Coverage

Provider Type

  • Physicians

A certified nurse midwife (CNM) is a registered nurse who has received training in obstetrics and gynecology, and is certified by the American College of Nurse Midwives. A midwife assists in delivering infants, as well as providing antepartum and postpartum care. CNMs must be licensed by the state of California and working under the license of an actively practicing physician. CNM coverage is limited to services performed within the scope of a CNM's license and according to the terms of the member's plan. Home births are not covered. Services rendered by CNMs must be prior authorized to be considered for payment.

If a member is assigned to a primary care physician (PCP) participating with a delegated participating physician group (PPG), and the PPG does not have any participating CNMs in its network, a prior authorization request and authorization to the out-of-network CNM provider is required from the PPG prior to the member accessing services with the out-of-network, non-participating CNM.