Lurking from GP--Question about US insurance billing

AprilZ81 · June 2015

The answer to this question may vary from doctor to doctor, but I have a question on the Global Pregnancy billing.

Since most pregnancies span two calendar/plan years can I ask my doctor to wait until the end of the pregnancy to bill my insurance? We have a high deductible and very high out of pocket max and it would be very helpful if the pregnancy claim could hit at the same time as the hospital claim.

Thanks!

pb&fluff · June 2015

I'll preface this by saying I'm a nurse and not a medical coder/billing professional. But would that be considered insurance fraud (or something similar)? He needs to bill for services rendered on the dates he provided them.

AprilZ81 · June 2015

pb&fluff said:

I'll preface this by saying I'm a nurse and not a medical coder/billing professional. But would that be considered insurance fraud (or something similar)? He needs to bill for services rendered on the dates he provided them.

It was my understanding that treating pregnancy as one event (my insurance and doctor treats pregnancy as one global event, not a series of services) kept the doctor from billing for each individual appointment, ultrasound and lab test to make it easier on the patient and the office. They would only be billing for one event anyway so it would be up to the doctor as to when to bill insurance.

I would never ask a doctor to commit fraud (insurance or otherwise) I'm just trying to figure out how much we need to have saved for deductibles and co-insurance. If the doctor bills pregnancy in one calendar year and then the delivery is in the next year we pay significantly more in premiums just because the pregnancy spans two years.

I hate trying to figure this stuff out. It is all so complicated and impossible to figure out.

LooneyLife · June 2015

I don't know how it would have been handled if we had more of a responsibility, but I was only responsible for a $20 co pay for the entire pregnancy. The office didn't bill me until after delivery.

I think billing will be different for every doctor. Some will calculate what they estimate you'll owe for the pregnancy and tell you at your first appointment. I've seen some people say they pay a deposit at the start and the rest after delivery.

But all of that has more to do with collection of payment vs. submitting charges to insurance. That would always happen as services are rendered therefore affecting your overall responsibility.

AprilZ81 · June 2015

LooneyLife said:

I don't know how it would have been handled if we had more of a responsibility, but I was only responsible for a $20 co pay for the entire pregnancy. The office didn't bill me until after delivery. I think billing will be different for every doctor. Some will calculate what they estimate you'll owe for the pregnancy and tell you at your first appointment. I've seen some people say they pay a deposit at the start and the rest after delivery. But all of that has more to do with collection of payment vs. submitting charges to insurance. That would always happen as services are rendered therefore affecting your overall responsibility.

That is awesome (bolded)! We are looking at $3500 (vaginal delivery) to $4,500 (c-section) assuming one calendar year. Our deductible is $2,600 and then we still have to pay 20% of costs after that until we hit our out of pocket max.

caseyandlizzie · June 2015

Insurance companies go by the date the service was rendered, so if I were you, I'd call your Dr's office and see if you can talk to someone in their billing department since they work with insurance companies on a daily basis. They may be able to work with you and your insurance to figure out the best way to go about this.

caseyandlizzie · June 2015

Oh, and I don't remember ever paying for an ultrasound, I just had to pay my copay each visit, and then received my bill from the hospital once I delivered.

formerlyGDaisy09 · June 2015

I'm assuming you're getting your estimates through your insurance company's website? I know mine has a "estimate your healthcare costs" calculator.

I would start by asking your hospital how global billing works. my guess is that your OB/GYN really has little to do with the billing process. Now that most hospitals are operating on some form of an eMR it's mostly an automated process and the billing/coding department gets notification from the eMR when you've received care.

so far we've been responsible for $30 co-pays for midwife visits and $136 for the initial bloodwork and dating scan. budget-wise we've been able to cash-flow that into our monthly budget (I'm entering it into the line-item reserved for baby expenses and what i'm estimating our insurance will change once baby is added). Since you have a high deductible plan your charges will probably be much higher, do you have any kind of HSA, you could start one with your baby budget?

My experience is also that hospitals are more than willing to set-up 0% interest payment plans for large charges, most hospitals do accrual rather than cash accounting, so as long as you're paying and aren't considered "bad-debt" it works in their books. either way, next year you'll probably hit your max out of pocket early, so if additional care is needed later in the year you won't have to worry about it.

islandmonkey8 · June 2015

My OB bills all visits/delivery at delivery. However, my MFM and RE billed each visit. So, it really can depend. I think you're only going to get an answer if you call your insurance and doctors directly because everyone's answers will vary (as you can see above).

Apollo11235 · June 2015

My midwives do global billing for their services. I don't actually know how much it will be, but I've been told I'll be billed a flat rate after delivery for all prenatal/postpartum visits and the midwife's services at delivery itself. I'll also receive a separate bill from the hospital for my stay there. I have been billed separately for all other services along the way: blood tests, ultrasounds, etc., so my $200 deductible has long since been met, but I don't think a $2600 one would be at this point.

I would say call your doctor's office and see how they do maternity billing. From what I've heard, global billing is not super uncommon, so you may get lucky and find out your doctor does it, or you may be able to find someone in your area who you like and who does it.

sweetpotato123 · June 2015

We received a total estimate up front of the charges and were responsible to pay it each month over the course of the pregnancy. Any extra testing (nst, bpp), additional ultrasounds were submitted in real time.

oneplusoneistwo · June 2015

The way it worked for me (high deductible plan ($3K) with HSA, on copays) is this:

Each appointment was not billed separately, however, lab work and ultrasounds were the exception. So, for example, in 2014 I was billed approx $300 in lab work (through month 5 of pregnancy) and $450 for the anatomy scan. So this $750ish went towards my 2014 deductible. I wasn't billed for anything again until I delivered. Then I got a large amount from the OB after my c-section, (assuming that must include the global pregnancy billing) - then the hospital bills on top of that. These all went towards my 2015 deductible. So, for us, it wasn't wildly different that the pregnancy crossed 2 years - if we had been billed for each appointment, that probably would have made a bigger difference. That was my experience anyway - hope it helps!

brij2006 · June 2015

I have a large deductible and high max OOP. Ours did global billing and just billed us for everything at the end. The only things that went to insurance at the time of service, were ultrasounds and any bloodwork. Mostly because those all had a separate co-pay.