Once you've attended a tour and made the decision to have your baby with us, you are now part of our APM family! The following information will help you in getting started and insurance billing.
If you have any of the following insurance types, the care at APM WILL NOT BE COVERED BY YOUR INSURANCE:
- Any MediCal program; Straight MediCal, IEHP, Molina, LA Care, etc.
- ANY HMO including BC, BS, Cigna, UHC, Aetna regardless of whether midwives are a covered entity or not. APM is not contracted with any HMO.
- Any Covered California insurance program
Our backup physicians office does take most of the MediCal, Covered CA and HMO policies so some clients will initiate care with them, do the labs then transfer to APM.
Most PPO plans will cover Midwifery care at the Out-of-Network rates as APM does not contract with any PPO insurance companies.
If you have Cigna, Blue Cross, Blue Shield, BC/BS, Aetna, United Healthcare and it is a PPO, you can call the customer service number on the back of the card and inquire if "Midwifery Care by a California Licensed Midwife" is covered by your policy. We could have 10 women with Blue Cross and each one will have a different policy and benefits.
If Midwifery Care is a covered benefit you can then ask if there are any contracted midwives within 30 miles of your home address. If there are no contracted midwives, then you may be eligible for an in-network exception called a GAP exception.
Clients pay for APM's services and work with our billing service for any insurance reimbursement.
APM does not do insurance billing. Those with a PPO insurance wanting to bill for services will contract with and pay Earthside Billing to do that for you.
Once you have made the decision you can go to Earthsides website and begin a VOB: Verification of Benefits. Earthside charges $30 for this service as it is typically a 1-2 hour call with the insurance company (mostly sitting on hold). Once they have obtained the VOB they will contact you to set up a time to discuss your benefits and what is covered. You can then decide if you'd like to contract with Earthside to do the insurance billing for you. Once you contract with Earthside they will be granted access to your chart so they bill for both you and the baby.
Click on the link above for more information or to get started on the VOB go to "Get Started"
Families with a HealthShare account such as Christian Healthcare Ministries, Samaritans Ministry, and Solidarity can work directly with APM who will provide you with a Statement of the services including payments, the codes, tax ID and NPI numbers you'll need. There is a $50 fee for billing with these plans. As with any insurance, you'll pay for the APM care up front and get reimbursed by your health share plan.