This form gives us the information to verify your insurance coverage for out-of-hospital birth. Please read our Information page for Parents so you understand how our company works.
*This form is for people using a midwife or birth center and that provider will later file your claims with us.
*This form is for people using a midwife or birth center and that provider will later file your claims with us.
- USE CAP LOCK
- CHOOSE CORRECT ACCOUNT MANAGER (please ask your midwife the name of her account manager)
- LIST YOUR MIDWIFE'S FIRST AND LAST NAME. DO NOT INCLUDE CREDENTIALS.
FORMS TAKE A WHILE TO PROCESS, PLEASE ONLY CLICK SUBMIT ONCE. THANK YOU!
Please click on the link below to access the patient agreement via Docusign. This agreement does not obligate you or your midwife to file claims through us but informs you of our policies in the event your claims are filed with us. If you have any concerns or questions regarding the Agreement to Bill, please contact us! After we receive your insurance information, you and your midwife will receive an email with the details of your coverage. Together, we can experience success in billing your insurance for your care with a midwife. Congratulations on choosing a midwife for your birth journey!