• Verification of benefits

    Verifying benefits is the process of obtaining information regarding a member’s insurance coverage. This helps to present providers and clients with a true idea of coverage, to determine the best options for payment. The goal is to obtain optimum reimbursement while alleviating surprises along the way. This service includes verifying your benefits and submitting a gap exception or prior authorization, when possible.

    Verify My Benefits

  • Invoice Preparation

    Invoice preparation includes a detailed invoice for clients’ Flexible Spending Account (FSA), Health Savings Account (HSA) and/or Health Reimbursement Arrangements (HRA). This invoice may also be used to file a claim with your insurance for reimbursement purposes. This invoice is specifically designed to show that the money spent was an eligible medical expense. This service includes combing through your records and creating an itemized bill with the appropriate codes.

    Create My Invoice

  • Claim Submission

    Claim submission is ideal for clients with high deductibles and/or clients utilizing a provider who does not accept insurance. This service includes claim submission & following the claim until it has been added to your insurance successfully. It normally takes 30-45 business days for claims to be processed. *THIS SERVICE REQUIRES A VOB*

    Submit My Claim

FAQ's

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FAQ's •

  • Claims should be filed after all services have been rendered.

  • We recommend choosing a preferred provider organization (PPO) plan that has a low deductible and co-insurance. Please make sure the plan does not have exclusions for home births, midwives and/or birth centers.

  • We recommend applying for a Gap Exception. If approved, the services you receive from an out of network provider will be priced and paid at the in network rate.

    To get a Gap Exception approved, you’ll be required to prove that in-network providers are incapable or unwilling to provide the services you’re pursuing, the services are medically necessary and they are covered by your plan.

    Alternatively, you can use your out-of-network benefits. Please make sure your benefits do not have exclusions for home births, midwives and/or birth centers.

  • Most insurance companies have a 90 day filing deadline. Some insurances allow up to 12 months. We recommend completing a Verification of Benefits or reviewing your policy to understand your options.

  • Most insurers have an “allowable amount” that they won’t reveal to out-of-network providers, prior to submitting the claim because it’s considered “proprietary information”. However, the reimbursement can be calculated by subtracting your deductible from the allowed amount and multiplying it by the co-insurance.

    EXAMPLE: Your allowed amount is $2500, deductible is $500 and co-insurance is 20%.

    $2500-500 = $2000. Since your coinsurance is 20%, your insurance will pay 80% of $2000. $2000 x .80= $1600. $1600 would be the reimbursement amount.

  • It depends on the insurers policy. Every insurer handles reimbursement differently and they will not always allow us to specify where we would like the check mailed. If your services were prepaid and the check is mailed to your provider, your provider will be responsible for disbursement of funds.