Epidural not covered by insurance?

FutureMrsCaesar · March 2011

I just got a bill yesterday for my epidural from the anesthesiologist group at my hospital. It was billed as 'obstetric care' and under my insurance all obstetric care is supposed to be covered 100%. Do some insurance companys consider the epidural elective or something? Should I call and double check and make sure they won't cover it?

Swan21 · March 2011

I would call, I find it hard to believe it wouldn't be covered. Maybe they coded it incorrectly.

TakeLuck · March 2011

Call and double check! I got a bill for over $2000 a couple of weeks ago and after my head had stopped spinning, I called and it was a mistake.

flhokie · March 2011

I would call and check. For me, I had not yet met my deductible for 2011 and that (spinal in my case) was the first thing billed so I had to pay the negotiated rate which was right below my deductible amount. I did call in advance to make sure it was covered and was told it was--under anesthesia (not necessarily OB). At my hospital they said that if it's not covered by insurance you had to pay $500 cash at time of delivery and I didn't want any confusion which is why I called in advance. While I only had to pay my copay at my initial OB appointment I had to pay negotiated rates up to my deductible and then 20% of charges beyond that (up to an out of pocket max which I still haven't met).

RubineLime · March 2011

FutureMrsCaesar:
...Do some insurance companys consider the epidural elective or something?...

Exactly. Some do consider it elective and therefore won't cover it unless there is a specific medical reason why you needed one. In that case, the hospital may have not coded it in your favor.

izzourclue · March 2011

I got billed for the anesthesia separately. Probably because an epi is elective.

bisforbeatrice · March 2011

Why should insurance cover you being a wimp?

alli&pat · March 2011

Call and check. I had some blood work done early in my pregnancy and was charged in full for the lab's bill. Although I was seen at a clinic at the hospital I worked at and referred to another clinic at the hospital I worked at, they sent the blood to a lab not covered by my insurance plan. I called and explained what happened and that I had no choice for the blood to be sent to a different lab and they made a one-time code to make this particular lab "in network."

Could be that your anesthesiologist was out of network. If you call, they'll be able to tell you exactly why it was denied.

theprincessPAT · March 2011

alli&pat:

Could be that your anesthesiologist was out of network. If you call, they'll be able to tell you exactly why it was denied.

This happened to us. The neonatologist at our hospital is considered out of network but because they were at the hospital (i.e., our only choice) it is covered. Initially we were billed as if they were out of network (holy hospital bills) but we called and it's being fixed.

Puppins · March 2011

I got a bill for the epidural, then a week later I got a check from my insurance company for the total. I would call and check.

ABizzity · March 2011

Definitely call! I got a bill for nursery charges for $1500 and looked it up online at my insurance website and sure enough, it should be covered so I called them and they had the hospital re-bill it and they paid it.

honkytonk_kid · March 2011

Well, generally an epidural IS elective, but most insurance companies do cover them. Definitely call and check- sometimes anesthesiology groups are separate from the hospital, and bill separately. My c/s spinal was billed separately, but still covered.

StellarStina26 · March 2011

bisforbeatrice:
Why should insurance cover you being a wimp?

Look who is up for this discussion. And epidural isn't always for "wimps". I got one and loved it... but they were encouraging me to because my heart rate was spiking into 160s and 170s with them. I think a little pain medication is better than a heart attack no matter how much focusing and breathing I did.

Want a personalized experience?

Epidural not covered by insurance?

Re: Epidural not covered by insurance?

Choose Another Board

Search Boards