midwifery clients:

Looking for help with insurance reimbursement or understanding your benefits?

Please complete the form below and I’ll be in touch about my Verification of Benefits (VOB) and/or Superbill services.

Verification of Benefits – $40
I’ll call your insurance company directly and ask the right questions to get the most accurate information about your out-of-network coverage tailored to your unique birth plan, whether at home or a birth center.

Superbill – $125
After your care is complete, I’ll provide an itemized statement with the CPT and diagnosis codes your insurance company needs. You can use this to submit a claim for potential reimbursement.

Expectant Mom's Name

First Name

Last Name

Your (expectant mom) date of birth

MM

DD

YYYY

Phone

(###)

###

####

Email

Please check your spam/junk folder if you do not receive a response within 24-48 hours. Especially if you have a hotmail address

Midwife's Name:

First Name

Last Name

Practice / Birth Center Name:

If name is same as Midwife, put "same"

Midwife/Birth Center's location

City/State

What insurance plan do you have?

Example: BCBS, UHC, CIGNA, MEDICAID, etc.

Insurance member ID

Insurance group number

Insurance provider number

Number on the back of your card

(###)

###

####

Your estimated due date (or date you delivered)

MM

DD

YYYY

Inquiring about

Verification of Benefits

Superbill / Invoice needed

"Other" Please add response in comments

Message/Comments