Verification of Benefits (VOB) – This is the process of confirming a patient’s eligibility and the specific coverage and benefits of their insurance plan.

Explanation of Benefits (EOB) – This is a document that shows how a health plan will process a claim after services have been provided. It is not a bill. It lists the total charges, the amount the insurance company is expected to pay, and the remaining balance that is the responsibility of the patient.

The VOB and EOB are only estimates. Actual benefits can vary based on specific circumstances, and a patient should always consult their official health insurance plan documents for the most accurate information.

For health insurance, patients should be aware that the actual costs will depend on the patient’s specific health needs and any unforeseen complications that may arise. During pregnancy and birth, there can be complications that require additional care that was not part of the estimate (i.e., postpartum hemorrhage, administration of IV fluids, etc.).

Estimated health insurance costs are based on the level of care you think you will use, and it is often best to select a range of low, medium, or high to get a more realistic picture. For maternity care, these estimates do not include the care of the newborn since the baby is not yet born and does not yet have a health insurance plan.

Out-of-Network (OON) – Out-of-network refers to healthcare providers (or a facility) which is not part of a patients in-network plan coverage. A provider can be in-network while the facility is out-of-network or vice versa.

Gap Exception - A gap exception (also known as a network gap extension, out-of-network extension, or gap waiver) is a special agreement that allows a patient to receive care from an out-of-network provider at in-network rates when their specific insurance plan doesn't have an in-network provider available or the available providers are unable to meet the patient’s specific needs. A Network Gap Extension is an agreement between the client and their insurance provider to cover services from an OON provider at a negotiated rate.

These exceptions are granted on a case-by-case basis and often require a formal request, typically supported by a provider's letter or other documentation, to cover the care at a lower cost than a patient would normally pay for out-of-network services. Because there is no other birth center in the area, CBC request this exception for many patients, as there is no similar type of care available.

Single Case Agreement (SCA) - A Single Case Agreement is a contract between an out-of-network provider and an insurance company that allows a patient to receive care at in-network rates.

Financial Agreement - This is a legal contract and is the patient's agreement to be responsible for costs not covered by their health insurance, such as deductibles, co-pays, and non-covered services, while also authorizing the provider to bill their insurer. This agreement typically includes the insured's responsibility to pay balances after insurance, provide timely payments, and notify the provider of insurance changes.

Deductible – This is the amount of money a patient must pay out-of-pocket for a covered claim before their health insurance company begins to pay toward the claim. The deductible amount is chosen when the health insurance policy is purchased and it is a key factor in determining the cost of health insurance premiums.

Co-pay – This is a fixed, out-of-pocket amount patient’s pay for a covered healthcare service, such as a visit with their healthcare provider or a prescription. This is paid at the time the patient receives the service.

Non-Covered Services - These are treatments, items, or procedures that a health insurance plan will not pay for as part of a patient’s coverage. Patients are generally responsible for paying the full cost out-of-pocket for any non-covered services.

Coinsurance is a cost-sharing agreement in health insurance where a patient pays a percentage of a covered service after they have met your deductible. For example, with 80/20 coinsurance, you pay 20% and your insurance pays 80% for a service. You will continue to pay your coinsurance until you reach your out-of-pocket maximum for the year, at which point the plan pays 100% for the remainder of the year.