: coding system used to communicate with insurance plans on the claim forms to translate into specific services being rendered
- POS codes: coding system used to note place of service location for services rendered on insurance claims
- Revenue code: facility coding system used on insurance claim forms
- Verification of benefits (VOB): confirming your insurance plan is active and the details of what your insurance plans and how the shared costs for those services and facility charges are split between patients and the insurance companies
- Estimated cost of care: no medical practitioner will give you exactly the cost of care ahead of time that patients owe until the insurance claims are processed. We don’t know what exactly you will need for care (each pregnancy experience and history is different) and insurance plans make the final decision what charges are covered with the plan and not. Any practice or hospital you see will only give you estimations of costs until all services have been rendered and all insurance claims have been processed. We do have cash bundled discount rates that can make things easier for families (especially works well when your insurance plan doesn’t cover out of hospital births)
- Explanation of benefits (EOB): patients will get in the mail a statement from their insurance plan when claims are processed (NOT A BILL FROM MEDICAL PRACTICE) explaining what could be patient’s responsibilities for care rendered. In network providers legally have to bill patients for the difference that insurance plans didn’t cover. Out of network providers can choose to send patients a bill for the patient responsibility noted by the insurance plan. We look at each person’s individual situation, care that was rendered, and operational costs for the practice to make cost sharing between insurance companies and patients as fair as possible.