1st Appt today to discuss...benefits?

ashleyb0604 · February 2009

Did anyone have an appointment like this? I am kind of confused as to why they are going to make me pay a $20 co-pay to come in and tell me what my insurance will pay for...at least that's what I'm assuming maternity benefits means. I am not even meeting with my doctor, but with a NP.

Well, I am most likely not using this doctor anyway, so I guess that's fine. I have an appt 3/17 with the midwife we want to use, but I made this appt with my regular OBGYN just in case it doesn't work out with the midwife for some reason.

roxyu · February 2009

I'd cancel-I've never heard of this before. Wouldn't you consult with HR at your company to discuss benefits?

ashleyb0604 · February 2009

roxyu:
I'd cancel-I've never heard of this before. Wouldn't you consult with HR at your company to discuss benefits?

That's what I was thinking! I have already spoken with HR when we started TTC to find out about our STD and all that.

4realyo · February 2009

this is something you can easily figure out for youself by calling your insurance company or looking over your benefits package. your doctor's office sounds like a money grabbing whore and i would cancel the appt.

2linesin09 · February 2009

I don't think you should have to pay a co-pay for something like that. I mean what would they be billing your insurance company for? There is nothing "medical" going on so why woudl a co-pay even be necessary? Sounds very odd to me indeed. You know what I'd do? I'd call my insurance company and get their take on it. It seriously sound like they are scamming the system in all they want to do is go over your benefits as opposed to actually providing them!

mrsstocking · February 2009

they told me at my first appt that when I came back I would no longer have a co pay and at the next appt they would have a contract regarding what insurance is going to pay and what will be out of pocket for us.

FYI: I was EXTREMELY surprised when I got the statement from BCBS yesterday showing my charges from my first appt 1500 dollars worth of testing....whatever prior agreement they had with my dr knocked off about a grand.....and then my insurance company paid the rest?! amazing. I even have a $2000 deductible.

k_leigh_d · February 2009

I didn't have this kind of an appt with my doc, but it would be beneficial i'm sure if you do not know what your policy covers. i don't see the point though if you aren't GOING to see the doctor though. i've never seen a midiwfe, but maybe someone that has could tell you if the same things are covered for both.

wordtoyourmother · February 2009

ashleyb0604:
Did anyone have an appointment like this? I am kind of confused as to why they are going to make me pay a $20 co-pay to come in and tell me what my insurance will pay for...at least that's what I'm assuming maternity benefits means. I am not even meeting with my doctor, but with a NP.

Well, I am most likely not using this doctor anyway, so I guess that's fine. I have an appt 3/17 with the midwife we want to use, but I made this appt with my regular OBGYN just in case it doesn't work out with the midwife for some reason.

this is the best thing you can do.. call your insurance company and tell them what happened. Ask for their opinion. If this doctor's office is shady and is trying to pull some sort of billing scam the insurance company will not like it.

copays are reserved for seeing a doctor, or ER. I've never heard of this. Plus if you were just given an EOB (explanation of benefits) that should free of charge - you didn't see a doctor!

ashleyb0604 · February 2009

k_leigh_d:
I didn't have this kind of an appt with my doc, but it would be beneficial i'm sure if you do not know what your policy covers. i don't see the point though if you aren't GOING to see the doctor though. i've never seen a midiwfe, but maybe someone that has could tell you if the same things are covered for both.

Well if we do end up going with the midwife, I won't be worried about the benefits because she practices at the same hospital where I work and therefore ALL of my healthcare costs related to prenatal appts and the birth of the baby would be completely free. Great benefit of my job and the reason we are going with the midwife...plus her patient satisfaction rating is 97.1!

Michelle110 · February 2009

If you're meeting with a health professional - and a nurse practioner (NP) is one - they do have a right to charge you for an office visit. You should be discussing information other than your insurance at this appointment, althought that topic may come up as well. However, your insurance company or HR department are the ones who you should refer to for insurance purposes.

lschu · February 2009

Calling your insurance company can clear up the copay however a dr office can bill for a office visit consulation (face to face time) when consulting you and they may be doing just that even though you aren't seeing the dr.

In response to the above that is a excellent point on why you have insurance! the allowed amount is an amount that the insurance company agrees on for each procedure and your doctors and facilities cannot charge over that amount. If they do they have to write it off and the only portion you are responsible for is what is remaining sometimes it could be 50-75% if you have any questions call your customer service department and clarify.

Maternity should have 1 initial office visit which a copay (for this visit and this one only) may apply depending on you benefits this visit is only for the diagnosis that you are actually pregnant. From your second visit til when you are discharged from the hospital after delivery is called the global period in which your doctor will roll all your charges during your pregnancy into one bill.

The facility or hospital can also bill you for your stay and ancillaries or incidentals used in the stay.

Any diagnositc xrays or lab charges will come in and be charged as you have them done.

You will have quite a few charges coming through your insurance company what I would do is keep your explanation of benefits and only pay what your insurance company states is actually your responsibility including copay amounts.

Hope this helps

AMYfromKY · February 2009

We also had this. They also took my history, did some bloodwork, and a lot of other things. I'd go if I were you.

Michelle110 · February 2009

lschu:

Calling your insurance company can clear up the copay however a dr office can bill for a office visit consulation (face to face time) when consulting you and they may be doing just that even though you aren't seeing the dr.

In response to the above that is a excellent point on why you have insurance! the allowed amount is an amount that the insurance company agrees on for each procedure and your doctors and facilities cannot charge over that amount. If they do they have to write it off and the only portion you are responsible for is what is remaining sometimes it could be 50-75% if you have any questions call your customer service department and clarify.

Maternity should have 1 initial office visit which a copay (for this visit and this one only) may apply depending on you benefits this visit is only for the diagnosis that you are actually pregnant. From your second visit til when you are discharged from the hospital after delivery is called the global period in which your doctor will roll all your charges during your pregnancy into one bill.

The facility or hospital can also bill you for your stay and ancillaries or incidentals used in the stay.

Any diagnositc xrays or lab charges will come in and be charged as you have them done.

You will have quite a few charges coming through your insurance company what I would do is keep your explanation of benefits and only pay what your insurance company states is actually your responsibility including copay amounts.

Hope this helps

Depends on your insurance company. Mine does not have a copay at the first prenatal visit but has a copay at every subsequent visit, so my insurance is backwards from what you said. And I had a separate bill from the hospital when I delivered DD, which I had to pay out of pocket (like $250 or so).

yale · February 2009

My second appointment was with an NP - she went over my full family medical history, gave me a pap, breast exam, etc. Then yes, I met with the business manager and we went over insurance coverage and things I needed to find out from them - hospital stays, etc. I don't think it's that out of the ordinary.

yale · February 2009

Oh, and I haven't paid a copay yet - are you sure they're going to charge you a copay or are you just assuming? My care will require one copay at some point, but the way it was explained to me (in my meeting with the business manager) is that they wait for all the charges to come after delivery, and then they send us one bill.

SWMcFarland · February 2009

It may be the office policy to discuss expected patient contribution, etc. They like to set up payment schedules, etc. if necessary based on your personal circumstances. Additionally, if you have hospital co-pays, etc. they like to go over that too, along with any additional out of pocket costs for other tests (NT Scan, Amnio, CVS, etc.).

It's pretty common here in Tampa, but I don't know about KC!

cindeegal · February 2009

I actually had this exact appointment this week for my first one. My meeting with the insurance person was less than 5 minutes. She just told me that I had met my deductible already (knew that) and that everything was covered 100%. I then went on to meet with the nurse and went over medical history, peed in a cup, and gave blood.

I don't have a copay though so it wasn't a big deal for me. The copay is probably for meeting with the nurse, not with the benefits person. I'm going back in 2 weeks to visit with the doctor.

soontobeahigh · February 2009

I haven't had an appointment just for this, but I did speak to the billing person on one of my first visits to go over what my cost would be. I also only paid 1 co-payment at my first appointment and was given the option to set up payments for my delivery costs or just get a final bill. We paid in advance and got a discount for it. If there were any extra charges we would get a bill after delivery. I think we ended up paying something like $500 total for delivery and circumsision.

Want a personalized experience?

1st Appt today to discuss...benefits?

Re: 1st Appt today to discuss...benefits?

Choose Another Board

Search Boards