Payment Structure Q&A

  • What is an Assignment of Benefits (AOB)?

    An AOB is meant to transfer the patient’s ERISA rights to the provider, including the right to directly receive payment from the insurance company.

  • What is ERISA?

    ERISA is short for the Employee Retirement Income Security Act of 1974.

  • Which health insurance policies have ERISA rights?

    The majority of health insurance plans that are offered by employers are covered under ERISA. Plans that do NOT have ERISA rights include: Medicaid, Medicare, or health insurance that is offered by a church or a governmental entity.

Deductibles, Copays, and Coinsurance Q&A

  • Is the amount a client pays toward the out of network is also applied to the in network deductible?

    For most plans, there are separate deductibles for in and out of network. But some plans will have a "shared deductible." It's a good question to ask when you do the VOB. If you don't know, then assume the deductibles are separate.

  • Can I bill 59430 in addition to 59400?

    No. You may only bill 59430 when the postpartum care is not already billed within another code. You cannot bill 59430 in addition to 59400, 59510, 59610, 59618, or 59614.

  • Can I bill 59430 for each postpartum visit?

    Generally speaking, no, 59430 may only be billed once per client/patient. It covers all routine postpartum care. Non-routine visits, and routine visits that are after the "postpartum care period" may both be billed separately, but not with 59430. Unless...there is payor guidance that directs you otherwise. Always follow payor guidance, if it exists.

  • What is the difference between Extended Access and All Access?

    Billing for Midwives is now a multi-course program, that also includes a private monthly 30 min Zoom session to troubleshoot specific issues. This program is available for a monthly fee that includes all past courses, the private Zoom session, and new courses as they are created. The name for this membership has been changed to All Access to more accurately describe the new service model. Those who enrolled under Extended Access receive all the benefits of All Access, and will keep their contracted monthly rate until membership is canceled.