Maternity

How do I know if my maternity is eligible for sharing?

Maternity is eligible for sharing after the mother has been a member for 12 months. Sharing is limited to $150,000 for any single pregnancy event, including antepartum care, the cost of delivery and complications to the mother and/or child(ren), and postpartum care.

To be eligible, delivery must be performed by a medical doctor, doctor of osteopathy, or midwife who is properly licensed, certified, and/or registered in the state of delivery.

If the mother is not a member for 12 months prior to delivery, the following are instances where maternity bills are ineligible for sharing:

Medical bills incurred before the newborn’s membership date.
Unresolved maternity medical conditions of mother or child.

The newborn can be a member from birth if a request to add them to the membership is made within 30 days of the date of birth.

What if my maternity is not eligible for sharing?

As long as either mom or dad are Impact members, your baby can be considered part of your Impact household from birth. Complete and return the Application to Add a Family Member(s) within 30 days of birth. There is no application fee for adding your child to your membership.

Please Note: You do not have to provide the baby’s social security number to add the newborn to your membership.

Assistance may be available through an alternative program. We have Patient Advocates who can help. If you qualify, the alternative program may pay for your current pregnancy.

If you have not been a member since conception, any expenses related to your current pregnancy will not be eligible for sharing. However, discounts may be honored at your provider’s discretion. This includes medical bills for maternity or delivery related to the birth (mother or child). Remember, bills related to complications the baby experiences after delivery will be eligible for sharing, provided you add your baby to the membership within 30 days of birth.

Miscarriage – In the unfortunate event that you suffer a miscarriage, treatment of the miscarriage may be eligible for sharing even if the maternity was ineligible.

How do I find a provider?

Impact does not use a provider network. You may keep your current provider or go to any provider of your choice.

Present your Impact member card.

Ask the provider to bill Impact using the information on the back of your member card. All of the information that their billing specialist will need is on the card. Our phone number is also included on the card if they have any questions. If they ask what network Impact participates with, you can let them know that you are free to see any provider you choose.

Midwives – Midwives and home births may be eligible for sharing. We encourage you to schedule a call with the team for more information. A midwife must be licensed, certified, or registered in the state of delivery for sharing to be considered. Impact requires verification of these credentials and a copy of documents confirming the state license, certification or registration of the midwife. Failure to provide this documentation will result in the bills being ineligible for sharing.

Birthing Centers – These facilities are an option and follow the same process as other facilities.

Pre-Eligibility

Providers are encouraged to apply for a pre-eligibility review.

Pre-eligibility enables Impact to inform the member about provider options and potential incentives available. 3-5 business day notice required, expedited review on a case-by-case basis.

Medical records are required to determine pre-eligibility and failure to provide requested records for review will result in the bill being ineligible for sharing.

Providers can request a pre-eligibility review online or by calling 855-378-6777.

Please be advised that pre-eligibility is required only for non-emergent procedures/medical expenses. If a member requires emergent services, please proceed without submitting a pre-eligibility request and eligibility will be determined post-procedure.

How to Submit Medical Bills

In some instances, you may pay for your service up-front. In this case, you will request reimbursement from Impact.

You can do so electronically. Just use the link below to access the Member forms.