- Pregnancy
- Baby & Toddler
- Parents
- Getting Pregnant
- Baby Names
- Product Reviews
-
Registry
- Community
-
More
Want a personalized experience?
Download the free app
January 2011 Moms
Changing OBs Due to Insurance Issues
We have Coventry Commerical Open Access POS and we have met our deductible for the calendar year. My OB is charging me $1783 for his 'delivery fee' to pay out of pocket instead of going through our insurance when LO arrives to be paid by my week 34 appointment on Thursday. My DH doesn't want to pay a friggin dime since we never got a bill nor were we given anything detailing the expenses that this amount covers.
My OB claims it's his part of the deductible, yet our insurance told DH today NOT to pay anything because they are calling my OB's billing people to ask them why they're assessing this charge directly from us. They strongly feel that we are not responsible for this payment regardless if LO ends up arriving in December or in January (when our new deductibles kick in).
Also, my OB seesm a litle to intervention happy and is talking c-section because my LO is frank breech. I just believe he cares about charging me more money instead of focusing on my pregnancy.
My gut is telling me nothing seems right with this situation and that I should cancel my appointment to find another OB and/or midwife to handle the remaining part of my pregnancy.
Is anyone dealing with a similar situation?
EDIT - Keep in mind that the charges have nothing to do with the hospital cost. This is just for the OB's services 
Joseph Michael - 12/22/2010
5lbs 9 oz, 18.5 inches long
6 months: 16lbs 15 oz, 27 inches long
5lbs 9 oz, 18.5 inches long
6 months: 16lbs 15 oz, 27 inches long
This discussion has been closed.
Re: Changing OBs Due to Insurance Issues
~EDD Nov 18, 2017 with my IUI success story~
[spoiler]
I agree with this!! We had to pay $240 OOP to our OB but we don't make copays when we go in...that's just how they handle it. Seems like with all the appointments it probably just evens out anyway. I can't imagine paying that much more just to the OB!
I don't know much about the breech situation to say if he's skeeming you in that regard but from what I've heard and read most doctors will do a c-section if your baby is breach, for safety reasons.
As far as them soughting out after you for money and not even running it through your insurance is really odd. I wouldn't pay a single penny if your insurance covers it. Only pay what the insurance does not cover, if anything. Maybe there is some sort of mistake or glitch on your OB's end about it all - so I would talk things out with them a bit further. If they absolutely refuse to take payment from your insurance company then I would switch to a new OB and quickly. That's crazy.
My OB likes to schedule c-sections for breech babies around 34 weeks, that doesn't mean you will end up with a c-section for sure, if baby goes head down it can always be canceled.
The insurance payment things seems kind of sketchy though
Why on Earth would he be charging you the delivery fee before you deliver? I don't get it. And why wouldn't they bill your insurance, which more than likely covers (at least part of) this.
My OB hasn't billed me a cent and won't until the baby comes. But she'll bill it through my insurance first. Because that's how it works.
Definitely do not pay this until they attempt to bill your insurance. If you do need to pay it, verify coverage with your insurance first so you can get reimbursed.
From what I understand, some OBs these days are typically not even trained to do a vaginal breech delivery anymore-they are taught they are risky and often won't attempt it due to that risk/liability issues. They will simply schedule a c section when the time comes if the baby hasn't turned.
Now the insurance stuff is definitely sketchy though. My OB office was very clear from the get go-explaining at the first appointment that we would make payments along the way for the current care I was receiving (ultrasounds, bloodwork, diagnostics, etc) -and we did so, just paying off the total this past month. It does not include delivery or hospital costs, that'll be incurred later after it's gone through our insurance after it happens. I would definitely refuse to pay anything on delivery until afterward!
With the breech baby issue, it really depends on your OB & on the hospital you'll deliver at. I'm delivering at a small rural hospital with no NICU and the OB's suggest scheduling c-s's if LO is breech, or if a previous LO has gotten stuck in the birth canal.
About the insurance: every insurance plan is different, but I had to cover a $250 deductible for mine, which we paid to the hospital where labs were done. After our deductible is paid, we pay 10% of maternity care up to $1500. So far, the only bills I've gotten are from the hospital for labs & u/s. I also get statements from my ins company showing how much has been billed to them, what their allowable cost is, what they cover (90% of allowable cost), and what we're responsible for (10% of their allowable cost). I get these statements BEFORE I get the bills from the hospital, so I already know what I'll owe before I get the bill. Could you maybe sign up for something like that through your ins company to make sure all the charges are being billed to your insurance?
That is very weird. I asked my dr a billing question once and she said she didn't have anything to do with billing that I would have to talk to the girls up front.
I don't make co-pays but my share of the dr visits was 360.00. I did get a list of the dr's fees for delivery. They are submitted to my insurance after baby is born and they pay 80/20 (although I'm due in january, I don't know how my deductable will affect that)
I think it's very unusual for your dr to even talk billing with you..and to ask for money up front for something hasn't even been done yet!
The problem is is that none of the tests or services are done at the hospital itself (their delivery charges would be separate). My OB's billing person has been telling me I owe "X" amount of dollars toward his delivery fee ever since I hit week 22.
I already get statements from my insurance company about the impending charges and what gets paid vs what I am responsible for. The delivery fee was never billed through the insurance which is why I am hesitant to pay it directly to my OB.
5lbs 9 oz, 18.5 inches long
6 months: 16lbs 15 oz, 27 inches long
How much does your insurance cover after your deductible is met? (80%, 90%, 100%?) I'd definitely ask for something IN WRITING showing what his standard charges are, and how he's coming to the figure you owe him. My OB has a global fee for prenatal care/delivery/postpartum care that is around $3000. After my deductible, I owe 20% of the charges, which I was asked to pay up-front (well, by 30w). The OB assumes the hospital will get my deductible (she actually will, because of weekly u/s from here on out, but we couldn't have anticipated that in the beginning). I wouldn't have paid it if I didn't have in writing what the charge they would submit to the insurance was, along with confirmation from my insurance company of what they would be paying & what I would be responsible for. I would be VERY hesitant to pay anything to your OB in your situation, though - there's something wrong with the situation and his refusal to go through your insurance for payment.
Regarding the breech baby - 99% of OBs will not attempt a breech delivery vaginally, because of risk/liability & what it does to their malpractice insurance. My OB has already told me that a c-section will be scheduled if LO ends up breech again at my 35w u/s, because her office policies, as well as the hospital policies, don't allow vaginal breech deliveries. So I doubt he's trying to scam you on that.
It's not that he's scamming me per se, it's just that LO has time to flip over and I'd like to try some natural methods before considering a c-section. He also never mentioned attempting an external version before finally settling on a c-section. From what I have researched, baby's do eventually flip to the correct position, some do it last minute, and only a small percentage will remain breech end up as a c-section.
Right now, that part of the equation is on the hold until I can get to the bottom of what's going on with the charges. I'm not paying anything and need something in writing from my OB. I need that information so I can communicate to our insurance company what it going on and what they cover.
I'm just SO over this right now
5lbs 9 oz, 18.5 inches long
6 months: 16lbs 15 oz, 27 inches long
we're being billed 650 for our delivery, which was supposed to be paid at wk 24, even though we don't deliver til January. I did talk to the gals up front, and we've worked out where I"ll pay Jan 1, because I want to use 2011 FSA dollars to cover it. They've pretty much said, 500 of that amount is the deductible that I have to meet thru my insurance, the rest is the co pays for all the office visit, after that, my insurance covers the rest of the cost. You might look see, if your doctor is doing something like mine is. I balked at first, because of the early billing for services not yet completely rendered, but it turns out, the whole thing made sense when I spoke with the financial gals, and they were willing to work with a Jan 1 payment.
edit: did you look to see how your out of pocket max lines up with your deductible?