FAQ: Billing and Insurance for Nurse Midwifery Service and Birth Center

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If I have an HMO plan, how do I get a UC San Diego primary care or family practice physician as my primary care physician (PCP)?

We can assist you in choosing or changing your PCP to a UC San Diego Medical Center physician that has an open panel for HMO patients. PCPs are usually chosen based on your needs and geographic area. For assistance, you may call our Physician Referral Service at 1-800-926-UCSD (8273) or visit us on the web at www.health.ucsd.edu

Why do I need a PCP if I want the midwives providing my care?

Midwives and obstetricians are not listed as primary care providers on most insurance plans.

Do I need to see the PCP before I can come to the midwives for care?

Once you have a PCP at UC San Diego Health System, you can self-refer for obstetrical and gynecological services. You do not need to see the PCP first, as this can delay your entry into prenatal care. We will assist you in obtaining an internal authorization within the UC San Diego system. We encourage you to develop a relationship with your PCP for all of your health care, not just obstetrics and gynecology.

Are there restrictions about changing my PCP with my insurance company so I can access the UC San Diego system?

Each HMO has its own rules. Some will not allow a transfer of care or entry into care after 28 weeks of pregnancy (40 weeks is considered a normal term pregnancy). All insurance companies must be notified by the 15th of the month for change to be effective by the 1st of the following month. If you have an HMO insurance plan, you can call our Managed Care office at 619-471-9123 and they will be able to answer your HMO questions.

Will my insurance plan cover the midwives’ services?

UC San Diego Health System accepts most PPO insurance contracts. A few HMO plans are not contracted with UC San Diego Health System. Because these contracts change annually, you should contact your individual insurance company for the most up-to-date information.

What if my insurance company states that birth centers are not covered, or are covered with a different reimbursement rate?

The Birth Center is physically located in the UC San Diego Medical Center, and is not a free-standing birthing center. Your insurance company will be billed for a “hospital admission.” There is no difference in charge or reimbursement if you deliver in the Birth Center or in Labor & Delivery.

What if my insurance company cannot find my midwife’s name in their directory of covered providers?

Do not panic! Currently, insurance companies do not list midwives individually. The midwives bill as part of UC San Diego Medical Group’s department of Reproductive Medicine.

If I have a managed care Medi-Cal plan, can I see the midwives?

UC San Diego Medical Center contracts with several managed care Medi-Cal insurance carriers. We are not affiliated with Kaiser, Sharp or Universal Care.