Hello, My name is Angela and I work with home birth midwives to assist their clients with verifying insurance and itemized superbill needs. Midwife Michele Kazmier, CNM is out of network with all insurance plans. If you have out of network benefits, I can verify your insurance (see VOB Verification of benefits below) and create an itemized superbill for you to submit to your insurance for your midwifery care claim. The submitted statement should be processed by your insurance company to go towards your benefits (deductible, coinsurance, out of pocket) with the possibility of a reimbursement if you satisfy the patient portion of your insurance benefits. If you have an HMO or MEDICAID plan, unfortunately, your plan does not have out of network benefits and you will not be able to submit an itemized statement.

PLEASE NOTE: I am separate from Lavender Moon Midwifery, therefore, I have my own fees for the services I provide for expecting moms and families. Forms of payment I accept: Zelle, Paypal, and Venmo. My fees are required prior to rendering services.

Verification of Benefits: (fee: $40.00) A call is made for each verification of benefits. The right questions are asked to obtain the information needed for your home birth. A detailed form is sent to you afterwards with your benefits for out of hospital birth with Michele Kazmier / Lavender Moon Midwifery.

Superbill: (fee: $125.00) for you to provide to your insurance. This includes an itemized account of the care that you received from your midwife that includes CPT, diagnosis codes, and all required information neccessary to submit an itemized superbill yourself.

You will still owe your midwife her full fee. When you submit an itemized statement, your insurance should process the midwifery services rendered to go towards meeting any out of network deductible, coinsurance, and out of pocket max you may have. If your deductible is met in full, your coinsurance will then kick in and your insurance then pays a percentage of your care. Please read my blog: What is an out of network deductible? for a better understanding of how insurance companies process out of network claims.

Complete the form below and I will contact you about my VOB (verification of benefits) and Itemized Superbill services.

Name *

First Name

Last Name

Your date of birth *

YYYY

Phone

(###)

###

####

Email *

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

What insurance plan do you have? *

All Medicaid and most Marketplace plans do NOT have out of network benefits.

Insurance member ID

Insurance group number

Insurance provider number

Number on the back of your card

(###)

###

####

Are you the main subscriber for your insurance plan *

Yes, I am the main subscriber

No, my partner is the main subscriber

No, my parent is the main subscriber

Your physical address on file with the Insurance Company: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your estimated due date (or date you delivered) *

YYYY

Location of birth *

Where do you plan to give birth?

Home Birth

Hospital (if you transferred/transported prior to today's date)

Will you be adding baby to your insurance plan? *

This will help me know if you want to submit a claim for the baby to your insurance

Yes, I am adding baby to my plan

No, I am not adding baby to my plan

I will be adding baby to a different plan (please explain in comment section below)

Inquiring about *

Verification of Benefits

Superbill / Invoice needed

"Other" Please add response in comments

Message/Comments/Questions

Please check your spam/junk folder if you do not receive a response within 24-48 hours. Thank you!

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