Clicking the Submit button will populate a document to designate your midwife as your Authorized Representative for insurance purposes. This authorization is essential for your insurance company to process your maternity claims properly.
We apologize that many of the fields on this page and the authorization document are repetitive; however, it is vital to complete the fields on the following pages entirely and accurately for your claims to be processed.
The last page is an agreement between the patient and our company to process your claims.
Insurance details will be sent to your midwife.