Medical: Maternity

IN THIS ARTICLE

What to do when you are pregnant!
What to do to add your baby to our benefit plans!
<<Must be done within 31 days of the baby's date of birth!>>

What to do when you are pregnant!

Congratulations! You are going to have a baby, how exciting 👶🎉 ! 

Most of your maternity and delivery bills will be reimbursed by CHM, but some will be reimbursed by your HRA.  It is important for you to track all of your expenses and to know how they are to be reimbursed!  

Step 1: Download this TRACKER and create your copy to use for tracking your pregnancy and delivery bills.

Step 2: Read through this website https://chministries.org/maternity/ to understand CHM's coverage for maternity and delivery. Take the time to read through the Frequently Asked Questions and Maternity Guide as they are your VERY BEST CHM resource for maternity coverage!

Step 3: Familiarize yourself with this TIMELINE to help you understand the scope of a maternity/delivery incident.

CHM ONLY shares medical bills that they receive within SIX months from the date of service. 
So, submit your bills as soon as you receive them!
Follow these instructions on how to Submit Bills to CHM.
You must call CHM at 1-800-791-6225 and speak with their Maternity group within the first 16 weeks of your pregnancy.  When you do this, CHM will reduce your Maternity Personal Responsibility (MPR) from $1,500 down to $1,000.  The Stone will reimburse $1,000 of your MPR through EGP. Ask Denise how!
If you don’t make this call, you will be charged a Maternity Personal Responsibility of $1,500. The Stone will reimburse the first $1,000 through EGP, but the remaining $500 will need to be processed through your HRA/Out of Pocket/Health Fund.

CHM shares qualifying medical bills for prenatal, delivery (including cesarean and multiple births), home births, midwives, postnatal up to six weeks and if any complications arise for mother and baby. Below you will find what CHM shares at each stage of pregnancy.

Though maternity costs are eligible as described below, there will be times, depending on your provider, that you may need to pay up-front for some services and wait until CHM shares them (90-120 days). If these expenses represent a financial hardship for you and your family, please contact Denise to discuss the Medical Advance process and how ASCC can help!


Maternity Medical Bills Covered by HRA/Out of Pocket/Health Fund

CHM does not reimburse for all maternity/delivery expenses.

Below is a list of expenses that CHM does not reimburse you for, but that you can submit through your HRA/Out of Pocket/Health Fund coverage. Pay for these services with your EBC HRA CARD!

  1. Prenatal:
    1. Genetic testing, if not shared by CHM.
    2. Immunizations for dad (dtap, flu shot, etc.) (Immunizations related to mother's prenatal care are eligible to be shared with CHM).
    3. Prenatal vitamins
  2. Postnatal:
    1. Baby immunizations, after hospital stay
    2. Breast pumps: we recommend purchasing the breast pump with your personal card and then submitting it to EBC for a manual reimbursement (instructions). A prescription is required from your OB/GYN which will need to be uploaded with your receipt (you can purchase through Target, Amazon, etc.). Ask your physician for suggestions!
  3. Vasectomy:
    1. Though not "Maternity" in nature, many have asked if vasectomies are covered (eligible for sharing) by CHM.  CHM considers this service an 'elective sterilization' and therefore does not share the related bills.
    2. However, vasectomies are eligible for coverage through your ASCC HRA, employee Out-Of-Pocket, and ASCC Health Fund.

Maternity Expenses not Covered or Reimbursed by any part of our Plan

  1. Doula services
  2. Birthing tubs or related items if delivering with midwife
  3. Childbirth education classes
  4. "Rooming In" charges for mom to stay in the hospital after having been discharged but to stay close to baby while in NICU.

OB/GYN Agreement

You will need to obtain a prepayment agreement, also known as a “stork package” or “Global Bill”, from your OB/GYN as soon as possible. The prepayment agreement usually includes:

  • OB/GYN office visits
  • OB/GYN labor/delivery charges
  • Sonograms/ultrasounds
  • Blood work

Once you have received your prepayment agreement, make sure to submit the appropriate forms and needs through the CHM Member Portal.

Hospital Bills

If you plan to give birth at a hospital, you’ll need to contact the hospital in advance to take advantage of cash pay/prepay discounts.   This is different from your OB/GYN’s Global Bill.

You may receive a hospital prepayment agreement which can include:

  • Labor and delivery charges
  • Room and board, these are not always included in the hospital’s quoted price, so we suggest asking if they aren’t included upfront

If the hospital requires payment upfront for a discounted rate and/or they require a deposit before delivery, CHM will try to get you the amount required prior to the baby being born (if submitted to them in a timely manner). After delivery, you will need to submit the final bill to CHM.

If you will be requesting an advance from ASCC to cover this pre-payment cost, it is best to pay this with a personal check.   Here's why: 

  • If you pay the full charge ($5,313.16, for example) with a credit card and get an advance for the full charge ($5,313.16).   You then use the advance funds towards your next credit card bill.  But, after delivery, you learn that your actual delivery costs less (say $4,000), the hospital will credit your credit card the difference ($1,313.16).  You will receive the $4,000 from CHM and have those funds on hand, but need to pay back the full advance to ASCC of $5,313.16.  The credit of $1,313.16 is held in your credit card account.
  • If you pay with a check, the St. David's would directly refund you the $1,313.16, you would receive $4,000 from CHM, and would then have all the cash on had to repay the full advance of $5,313.16.
  • Ask Denise if you have any questions about this!

If the hospital does not require payment upfront, CHM will not share prior to delivery and the final bill will need to be submitted, once received, for reimbursement.

Some hospitals don’t have any kind of prepayment agreement (you will just get a bill after delivery, ensure you have received discounts, pay, and submit to CHM for reimbursement). 

Some hospitals give estimates (which you would send to CHM, but CHM cannot use it for prepay, so you would wait until after delivery to get the bill, ensure discounts, pay, and submit to CHM).  

You should receive an itemized statement for mom's hospital charges AND an itemized statement for baby's hospital charges. These will probably be two separate accounts and baby's account may not be under baby's name.  You will need to explain clearly that you are needing an itemization of services for baby girl or boy, born to mom, on delivery date.

Once you have any documentation of any kind from the hospital, make sure to follow the instructions for submitting an add-on bill.  The more information you get to CHM, the better!

St. David's North Information:

  • Jennifer Pena: St. Davids North Austin Financial Counselor. Discuss payment up front. 512-901-1504.
  • Austin Anesthesiology Group. 512-343-2292. You can call one month prior to pay for epidural, but not required. Call 6 weeks after to get itemized receipt mailed to you.  Make sure to ask for discounts!
  • St. David's Billing Department. 866-391-2015. Call to get itemized receipt 6 weeks after baby.
    • St. Davids will have a flat charge of $5,313.16 for pre-payment of vaginal delivery.  
    • You should receive TWO itemized bills from St. David's after delivery.  One for the mother and one for the baby.  They will look like this "Patient: Denise Moss" and "Patient: BB-Denise Moss" for a baby boy..."BG-Denise Moss" for a baby girl.  Both of these need to be submitted to CHM.  There may be additional charges that were not included in the prepayment (such as a circumcision) for which you will need to request a discount and pay.  

Anesthesiology Charges

Anesthesiology charges are eligible for sharing, but CHM does not share these expenses prior to the birth. If a deposit or payment is asked for upfront, you will need to pay with your personal card and then reimburse yourself once CHM reimburses the need. You can upload the estimated bill into the CHM Member Portal prior to the baby being born, then submit the final bill after the birth. This can help significantly shorten the sharing time.

Birthing Center/Home Birth

If you are not giving birth at a hospital, you will just need one prepayment agreement with the provider who will be delivering the baby. This prepayment agreement should include any services from prenatal care, delivery of the baby, and postnatal care up to 6 weeks after the birth. Once you have received your prepayment agreement, make sure to submit the appropriate forms through the CHM Member Portal.

Changing Providers

If you choose to change providers in the middle of pregnancy, you will need to contact CHM to inform them of the change. CHM will require a letter of explanation detailing:

    • Name of the original provider
    • Last date of service with the original provider
    • Reason for transfer of care
    • Name of the new provider
    • Date that care with new provider began

You will need to ask the first provider for a refund of any services not rendered. If they provide a refund, you will submit a final itemized bill to CHM. If they will not provide a refund, you will submit their refund policy letter to CHM.

After this, you will submit itemized bills from new provider to CHM. When CHM has everything needed from the first provider, they will consider sharing for the new provider.

Notes from CHM Guidelines about changing providers:

Postpartum Depression Care

Postpartum depression can be shared by CHM as a complication for an eligible maternity event, miscarriage, or stillbirth. Sharing can include inpatient treatment, counseling, prescription medications, and follow-up care as needed up to 90 days from the date of delivery or loss. Medical bills and/or medical records submitted to CHM must specifically indicate a postpartum depression diagnosis. (If charges related to postpartum depression care are not reimbursed by CHM, they may still be eligible to be reimbursed by HRA.)

CHM Maternity Contacts

Maternity phone number: 1-800-791-6225, Menu Option #6.

Below are excerpts from the CHM Guidelines regarding maternity care.

What to do to add your baby to our benefit plans!

Congratulations! Your baby is here, how exciting 👶🎉 !

There are a few things you must do now to add your new little one to our benefit plans. 

These must all be completed within 31 days from the date of birth!
  • Right away - Email denise@austinstone.org with your new baby's full name and official date of birth.
  • As soon as you have your child's Social Security - Reach out to Denise to schedule a 30 minute meeting to add baby to benefits:
  • Bring your child's SSN and the following HIPAA form to the meeting:
  • Your child will be added to your HealthiestYou membership a few weeks after CHM has been notified. Our HealthiestYou membership is through CHM. If after a few weeks you do not see your new child on your account, please call CHM to discuss...1-800-791-6225