Delivery Payment SUPER LONG and Confusing...

cbkeni · December 2011

I'm going to try really hard to make this as un-complicated as possible...

My doctor's office tries to get you to start making payments on your labor costs at the beginning of your pregnancy so that when you actually have the baby you're already all paid up and don't have to worry about it. I get the idea behind it especially because a majority of their patients don't have insurance (it's why I picked them, at the beginning of my pregnancy my insurance hadn't kicked in yet and they offer a 40% discount) so I can see how it'd be an ok idea.

The thing I find weird is that my insurance finally did kick in in August and that's when they brought up making payments, if they had mentioned it before they knew I would be getting insurance it would make more sense to me. They were giving me a total of about $1700 that I would have to pay out of pocket that included all the other costs (like labs and anything else) from their office and I basically agreed to make a payment of $100 that day but asked them to double check with my insurance company in case the total would be less and they said they would (and I didn't sign anything). Then I started getting bills in the mail for labs ($350) and ultra sounds ($321) and whatnot and the insurance company said they don't cover those, but that when I pay those bills the payments will be applied to my deductible so that total would be more like $1000 and to have my doctors office call them to straighten it all out.So rather than having all the costs balled up into one they were sending me separate bills that I needed to pay off, but that would lower the overall total.

So after that I would go to my appointments and once every few appointments they'd ask me to make a payment (not every time) and I would explain to them that they had told me they were going to call my insurance company and come up with a solid plan and a closer idea of the total so I didn't pay more than I had to. They would always say something like "Oh! Ok yea sorry, alright I'll note that on your file so we can look into it" and that would be that.Because honestly I wasn't going to pay each bill separately AND make payments on a total that included those bills.

Last month I get a call from their billing lady (SUPER rude *** BTW and I have had drama with her in the past) literally yelling at me telling me I owe them money and I've been avoiding making payments and making excuses even though I agreed to a payment plan and all this other BS. So I start yelling back telling her that the office has had months to sort this out with my insurance which they continuously told me they would do and never did. Then I mentioned that all I've been holding out for is a general idea of the total because I wasn't about to make payments for more than I had to (and honestly at this point I was really just pissed off and did NOT feel like cooperating anymore) and that at this point there was no way I could pay off even $1000 before the delivery (I'm due 1/4) and that I would prefer for them to just bill it after I have the baby. She calmed down and said she would look into it and straighten everything out. She also tells me that she took the liberty of putting the $100 I paid towards the total and applying it to the $321 U/S bill I had received which sort of pissed me off just because who the hell is she to decide it's ok to do whatever works best for her with my money...but I dunno maybe I was over reacting to that.

Since then I went to I think 2 more appointments where they didn't say anything so I assumed it all got worked out. Yesterday I went in for another appointment and the lady at the front desks calls me back up (after I checked in and had settled down to wait) and pretty much tells me I need to pay the balance for the delivery costs which she then proceeds to tell me is $2000! So I explain ALL the drama that's been going on with this and mention that last time I checked they told me $1700 and my insurance told me closer to $1000 so where the hell did she come up with $2000? She tells me that I have a $2000 deductible that hasn't been met and then informs me that I also have a $300 co-insurance payment that I have to make. I tell her there is obviously something wrong and even if she's right there is NO way I'm worrying about paying that off in the next couple weeks so she shoots me a wicked attitude and goes "well pay what you can now at least.." to which I reply that I have no extra cash to put towards this at this point because my last day of work is Thursday and all our money is being saved for after the baby so we can pay bills and it's not that I won't be paying it ever it's just that I would feel better paying after the delivery so I know I'm not paying more than I need to. She basically tells me that this total HAS to be paid before the delivery! $2300?!? This is when my DH (who rarely gets involved with this type of thing but is HELLA scary when he's mad) comes flying up to the window screaming at the lady telling her that at this point we will not be paying jack sh!t until after the birth when we know EXACTLY how much we will owe and have it confirmed through the insurance company so we know they're not ripping us off. So she tries her hardest to look like she's not pooping her pants and says "Fine, I'll note that on your file. But they will be expecting you to make payments at your future appointments" and slams the window shut on us as fast as she can. So I obviously spent the rest of the night crying about it because I really hate people looking at me like I'm some scum bag deadbeat who doesn't pay their debts and I have to see these people once a week from now till I have this kid. But I really feel like they're being super shady and weird and now I really don't trust them not to rip us off.

Here's what I'm wondering; can they even demand payments on a service that hasn't been rendered yet? My stepmom brought up a good point too, what if there's some sort of situation where I deliver somewhere else (her example was what if I go into labor at their house, which we will be at for the holidays which is an hour away from my hospital but they have a really great hospital about 10 minutes away, and I end up delivering there). My Doctor's office also works with Doctors from different offices so there is a chance I may end up having a completely different doctor from a different office deliver the baby.

Also is it normal for a Doctor's office to expect to be paid before the delivery? I always assumed you pay after it happens and they bill it. Like I said I can sort of see why they might have come up with a "Pay Before" option, but I feel like it should be just that, an OPTION.

Really sorry this is so long, I'm trying not to leave anything out that might help someone explain what the hell is going on to me... Big Smile

summer1117 · December 2011

You really need to handle this with your insurance company directly first to get an idea of what you owe and potentially will owe. You will need to find out what your deductible is, how much you still owe on your deductible, what your co-pay to your doctor is for visits, and what percentage you pay after your deductible is met. I wouldn't rely on the doctor's office to tell you that. It is dependant on your insurance plan. The doctor's office should be sending every medical charge to your insurance company. Then whatever isn't covered, you may owe to your doctor. If you are having issues figuring all of this out, I would talk to a financial advisor at the hospital you will be delivering out to see if they could help you.

katokc1 · December 2011

I'm in a similar situation as you, however, my dr/hospital is much more accomodating. In my 2nd Trimester, I received a call from the financial counselor for my dr/hospital informing me of my deductible and co-ins. They gave me an estimated cost of delivery and I have to make payments to cover that cost before baby is born. I was like you and thought there is no way this is normal, but apparently more hospitals and dr.'s are trying to get their money from their patients with insurance. If I were you, I would call your insurance and see if they can get to the bottom of this for you. Unfortunately, I think people tend to treat you better if a debt is paid vs. unpaid and I'm going thru my savings and any extra money we have to have mine paid before this baby is born. FWIW I hope you're able to get this resolved and I think it's ridiculous that we have to do this when people on welfare can have dozens of children on our tax dollars-but thats a whole other conversation

jinx75 · December 2011

Lurker here

I worked on the insurance side of healthcare before becoming a coder and wanted to let you know pregnancy is consider a "global package." That means that for most, if not all insurance companies, there is one global (all inclusive) fee for prenatal care, delivery and your 6 week check up. When you go in for your first appointment the billing rep at the dr's office will call your insurance co and confirm what they cover in full, minus any deductibles you might have. When I was pg with my first child my insurance was a 90/10 plan, no deductible. That meant that ins would cover 90% of everything and I covered the other 10%. My Obs office gave me a total I'd owe for prenatal care and I made payments each month to cover that cost. After DD was delivered and ins paid I got a final bill for the 10% for her delivery. Your OBs office is demanding you pay the delivery cost prior to delivery because you entered into a payment plan with them and failed to keep your end of the agreement. Regardless if the total cost was $1700 or $2300 you only paid $100 of that and haven't paid since. They know that it's alot easier to attempt to get payment from someone they see face to face each month or week versus trying to call someone after the services have all been rendered and trying to recoup their costs. I'm not trying to sound harsh just explaining it from a business standpoint. The payment plan is a courtesy they offer their patients because they could demand payment in full up front or refuse treatment. It would definitely benefit you to contact your ins co and find out what all your OBs office has billed them, office visits, ultrasounds, labs etc etc and what they have paid and what they show you owe. Even if you're paying the OBs office just $50 a month it'll go a long way to get them off your back and make your delivery as stress free as possible.

GL!

rosebud218 · December 2011

Sorry your going through this, it is and sounds awful.

2BMrsMcW · December 2011

Definitely work with your insurance agency to get a better picture! The whole idea of co-insurance and deductibles has always confused me...and I used to work in insurance!

My doctor's office sent me a note early in my pregnancy that said I owed them $1000 - with no other explanation - and noting that I could break it into 2 payments. Then, I changed jobs and insurance (nightmare in paperwork land), and talked with both my dr's office billing department and my insurance company to understand what changes that meant in terms of what I owe the doc. My doc calculated what I would owe as far as a deductible based on the due date of the baby, and I had to pay that by week 28. However, all of that is considered 2012 money, so I am still responsible for my 2011 contribution toward the deductible.

SmittyPants · December 2011

With lab work, exams, and ultrasounds, you may very well owe your doctor $2300 right now. It is your responsibility to find out your deductible (what you must pay out of pocket). My deductible is $3500, meaning nothing is covered by my insurance until I've paid that much out of pocket.

Your doctor's office submits a bill to your insurance company, and it is your insurance company that decides how much of that bill, if any, is covered. The insurance company will then pay (or not pay depending on your deductible and your insurance plan) and you will then be responsible for the balance of the payment.

If you are afraid of overpaying then that is something you take up with your insurance provider, not your doctor.

cbkeni · December 2011

jinx75:
Lurker here

I worked on the insurance side of healthcare before becoming a coder and wanted to let you know pregnancy is consider a "global package." That means that for most, if not all insurance companies, there is one global (all inclusive) fee for prenatal care, delivery and your 6 week check up. When you go in for your first appointment the billing rep at the dr's office will call your insurance co and confirm what they cover in full, minus any deductibles you might have. When I was pg with my first child my insurance was a 90/10 plan, no deductible. That meant that ins would cover 90% of everything and I covered the other 10%. My Obs office gave me a total I'd owe for prenatal care and I made payments each month to cover that cost. After DD was delivered and ins paid I got a final bill for the 10% for her delivery. Your OBs office is demanding you pay the delivery cost prior to delivery because you entered into a payment plan with them and failed to keep your end of the agreement. Regardless if the total cost was $1700 or $2300 you only paid $100 of that and haven't paid since. They know that it's alot easier to attempt to get payment from someone they see face to face each month or week versus trying to call someone after the services have all been rendered and trying to recoup their costs. I'm not trying to sound harsh just explaining it from a business standpoint. The payment plan is a courtesy they offer their patients because they could demand payment in full up front or refuse treatment. It would definitely benefit you to contact your ins co and find out what all your OBs office has billed them, office visits, ultrasounds, labs etc etc and what they have paid and what they show you owe. Even if you're paying the OBs office just $50 a month it'll go a long way to get them off your back and make your delivery as stress free as possible.

GL!

I didn't agree to anything, they told me that they would like me to pay in advance and I asked that they speak to my insurance and get back to me with a realistic total before I would agree to anything which they originally said was fine. Then they called me 2 months before my due date accusing me of entering into a payment arrangement with them and not keeping up my end. I never signed anything or even made a verbal arrangement. I did pay $100 but that was sort of a "sure why not" payment, nothing was ever agreed upon.

jinx75 · December 2011

cbkeni:
jinx75:

Lurker here

I worked on the insurance side of healthcare before becoming a coder and wanted to let you know pregnancy is consider a "global package." That means that for most, if not all insurance companies, there is one global (all inclusive) fee for prenatal care, delivery and your 6 week check up. When you go in for your first appointment the billing rep at the dr's office will call your insurance co and confirm what they cover in full, minus any deductibles you might have. When I was pg with my first child my insurance was a 90/10 plan, no deductible. That meant that ins would cover 90% of everything and I covered the other 10%. My Obs office gave me a total I'd owe for prenatal care and I made payments each month to cover that cost. After DD was delivered and ins paid I got a final bill for the 10% for her delivery. Your OBs office is demanding you pay the delivery cost prior to delivery because you entered into a payment plan with them and failed to keep your end of the agreement. Regardless if the total cost was $1700 or $2300 you only paid $100 of that and haven't paid since. They know that it's alot easier to attempt to get payment from someone they see face to face each month or week versus trying to call someone after the services have all been rendered and trying to recoup their costs. I'm not trying to sound harsh just explaining it from a business standpoint. The payment plan is a courtesy they offer their patients because they could demand payment in full up front or refuse treatment. It would definitely benefit you to contact your ins co and find out what all your OBs office has billed them, office visits, ultrasounds, labs etc etc and what they have paid and what they show you owe. Even if you're paying the OBs office just $50 a month it'll go a long way to get them off your back and make your delivery as stress free as possible.

GL!

I didn't agree to anything, they told me that they would like me to pay in advance and I asked that they speak to my insurance and get back to me with a realistic total before I would agree to anything which they originally said was fine. Then they called me 2 months before my due date accusing me of entering into a payment arrangement with them and not keeping up my end. I never signed anything or even made a verbal arrangement. I did pay $100 but that was sort of a "sure why not" payment, nothing was ever agreed upon.

They more than likely viewed this payment as entering into the payment agreement. I'm just speculating but it's a real possibility.

mundayem · December 2011

My OB did the same thing where they contacted the insurance company to find out what my percentage would be and then put me on a "budget billing plan" so I would pay off everything before delivery. Honestly the people at your OB's office are not the billing department and they aren't the ones who deal with the insurance company. They only know what the billing department tells them. When it comes to insurance and payment schedules it's really your reposnsiblity to find out what's going on and how you need to handle it.

You have every right to contact your insurance company yourself and find out what your OOP expenses will be. Once you figure that out you can contact your OB's billing department and work something out with them. It would probably go a long way with your OB's office if you are proactive about it and try to figure out what is going on and what the amount you owe will be.

cbkeni · December 2011

mundayem:
My OB did the same thing where they contacted the insurance company to find out what my percentage would be and then put me on a "budget billing plan" so I would pay off everything before delivery. Honestly the people at your OB's office are not the billing department and they aren't the ones who deal with the insurance company. They only know what the billing department tells them. When it comes to insurance and payment schedules it's really your reposnsiblity to find out what's going on and how you need to handle it.

You have every right to contact your insurance company yourself and find out what your OOP expenses will be. Once you figure that out you can contact your OB's billing department and work something out with them. It would probably go a long way with your OB's office if you are proactive about it and try to figure out what is going on and what the amount you owe will be.

I agree, if they had said once "It's really your responsibility to find out the total" I would have, but I don't work for an Insurance Company OR a Doctor's Office so as far as I'm concerned if the Doctor's Office tells me they're going to find out what that total is I'm not going to believe that they'll take care of it. Now I obviously know better but that just makes me more angry about it. They said they would do something, they didn't do it and now they're trying to treat me like some scum bag.

cbkeni · December 2011

I called my Insurance Company and they said that I have a $2000 deductible that I've already paid $900 towards, and that if the Doctor's office wants an estimated cost they would say around $1500 for my total (but she said it "unofficially" because their policy is not to give estimates...?).

The one thing I did think of was maybe the woman I spoke to thought my deductible renewed in January, but it doesn't renew until April and I've told them that. And even if she was right that does not excuse the attitude.

The woman I spoke to from my Insurance Company also took the liberty of looking through my notes to see exactly when the woman from the billing department at the Doctor's Office called...she never did. So all those times she told me that she would call she lied. Again if she had said "You call it's your responsibility" I would have, but the way she made it sound was as if it was a normal every day part of her job to do it.

And one PP pointed out that I should be talking to the billing department directly and not the receptionist and that's true. I think just because it's a small office and the billing department sits at a counter like 2 feet from the front desk and will usually turn around and join the conversation I sort of always felt like I was talking to them...that makes no sense...it just seems like everyone in the office is involved in everything kind of...but you're definitely right from now on I am dealing DIRECTLY with the *** in the billing department.

I'm going to call them as soon as I get out of work to get this crap straight!

cbkeni · December 2011

LegalPawn:
I don't understand why you didn't just call your insurance company and find out for yourself after dealing with constant requests for payment from your OB's office. Sure the office said they'd "look into it" but clearly they never did. You should have just taken the responsible route and gotten the answer for yourself.

Yea I know, insurance stuff confuses the crap out of me though so I sort of appreciated the idea of someone who knew what was going on helping me out. It was just one of those things where I was relying on someone to do what they told me they would. And it didn't turn into an issue until just last month, until then I assumed that it wasn't too big of a deal if paid afterwards. Every time they did bring it up I would tell them I was waiting for a total from them and they would just be like "Oh ok" and let it go. Then last month when the billing lady called me flipping out was when I realized it was turning into a big deal.

That's what I mean, it's not so much that they wanted me to pay (although I will admit I had never heard of that before so it was kind of weird to me but now I get that it's apparently totally normal) it was more just that it started out as "no big deal we'll get everything straightened out for you" and wound up being like "OH MY GOD HOLY DRAMA THIS IS A HUGE DEAL AND YOU OWE US MONEY" and there was no warning in between. Like I trusted them to help me out with something I don't really know about and I feel like they dropped the ball and now they're trying to make me feel like a piece of sh!t about it.

I'll admit I made a mistake but seriously they're handling it like a bunch of jackasses.

cbkeni · December 2011

Oh also! I was really just wondering if this was all normal and whatnot. I wasn't like "wah! what am I gonna do?!" Obviously now I know I have to get it all taken care of, it was more like "if you found yourself in this position would it make you kind of angry?" It's just on the top of my mind and I was just curious...I sort of forgot the whole point to my own post!

I do appreciate the help and input from everyone!

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