Insurance Billing Question

Knottie80968440

Hello, 

I had a question on insurance billing and what is normal for doctor's offices to do.  My insurance deductible has been met for this year, meaning any appointment that I have this year should be covered by my insurance.  Unfortunately, my doctors office doesn't bill the insurance for the entire pregnancy until after the baby is born.  Since I am due in April, this means that almost half of my appointments which would have been covered by insurance, aren't going to be covered because they are billing it in April of next year. I'm contemplating finding a new doctor for this reason, as I just picked a local OBGYN that had available appointments. Is this something that all the doctor's offices do? Or does this sound as crazy to you as it does to me?

Thanks!! 

BrittnyS10

My office also bills for the visits after the baby is born, but they bill me for ultrasounds, blood tests, etc within a few weeks of having them done after first submitting the claim to my insurance. I have already paid over half my deductable for this year, but i know just the hospital bill will hit my deductable next year, so i figure if i dont have to pay for the visits till after the baby is born then even though they are technically this year they should be covered once i reach my deductable in april. At least thats the way i understood it when they explained it to me.

dkny155

What your doctors office is doing sounds normal. They are not going to bill your insurance now for appointments you haven't had yet. They only bill for each appointment once you have been seen. I think any other doctors office will do the same thing. If they bill now for next year that is considered fraud.

littleredx2

That is typical Global billing for pregnancy. I've only ever known doctor's offices to bill this way so I'm not sure you will find an OB that does it differently. Typically the only things billed for immediately are labs and ultrasounds that don't fall under the global pregnancy.

Jules08

Can you clarify, has your deductible been met for the year or has your maximum out of pocket been met for the year?  These are two very different things.

With my first, it was all in one calendar year so I only needed to keep track of my bills / payments to make sure that I didn't pay more than my maximum out of pocket.

So far this time, I have had 4 OB visits and have only seen 1 bill, but expect to see more.  However, before I got pregnant, we planned to be paying my maximum out of pocket for this calendar year as well as next years.  The hospital visit alone maxes mine out.  (I think with my first, my total billing was for $48,000)

I am not sure how helpful this is, but I guess it's something to compare to.

Knottie80968440

Thank you both for your advice!  I don't expect for the doctors office to bill my appointments for next year in this years, but I just wanted the appointments I have had this year to be billed in this year instead of in April. (sorry if that is super confusing, haha)  It sounds like it's normal for my doctor's office to be only billing at the end so I guess it's okay! 

Knottie80968440

Yes, my deductible and out of pocket has been met for this year.  I have had one appointment already, and I have another tomorrow.  I wish they would bill me as I have each appointment but they wait until the very end after I have the baby to bill me for all the appointments at the end.  This doesn't seem right because I will have to pay the full amount for these appointments I have already had, when my insurance should be covering all of the expense.  Thank you for your help!  I wish that this were all in one calendar year because it would be easier to explain.

Jules08

Knottie80968440 said:

Yes, my deductible and out of pocket has been met for this year.  I have had one appointment already, and I have another tomorrow.  I wish they would bill me as I have each appointment but they wait until the very end after I have the baby to bill me for all the appointments at the end.  This doesn't seem right because I will have to pay the full amount for these appointments I have already had, when my insurance should be covering all of the expense.  Thank you for your help!  I wish that this were all in one calendar year because it would be easier to explain.

I get what you are saying  

My guess is that you will hit your maximum out of pocket again next year and that you would have regardless of the 2015 appointment billings being sent this year or next. 

Let's say your Max OOP is $5K, you've already hit that for this year then any 2015 billings would be covered at 100%; however, you have to pay that $5K again next year. 

So say you get billed for 2015 appointments in 2015, in 2016 you are still going to pay your $5K Max OOP with the first part of your hospital charges.  OR say you don't get billed until 2016 and you pay $5K towards 2015 appointments, your hospital charges would be covered 100%.  Either way, you are likely going to be paying your Max OOP again.  KWIM?

mrstrax

Knottie80968440 said:

Yes, my deductible and out of pocket has been met for this year.  I have had one appointment already, and I have another tomorrow.  I wish they would bill me as I have each appointment but they wait until the very end after I have the baby to bill me for all the appointments at the end.  This doesn't seem right because I will have to pay the full amount for these appointments I have already had, when my insurance should be covering all of the expense.  Thank you for your help!  I wish that this were all in one calendar year because it would be easier to explain.

Assuming your out of pocket is less than like $7k, you'll probably be over next year as well because of the hospital bill. The two/three appointments worth of billing will likely be negligible either way.

UnbreakableKimmySchmidt

DH and I were lamenting this too...we should have had an end-of-the-calendar year baby, would have made insurance easier!

BrittnyS10

mrstrax said:

Knottie80968440 said:

Yes, my deductible and out of pocket has been met for this year.  I have had one appointment already, and I have another tomorrow.  I wish they would bill me as I have each appointment but they wait until the very end after I have the baby to bill me for all the appointments at the end.  This doesn't seem right because I will have to pay the full amount for these appointments I have already had, when my insurance should be covering all of the expense.  Thank you for your help!  I wish that this were all in one calendar year because it would be easier to explain.

Assuming your out of pocket is less than like $7k, you'll probably be over next year as well because of the hospital bill. The two/three appointments worth of billing will likely be negligible either way.

Honestly if your out of pocket cost is like $7k i would suggest looking at other plan options. I currently have a high deductable HSA plan but am going to switch to a traditional low deductable plan once my work opens up insurance elections next month.

mrstrax

BrittnyS10 said:

mrstrax said:

Knottie80968440 said:

Yes, my deductible and out of pocket has been met for this year.  I have had one appointment already, and I have another tomorrow.  I wish they would bill me as I have each appointment but they wait until the very end after I have the baby to bill me for all the appointments at the end.  This doesn't seem right because I will have to pay the full amount for these appointments I have already had, when my insurance should be covering all of the expense.  Thank you for your help!  I wish that this were all in one calendar year because it would be easier to explain.

Assuming your out of pocket is less than like $7k, you'll probably be over next year as well because of the hospital bill. The two/three appointments worth of billing will likely be negligible either way.

Honestly if your out of pocket cost is like $7k i would suggest looking at other plan options. I currently have a high deductable HSA plan but am going to switch to a traditional low deductable plan once my work opens up insurance elections next month.

We have a high deductible HSA too but DH's company pays into the account on top of what comes out of his paycheck and the monthly payments are way lower, so it ends up significantly cheaper for us to have high bills instead of bigger monthly payments to insurance even if we hit the max OoP. It's an important thing to look into though!

kimey1

That seems annoying and honestly a little frightful because you won't know how much it will be. It seems positive that you've already met your deductible and OoP for 2015. Would it help to apply for a low deductible and OoP insurance for 2016 since enrollment is next month? That way you'll pay a high monthly amount but most things (if not all things) would be covered by the time you get your bill in May or June.

Feel free to correct me if I am wrong. It's my first time dealing with such high payments in the US healthcare system, and I dunno what things may not be covered re: labor. I'm a FTM and it happens to be in the States. Previously my doc visits were on a student health insurance and I didnt have reasons for any huge bills do this is all very new to me. I was floored when I saw the bill from the mmc earlier this year.

mrstrax

kimey1 said:

That seems annoying and honestly a little frightful because you won't know how much it will be. It seems positive that you've already met your deductible and OoP for 2015. Would it help to apply for a low deductible and OoP insurance for 2016 since enrollment is next month? That way you'll pay a high monthly amount but most things (if not all things) would be covered by the time you get your bill in May or June.

Feel free to correct me if I am wrong. It's my first time dealing with such high payments in the US healthcare system, and I dunno what things may not be covered re: labor. I'm a FTM and it happens to be in the States. Previously my doc visits were on a student health insurance and I didnt have reasons for any huge bills do this is all very new to me. I was floored when I saw the bill from the mmc earlier this year.

Most offices (at least around here) have you sign off on the total amount for global billing, so I know it will be (pre-insurance) $X for vaginal birth or $Y for a c-section for everything but labs, u/s and possible circumcision, which they also listed those costs. With those numbers available you can contact your insurance company and ask what you can expect to actually be billed.

You can also call your hospital's billing department and ask for an estimate for the delivery, hospital stay, baby's bills and epidural/IV so you can talk to your insurance about that too.

kimey1

Thanks @mrstrax - seems like the same as what we've been doing re: labs and doc visits. I'll take your advice while I decide where to give birth!

mrstrax

@kimey1 glad to help - I can't imagine learning this system the first time with pregnancy. So confusing with so many separate bills! Just remember, everything is an estimate. So many things can come up in the hospital that they would need to bill for, so I would round all the numbers up as you try to budget for the next year or so

RachieTK

I pay a copay at my first visit and that's all. Everything else is fully covered (except harmony test) and I have a $250 copay at the hospital when I have the baby. It must depend on your insurance and/or doctor.

BrittnyS10

mrstrax said:

BrittnyS10 said:

mrstrax said:

Knottie80968440 said:

Yes, my deductible and out of pocket has been met for this year.  I have had one appointment already, and I have another tomorrow.  I wish they would bill me as I have each appointment but they wait until the very end after I have the baby to bill me for all the appointments at the end.  This doesn't seem right because I will have to pay the full amount for these appointments I have already had, when my insurance should be covering all of the expense.  Thank you for your help!  I wish that this were all in one calendar year because it would be easier to explain.

Assuming your out of pocket is less than like $7k, you'll probably be over next year as well because of the hospital bill. The two/three appointments worth of billing will likely be negligible either way.

Honestly if your out of pocket cost is like $7k i would suggest looking at other plan options. I currently have a high deductable HSA plan but am going to switch to a traditional low deductable plan once my work opens up insurance elections next month.

We have a high deductible HSA too but DH's company pays into the account on top of what comes out of his paycheck and the monthly payments are way lower, so it ends up significantly cheaper for us to have high bills instead of bigger monthly payments to insurance even if we hit the max OoP. It's an important thing to look into though!

Lucky you! My company pays into my hsa too, but i figured out that choosing the low deductable plan (assuming my options are about the same as last year) even considering the additional monthly cost i should save about $1000. And im glad that ill at least be able to use what i still have in my hsa even when im not on that plan. Its definately worth looking at all the options, sometimes the high deductable with a good company matched hsa is a better choice.

kimey1

@mrstrax Yeah... That's why I'm considering giving birth in my home country. It's free and the doc visit bills prob wont even add up to half the premium you pay in the 9months till birth in the States. Plus my folks are there

mrstrax

kimey1 said:

@mrstrax Yeah... That's why I'm considering giving birth in my home country. It's free and the doc visit bills prob wont even add up to half the premium you pay in the 9months till birth in the States. Plus my folks are there

Yay for having your parents there! My only thought there would be looking into how citizenship will work and how long you can stay because getting a newborn a (American) passport can be a hassle. Well and obviously what your SO thinks

kimey1

@mrstrax Yeah, I know the child would be a dual citizen. If we can't get the American one, the Korean one will do. Takes 3days-a week for adults so it shouldnt take too long.
Have you gotten it for one of your children? How long did it take?

mrstrax

@kimey1 I'll PM you so we don't totally hijack this thread

NachosAndPeaches

I don't have too much to contribute because I suck at this stuff but I remember getting a bunch of reimbursement checks from our insurance after DS was born for copays (I guess after I met my out of pocket max), and it was awesome. I had no idea id be reimbursed!

JadaBlue

@kimey1 I have experience adjudicating U.S. Consular Reports of Birth Abroad. Depending on your circumstances (marital status, sex of Amcit parent if one is not an Amcit) the process/rules are quite straightforward. If your child would be an Amcit don't return to the U.S. without getting the CRBA. PM if you have any questions. Sorry for the hijack!

Ready4theParty

It depends on your insurance. With DD we had a different provider but we paid a copay every visit and then everything else was covered. With this one we have an HSA vs a PPO and I have been very careful about what is covered and what is not. Most of our visits are covered as preventative.