Seton Medical Requiring 25% of Estimated Delivery Costs

BabyTime01032012 · November 2011

A couple months ago I started a thread asking about how much this delivery will most likely cost me. https://community.thenest.com/cs/ks/forums/thread/57560699.aspx

This prompted a side discussion of people being called by hospitals and being asked to prepay.

I just got the call, and at first they made it sound like I had to pay $600 before I'd be admitted. Then when I asked to be transferred to a supervisor, she said it was their policy to collect 25% up front. I said I want something in writing. I'm just not forking over $600 with no itemized estimates. She said she'd send something in the mail.

From the previous discussion it sounds like some people paid up front and some people did not. I don't want to run into trouble being admitted, but I also don't want to pay anything before I get a final EOB from my insurance.

What do you all suggest?

august8080 · November 2011

They were pretty pushy over the phone with me about pre-paying and I said I wanted to wait until my insurance EOBs had cleared before I paid anything. They accepted that answer. If you're not comfortable paying, I'd just politely push back until y'all reach an acceptable resolution.

mcurban · November 2011

You do not need to pay a cent to be admitted. If they persist, ask that they contact your insurance company (who, by the way, will not pay anything to them, either).

BabyTime01032012 · November 2011

august8080:
They were pretty pushy over the phone with me about pre-paying and I said I wanted to wait until my insurance EOBs had cleared before I paid anything. They accepted that answer. If you're not comfortable paying, I'd just politely push back until y'all reach an acceptable resolution.

That's what I said too! And I can't believe they were still being pushy! They said the 25% down is a policy. That's why I want something in writing. Something just doesn't feel right to me here.

august8080 · November 2011

Well, policy or no policy, they are not going to deny you care if you haven't pre-paid so if you can't get something resolved at least you know it doesn't really mean anything--you can still have your baby there. Stand your ground but always be polite--billing people get b!itched at all day long.

How is your insurance plan set up? Do you have a deductible you know you have to meet? Is there a flat rate per day in the hospital? You owe a co-insurance (% of the total cost)? What's your out of pocket max and how close are you to reaching it?

Keribells · November 2011

I delivered at Seton in Kyle and didn't pay a dime prior to admission and they never asked.

2bmrslove · November 2011

I agree 100% with being poliet. I'm in billing and if someone is b*tchy I will not budge on anything. I also agree with not paying anything upfront until you hear from your insurance company and have something in writing. Good luck.

Kitkatishbakk · November 2011

Scott & White is requiring me to pay 100% of their estimated costs by the end of 30weeks. They called my insurance (right in front of me) and verified deductibles, costs, etc....End result is I have to pay $1,865 before the end of April...This is because my deductible ($750) will be both years: 2011 & 2012 and my 10% coinsurance for standard delivery hospitalization.

I also doubted this and it really annoys me. My FSA states they will only reimburse AFTER EOB's have come out, so basically I have to pay for this all OOP which makes saving for baby a lot harder.

august8080 · November 2011

End result is I have to pay $1,865 before the end of April...This is because my deductible ($750) will be both years: 2011 & 2012 and my 10% coinsurance for standard delivery hospitalization.

This doesn't sound right. You are not delivering your baby in 2011 AND 2012 at their hospital, so you should only have to pay one deductible. Don't take the word of the first insurance rep who answered the phone. I'd definitely go up the chain of command on this one.

BabyTime01032012 · November 2011

august8080:
Well, policy or no policy, they are not going to deny you care if you haven't pre-paid so if you can't get something resolved at least you know it doesn't really mean anything--you can still have your baby there. Stand your ground but always be polite--billing people get b!itched at all day long.
How is your insurance plan set up? Do you have a deductible you know you have to meet? Is there a flat rate per day in the hospital? You owe a co-insurance (% of the total cost)? What's your out of pocket max and how close are you to reaching it?

I have no copay with my insurance. I pay 10% co-insurance. As for my deductible max, it is $3000 (I think). I know I'm not even close because my new policy just started 10/1/11.

They got the $600 estimate from my 10% co-insurance. They are asking me to pay 25% of that up front.

BabyTime01032012 · November 2011

august8080:
Well, policy or no policy, they are not going to deny you care if you haven't pre-paid so if you can't get something resolved at least you know it doesn't really mean anything--you can still have your baby there. Stand your ground but always be polite--billing people get b!itched at all day long.
How is your insurance plan set up? Do you have a deductible you know you have to meet? Is there a flat rate per day in the hospital? You owe a co-insurance (% of the total cost)? What's your out of pocket max and how close are you to reaching it?

I have no deductible with my insurance. I pay 10% co-insurance. As for my policy portion max, it is $3000 (I think). I know I'm not even close because my new policy just started 10/1/11.

They got the $600 estimate from my 10% co-insurance. They are asking me to pay 25% of that up front.

Ricola · November 2011

I got a letter from Seton SW telling me to pre-pay either all of the estimated max amount for me (my $3k co-pay) or 25% at the least. I did pay the 25%, since I know that I will definitely use that up with the delivery and at least 2 day hospital stay. I also had to pay up front for my OBGYN's services for the whole pregnancy, delivery and post partum care.

Kitkatishbakk · November 2011

august8080:

End result is I have to pay $1,865 before the end of April...This is because my deductible ($750) will be both years: 2011 & 2012 and my 10% coinsurance for standard delivery hospitalization.

This doesn't sound right. You are not delivering your baby in 2011 AND 2012 at their hospital, so you should only have to pay one deductible. Don't take the word of the first insurance rep who answered the phone. I'd definitely go up the chain of command on this one.

Sorry - I should note - Scott & White provides clinical & hospital care, so they bill both sides....

In Austin, I assume it happens like this.... You see Dr. in Dr. Office.... & Dr. office bills you for that care (prenatal). You deliver baby at Hospital, and hospital bills you.

Here, the hospital provides both sides of care. The doctors are employed & paid by the hospital...there are little to no private practice physicians at Scott & White..... therefore they bill clinical care & hospital care. Since I am having my prenatal care at the "clinic", they bill both deductibles because all of the care is being provided by S&W.

CagleBaby · November 2011

I wouldnt pay anything. What if something happens and you dont deliver at that hospital?

Abrooks · November 2011

I've delivered two kids at Seton and never paid up front and do not recommend it. Just don't do it. They can try but it's an estimate and honestly you can lose money on it by paying an estimate up front.

sweetdreams2000 · November 2011

I will be delivering at Seton in April, but I haven't called, and they haven't asked. My dr however sent me my first bill for delivery charges after anticipated insurance, and I refused to pay until next year b/c of my HSA and asked them to document my chart that I would pay closer to delivery so that I could prove payment in 2012. They seemed to be okay with that, and my last statement I just got had a note on there that I had deferred until 2012. I understand paying a little in advance, but really, 6+mths in advance to me is crazy.

sweetdreams2000 · November 2011

Oh, and out of curiousity, what triggers the pre-payment alert to the hospital? Is it filling out the pre-authorization paperwork?

BabyTime01032012 · November 2011

sweetdreams2000:
Oh, and out of curiousity, what triggers the pre-payment alert to the hospital? Is it filling out the pre-authorization paperwork?

Yes, from what I understand, after you fill out your pre-registration they call you about a month before you're due.

HSartteach · November 2011

We actually chose to pre-pay all at the hospital. After we pre-registered about a month before my due date, I was sent a bill telling me what my delivery would be after my insurance had been contacted. The only things we had to pay for after was the additional things like the anesthesiologist, the surgery for my c/s, etc.

For us it was the right choice. But, that was us. You have to do what is right for your family.

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