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Dealing with Insurance Companies
In-network Exception
Many midwives are considered “out-of-network” providers. This means that claims billed to the insurance companies are to be considered at a very low reimbursement rate, or may just deny all together.
Note: These forms are not for general public use and may not be ‘bulk’ copied. Appeal templates are sole property of Larsen Billing Service, LLC and are for the use of parents and midwives who have hired Larsen Billing Service to manage their insurance billing. Copying and sharing these templates for any reason other than their intended use, is in direct violation of the copyright laws connected with these documents.
There is the option of requesting an “in-network exception request” or a “gap exception”. If one is granted, that would allow submitted claims to process at the in-network rate. When Larsen Billing Service performs your verification coverage, we automatically seek after this exception. We also keep you and your midwife informed of the outcome. On rare occasions, this request for an exception can ONLY be made by the member themselves. When this is the case, we will be happy to assist in this process.
Patient/Member Exception Requests
Unfortunately, there are some plans that will not allow for the provider or billing service to apply for an in-network exception on your behalf. These companies will only allow the patient/member to apply for an exception request. If this is the case, LBS can provide you with a Letter of Request for you to edit/utilize as you pursue an exception for in-network coverage for your midwife. There are two separate letters, one for midwife only and the other for midwife and birth center. Download Letters of Request »
We have provided an In-Network Exception Checklist for you to use as you pursue this exception.
Appeal Templates for Parents
Appeals
The outcome, or ruling, of a claim is determined by the insurance company. Not all rulings are considered fair and reasonable. Most of the time, Larsen Billing Service can have the claim reviewed for reconsideration without having to send in an appeal. An appeal is a process for requesting a formal change to an official decision. Most insurance companies will allow the provider (midwife) or the billing service to initiate the appeal. There are some insurance companies who will not allow this, stating that the appeal MUST come from the member or the policy holder, and that it must be in writing.
There may also be times that a claim denies and the best approach for reversing the denial is to have the member send in the appeal. Time and time again we find that members have a higher success rate when negotiating such things with insurance companies, than the provider or us, the billing service.
For this purpose, Larsen Billing Service provides Appeal Templates for parents who want, or need, to send an appeal on denied claims. Read more on these topics by downloading the Appeals Templates below:
Permission to Appeal on Member’s Behalf
There are times when an insurance company will require permission from the member before a midwife, or billing service can submit appeals in their behalf. Larsen Billing Service has created a template for you to use if your insurance company requires this of you. Download form template »
Tips For A Successful Appeal
Larsen Billing Service has put together a few tips to help the member obtain a successful appeal.
Read our tips for a successful appeal »
Other reasons for a member to send in an appeal:
- To obtain permission to take part in a home birth and to choose your midwife, requesting that her services be considered for insurance reimbursement. You have the right to choose your model of care.
- To obtain an in-network exception: Have your midwife be considered for insurance reimbursement at the in-network rate.
- To obtain an in-network exception: Have a birth center be considered for insurance reimbursement at the in-network rate.
Understanding Your Insurance Claims
Want to have a ‘crash-course’ on understanding the outcome of processed claims? Here is a document to help clarify a few of the basics. Read Understanding Your Insurance Claims »
Note: This document is for information use only and is not intended for publication.
Pay Plan Set up with your Midwife that Larsen Billing is Managing
How to get a pay plan to us: You may fax your completed payment plan agreement to the LBS Client Billing Department at 866-387-5115. Your midwife may also forward to this fax line or fax to her assigned LBS biller.
How to contact us: 24/7 phone 888-458-8015, 24/7 fax 866-387-5115
What we expect: Adherence to the payment plan terms that you have agreed to. We appreciate timely payments and direct communication if you are unable to make a payment for any reason.
Please note: Failure to complete your payment plan may result in your account being forwarded to formal collections which will impact your credit rating. Make a Payment »
Patient Reimbursement Program for Members
We realize that there are times when an insurance company will not accept claims directly from your provider or the billing service. For this reason, Larsen Billing Service offers the Patient Reimbursement Program. This program is designed to assist members who want or need to submit reimbursement information to their insurance company on their own.
If you choose to take part in this program there is a one-time fee of $49.00. With this, Larsen Billing Service will:
- Provide you with the appropriate itemized receipt which will detail the services rendered by your midwife
- Fill out the appropriate medical claim form for your insurance reimbursement
- Detailed instructions for you to be able to file for reimbursement directly with your insurance company
- Supply you with supportive materials such as appeal templates if necessary
- Be available to answer general questions regarding this process
For more information or to sign up for this service, please download Patient Reimbursement Program. If you have questions, please contact our Client Billing Department at clientbilling@larsenbilling.com
Note: LBS cannot guarantee that your insurance company will approve or even process the information we provide to you. This Patient Reimbursement program option is designed as a “last ditch” effort to help a member in obtaining reimbursement for professional services rendered and paid for in full to the midwife.