Insurance

Birthways Midwifery Proudly Accepts Most Insurance

Check your insurance using the form below. To submit payment, please follow the "Pay My Fee" button below.

* Indicates required field

Legal Name (insurance policy) *

First

Last

Date Of Birth *

Phone Number *

Social Sec. Number *

Email *

Estimated Due Date/Date of Last Period *

Name of Primary Insured *

Relationship to Primary Insured *

Self Spouse Parent Other

Member ID *

Group Name or Group Number *

Customer Service Phone Number *

Payer ID or EDI *

Does patient have other medical insurance coverage? *

Upload File *

Max file size: 20MB

Date of Initial Visit or Consultation *

Insurance Company Name *

Insured Primary Address *

Line 1

Line 2

City

State

Zip Code

Country

Claims address, city, state, zip ( On Your Insurance Card) *

(if yes above, please enter all secondary insurance information and subscriber information) *

Submit