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 physician (PCP)?

We can assist you in choosing or changing your PCP to a UC San Diego Health System physician who is accepting new patients with HMO insurance. PCPs are usually chosen based on your needs and geographic area. Call our physician navigators at 1-800-926-8273 for help selecting a PCP. Also visit Primary Care.

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 your PCP first, as this can delay your entry into prenatal care. We will assist you in obtaining an internal authorization for insurance purposes. 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). We encourage you to call your insurance company directly.

Will my insurance plan cover the midwives’ services?

UC San Diego Health System accepts many insurances. See Insurance Accepted. Please contact your individual insurance company for the most up-to-date information on services covered.

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 and 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 our department of Reproductive Medicine.

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

UC San Diego Health System contracts with several managed care Medi-Cal insurance carriers. See Medi-Cal Plans Accepted.