Fees at the FCWH Nurse Midwife Practice
At Full Circle Women’s Health nurse midwife practice, we are dedicated to working with all women who seek integrated, holistic care. Please contact us so we can help you find a way to become a part of our practice.
We offer a “Meet the Midwives” visit at no charge, which is an opportunity to discuss who we are, what you are looking for, and if we can meet your needs. We encourage you, your partner, and any family members to discuss any questions or concerns you may have.
Services and Fees
Services: Prenatal care visits occur every 4 weeks until 28 weeks of pregnancy, every 2 weeks until 36 weeks of pregnancy, weekly until 40 weeks of pregnancy, then twice a week until your baby is born. Problem visits can occur at any time they are needed. Blood for diagnostic testing is drawn in our office. We refer you to a local radiology center for sonograms.
Your midwife will be in the hospital throughout your labor and birth to provide skilled care and support. After the baby is born, your midwife will visit you daily while you are in the hospital, then see you in the office for postpartum visits in one and six weeks.
Fee: The fee for our pregnancy care is $8,000. This includes pre-natal care, labor & delivery and post-partum care.
Am I covered by my health insurance for prenatal care, birth, and postpartum care?
New York State law requires insurance companies that provide maternity coverage to pay for midwifery care for any pregnant woman who desires it, even if the midwives are out-of-network.
Service: Midwives provide preconception counseling, family planning, gynecological care, annual pelvic and breast exams, pap tests and screening, and treatment for infections. They care for teens, and post childbearing women and can provide hormone replacement therapy. Midwives teach and answer questions about proper diets, personal hygiene, exercise, sleep and how to maintain a healthy lifestyle.
Fees: The fee for an initial gynecological visit is $250. Yearly follow up gynecological exams is $175. Problem or follow up visits range from $50 – $100 depending on the complexity of the issue. Payment is due at time of service unless prior payment arrangements are made with our billing assistant.
For those women who are uninsured or who do not have out-of-network benefits, we have a fee schedule based on the type of visit. If you do have out-of-network benefits, we may bill your insurance company for you after any deductible and or co-insurance is satisfied.
The FCWH nurse midwife practice is contracted to participate with BCBS, Affinity and Hudson insurance as in-network providers. The patient is responsible for any co-payment, co-insurance or deductible at time of visit.
FCWH accepts assignment on a majority of all other insurance companies. If you have coverage other than those we participate in, we suggest you call your insurance company to clarify your benefits. Most policies have out-of-network benefits available. Lab work, ultrasounds, additional testing and hospital fees are covered by most plans on an in-network basis, but you must contact your insurance company for verification and to pre-authorize in-patient labor and delivery providing your expected due date. We do not accept Medicaid for obstetrical services.
If you prefer, we can call your carrier for this information. Please contact our billing assistant, Tania Cruz, by phone (914 421 1500), fax (914 421 1501) or email (email@example.com). Please be prepared to provide the necessary information for us to verify benefits (i.e. patient name, patient date of birth, insurance company name, identification number).
Billing Questions and Answers:
What is the difference between in-network and out-of-network?
- Insurance companies contract with physicians, midwives, and other practitioners who then must accept a fixed schedule of lower reimbursement as in-network providers.
- HMOs, by definition, only cover in-network providers.
- Out-of–network providers are those not contractually committed to a specific insurance company.
Do I have out-of-network benefits?
- Call your insurance company. PPO policies normally have out-of-network benefits. HMO’s do not routinely pay for services provided by an out-of-network provider. They may provide out-of-network exceptions for maternity benefits. Be sure to inquire about the availability of this option. Historically, this is routinely provided based on the fact FCWH is the only nurse midwife practice in our area that guarantees a midwife delivery.
What is my deductible?
- Your deductible is the amount that you, the patient, is responsible for and is specific to your individual insurance policy.
- Call your insurance company. Ask them what your in-network deductible is (if any) and what your out-of-network deductible is. These amounts are the responsibility of the patient to pay to the provider.
What is a co-insurance and do I have one?
- Call your insurance company. Insurance companies may reimburse a fixed percentage of the reasonable and customary fee based upon your specific insurance policy. For example, an 80/20 plan means they will pay 80% of their reasonable and customary charge and the patient is then responsible for the remaining 20% after your deductible has been met. This 20% is your co-insurance. Some carriers reimburse at 100% of reasonable & customary.
What is “reasonable & customary” or “usual and customary”?
- Insurance carriers establish a specific reimbursement attached to a particular procedure for a provider according to their location or zip code regardless of the provider’s billed amount. (Be sure to request this amount from your carrier.)
- For example, your provider bills Aetna for an annual gynecological office visit in the amount of $150. Aetna will reimburse their “R&C” of $87.50 less your copayment, coinsurance or deductible.
How do I know what the reasonable & customary reimbursement is for my service?
- We will provide you with the necessary procedure code or codes for your service to give to your insurance company. In most cases, they will not release the “reasonable and customary” reimbursement to an out-of-network provider. This information is provided to the patient only.
What about lab work, ultrasounds, and hospital fees?
- These fees are separate from FCWH fees. Your coverage will continue to cover laboratory, radiology, and hospital fees in the same way as when seen by an in-network provider. We recommend you check with your insurance company to be sure.
Who will receive payments from the insurance company?
- Out-of-network payments are routinely sent to the patient. It is the responsibility of the patient to sign the check over to Full Circle Women's Health and to mail it as soon as it is received.
What if this arrangement presents a significant financial hardship?
- We can assist you in several ways by offering payment plans or a sliding scale.
- Please let us know if we can help. We honor your commitment to FCWH and ours to you; we look forward to beginning or continuing our relationship with you and your family.
If you have any further questions and or concerns, please contact our Billing Assistant, Tania Cruz at firstname.lastname@example.org or call (914) 421-1500. Tania is available to help you understand your coverage and out-of-pocket costs for Full Circle Women’s Health services.