How to Use
Out-of-Network Benefits
Disclaimer: This guide is for educational purposes only, not legal or financial advice. Midlife Midwife MKE cannot guarantee insurance reimbursement.
Navigating insurance can be tricky, and every plan is unique. Knowing your benefits is crucial, especially when considering out-of-network care with Midlife Midwife MKE.
I am not in a network with any insurance plan.
Despite this, there is a possibility that you will be eligible for reimbursement. However, it's important to keep in mind that I cannot guarantee that your insurance provider will offer reimbursement.
In order to potentially receive reimbursement, you may need to utilize your out-of-network benefits.
Here’s a guide to help you
Contact Member Services: Find this number on your insurance card. Explain your interest in out-of-network women’s health services, providing details about Midlife Midwife MKE from this page’s bottom.
Inquire About Benefits
Clarify your out-of-network outpatient benefits, which include:
Deductible: Your initial payment before insurance kicks in.
Out-of-Pocket Maximum: The yearly cap on your expenses before full coverage.
Copayment/Coinsurance: Your share per appointment, either a percentage or flat fee.
Allowable Visits: The number of covered visits annually.
Allowed Amount: The maximum the insurance pays per service, often less than the provider’s rate.
Check Covered Services
Ask about the specific CPT codes covered. Commonly used by Midlife Midwife MKE are:
Initial consultations from 15 to 74 minutes (codes 99202-99205).
Established patient visits from 10 to 54 minutes (codes 99212-99215).
New and established exams by age (codes 99384-99387 for new exams and 99394-99395 for established exams).
Learn Claim Submission
Get details on sending claims for reimbursement, a crucial step to receiving payment back.
Document Your Call
Record the representative’s name and a call reference number for future clarifications.
Tips for Calling Your Insurance
Plan at least 30 minutes for the call to avoid rushing.
Keep writing materials or a spreadsheet ready to record details.
Don’t hesitate to ask questions—understanding your benefits is your right!
Feel empowered to manage your healthcare finances by leveraging these steps for potential reimbursement with Midlife Midwife MKE.