More Financial and Insurance Info
Families that choose the Goshen Birth Center are seeking a special kind of birth. We aim to make our services affordable and accessible. Please refer to the following information as you plan your expenses. SCROLL DOWN FOR MORE
One of the challenges in the early days of pregnancy is getting an understanding of your health insurance coverage and figuring out cost for having your baby. It can be overwhelming! There are so many terms and information to collect. Our goal here is to give you the information in basic form and get your started in your planning. First the basics- maternity care is billed differently than other health care.
First the basics- maternity care is billed differently than other health care.
Maternity care is billed in “global fee” format. This means that you do not pay for each prenatal visit at the time of service like other office visits. However, you will make payments throughout your prenatal care so that your estimated cost is paid by the time you are 36 weeks pregnant. Labs and ultrasounds are billed at time of service over the course of your prenatal care. Once your baby is born the bill for the professional and facility fee is submitted to your insurance.
Professional Fee: Paid to your midwife or doctor for your prenatal care, birth and all office follow up post partum. In our case this is paid to Fairhaven OBGYN for the services of the midwives.
Facility Fee: There is a separate fee for the facility you use for your birth. We charge one fee that covers both mother and baby care all in one. The hospital charge separate fees for mother and baby greatly increasing your cost. This fee is billed once the birth has occurred.
You will meet with the financial counselor at Fairhaven during your first appointment. The counselor will discuss our payment policies with you and help you determine your cost to use the midwives and birth center. You will be expected to pay your deductible and co-insurance estimates over the course of your prenatal care to be paid in full by 36 weeks pregnancy. If the estimate is not fully paid we reserve the right to refuse use of the birth center.
*It is very helpful if you come to that appointment educated and familiar with your benefit plan. See the pdf linked on the financial page for help obtaining this information.
Terms & Definitions
Deductible: This is the amount of money you are responsible to pay towards your medical costs before insurance starts to pay. Plans may have an individual deductible (a dollar amount each member will meet on their own) or a family deductible (a dollar amount that all family members’ costs contribute to). A deductible resets once a year.
Co-Insurance: the percentage of medical costs that you are responsible for once your deductible has been met.
In-Network: providers and facilities contracted with your specific insurance plan for coverage
Out-of-Network: providers and facilities that are not contracted with your insurance plan and thus cause you to pay a higher rate for their services
*Most plans have a different deductible and co-insurance amount for their in and out of network charges
Out-of-pocket maximum: This is the maximum amount that you pay for medical expenses during the plan year. In other words, your total costs for medical services will not be higher than this amount.
How to determine your benefits:
Contact your insurance company; check your insurance card for a number or website to contact a customer service representative. Once you reach a representative provide them with the required information.
We have prepared a worksheet to help you get the correct information. Just download and print the Benfits Worksheet PDF:
Once you are registered as a client of the birth center we will call to verify all of this information as well.
Now that you have your benefits you can determine your cost for the birth center. Once that estimate is made we will work with you to make a payment plan.
GBC is in network with the following insurance companies:
Anthem Blue Cross Blue Shield
United Healthcare & UMR
Physician’s Health Plan (PHP)
Sagamore/ Cigna Health Network
If your insurance company is not in network with us and you are
interested in working to get your insurance plan to cover GBC please
call Betsy Black for more information on how to get a “Gap Exception”
Other Out of Pocket Expenses
There are a few services that are not covered by our facility fee and are due within 30 days of the birth:
Indiana Newborn Metabolic Screen $100: This is a mandatory test done at the second home visit. The fee goes directly to the Indiana Newborn Screening Laboratory.
IV & Medication charges: Varies from $100-300 depending on use
Nitrous Oxide: $200, a $50 refundable fee is paid prenatally if you use the nitrous oxide for more than 30 minutes the full fee is charged.
Extended Stay: $25 per hour post-discharge, up to 24 hours stay. Stay overnight for less than the cost of a hotel room.
Labs: If we send a blood sample to the lab either Goshen Hospital or South Bend Medical Foundation, they will bill you directly. This will apply if you are RH negative or if your baby is jaundiced.
RhoGam injection: $150 (billed by Fairhaven) for Rh negative mother if baby is Rh positive