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If not specified in a QualChoice coverage policy (Benefit Interpretation), QualChoice follows care guidelines published by MCG Health.

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Effective Date: 07/21/2004 Title: Midwife
Revision Date: 09/01/2018 Document: BI055:00
CPT Code(s): None
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

QualChoice will reimburse a properly credentialed and physician supervised licensed mid-wife providing services in a hospital-affiliated setting. 


Medical Statement

Services by a licensed mid-wife in a hospital-affiliated setting are covered when medically appropriate.  The midwife must:

 

  • Be credentialed by this plan, which includes:
    • Be licensed or certified in the state in which he/she is practicing;
    • Have sponsorship by a network Ob/Gyn.
  • Practice within the scope of his/her license;
  • Render services covered under the plan.

Application to Products

Unless indicated otherwise, this policy applies to all QCA Health Plans, unless a specific limitation exists.  Consult individual plan sponsor benefit descriptions for self-insured plans.  In the event of a discrepancy between this policy and a self-insured customer’s benefit description, the benefits plan will be followed.  Applicable state mandates will be followed with respect to self-funded non-ERISA plans and fully insured plans.  Federal mandates will apply to all plans.


Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.