XP: Question about outrageous charges by MFM office (long)

amd1982 · August 2012

Hi ladies,

Question regarding insurance and MFM office protocol, hopefully someone has experience and can help because i got quite frustrated today with being bounced around like a tennis ball. i satisfied my $1,000 deductible in January of this year. Since then I've paid 20% of all services and I'm at around $1,100 (have to get to $2500 total and then everything is paid 100% after that).

I went for an NT scan in the middle of August since my old OB office was not certified to perform those u/s. I was in the room for a total of 20 min, and the doc failed to tell me anything about the fact that they really weren't going to tell us sh** because they are twins and would never be able to determine which baby had Downs, etc. So basically I feel like I should have just gone for a regular ultrasound, but I really didn't have a choice since my OB office didn't offer any type of service.

Fast forward to today: i get a bill from the MFM office which is part of the local hospital. They charged my insurance $1750 for the ultrasound and $900 for professional fees. The insurance paid them a portion, but I have to pay $400 for an ultrasound that honestly did not give us any more information than a regular ultrasound. I am mad - I know $400 is not something to stress about, so I'm not. but it angers me because I feel like i was taken advantage of - not to mention the fact that $400 would pay for practically 2 cribs for LO's! i contacted my insurance company BCBS and they were very rude, basically acting like i was dumb even though i have pretty good knowledge of the insurance industry. did anyone else experience this? is there something i can do in terms of working with the MFM office to re-code? The girl I spoke with today at the office was new and very nice, but she said i need to call tomorrow to speak with the person in charge of billing and coding. TIA and sorry so long.

Rynleigh · August 2012

Bleh. I don't have any advice for you. I ditched BCBS after my last pregnancy because I still had over $3K in debt (i.e. co-insurance) to pay after my office visit copays, deductible, and premiums for just 4mo of care + one ER visit with their coverage (that was all before the birth, hospital stay, etc).... and that was back in 2006. I thought it was absurd.

Been with Kaiser ever since and haven't even come close to meeting my $1000 deductible this year, let alone hitting my max out. Just $20 copays for ultrasounds (including the NT scan), $20 for labs, and $20 for specialty visits (MFM, Oncology). Prenatal standard visits have all been free of copay as preventative. I'm sorry they're trying to screw your finances that money should be for your babies.

yinyang124 · August 2012

That is terrible. I'm on Medicaid because I didn't have insurance pre-pg, and they try to screw me all the time. I would definitely argue with the MFM billing office and see if there is anything they can do.

GypsyEsq · August 2012

In general the MFM will do a separate charge for each baby - so 2x the ultrasound costs and 2x the "office" costs. I saw the same MFM my first (singleton) pregnancy and the costs were literally half what they were this time and my EOBs make it clear that I was being charged for each baby. I don't know if that's necessarily what your costs are for but, typically, an MFM visit for multiples takes longer than one with a singleton and therefore the patient is charged more. Talk to the office billing person but be prepared for an explanation that these are their normal costs. And while it's true that the blood work portion of the NT Scan/Triple Screen couldn't tell you as much about which baby might have higher odds of a birth defect, certainly the scan itself should have given you information -- did you not have an ultrasound where the NT fold was measured for each baby? If so, and they did that twice, then the charges are probably reflecting the specialized ultrasound.

Venus04d · August 2012

My MFM u/s cost me that much every time too. I was shocked that they charge for each baby.

jquirke9881 · August 2012

I looked up the price that my insurance (BCBS) was billed for my NT scan.

06/20/2012

Paid

Ancillary

847.00

06/20/2012

Paid

Lab or X-ray Rendering

927.00

E&RMommy · August 2012

Each practice has its own policies. Most have you sign something to the effect that you will be responsible for anything not covered by insurance.

They charge the insurance company an outrageous amount knowing they will never get that much. It's quite normal.

Really sorry you feel that it wasn't explained to you.

FWIW, the NT measurement does at least tell you more about other risks than just DS and Tri 13 and 18.

shaket83 · August 2012

I agree with what PPs said. It sucks, but the $$$$ involved with having multiples adds up QUICK!! I had to meet our deductible twice (once for 2011 and then again for 2012). Just think of it this way, your getting to your max out of pocket closer so that you won't have a nice big fat bill for the hospital stay. Sorry that it got dropped on you like a bomb though!

mysteriousmommy · August 2012

MFMs are expensive. I paid them a LOT of money and I have great insurance. I think I ended up owing them somewhere around $1500 when all was said and done. I don't know what they billed for my NT scan, but brace yourself for your anatomy scan. My anatomy scans (I ended up having 3 because my babies were never positioned correctly for them to see everything) where literally thousands of dollars EACH. It was utterly ridiculous. The long and short is that there really isn' anything you can do about it. I ended up not even really needing the MFM since my pregnancy was relatively uneventful, but it's one of those "I'd rather have it and not need it than need it and not have it" situations.

amd1982 · August 2012

Thanks for all the responses - I didn't mean to come off as if I'm annoyed by having two babies so it's double the cost. I guess most of my frustration stemmed from the fact that the doctor (even my old OB acknowledged it) has absolutely NO bedside manner. They were almost rude to me, and it's like "wait a second, I'm paying good money for these services. You should be explaining every single little thing to me."

All they said at the MFM was "neck folds and measurements are good." Then went to the OB and all they said was "things are good." so in my eyes, it's like i'm paying for nothing out of the ordinary. i scheduled my a/s scan for next thurs with my OB office instead of the MFM. Honestly, I want to have a positive u/s experience and not one where i leave with more questions than when i went in. as long as i have a good experience in the office, i'll pay whatever it takes for these two little angels

twinsmom23 · August 2012

Why do you even care about the charges? You are going to have to pay until you hit $2500 anyway. Who cares if it is now, or next month?

Jen0204 · August 2012

Joeblack:
Why do you even care about the charges? You are going to have to pay until you hit $2500 anyway. Who cares if it is now, or next month?

I'm very surprised that they said they couldn't tell you anything much because there are twins. That would make me very concerned that they're saying they can't distinguish between the twins. If you're di-di, then should be able to tell easily. If you're mo-di, it's very important for them to tell who is who in order to monitor for TTTS. If they seriously can't be bothered to identify your babies then I would look for a new MFM.

Other then that, I agree with this poster. Co-pays suck, co-insurance sucks, deductibles and maximum out of pockets both suck, but at the end of this pregnancy you'll have paid $2500 no matter what. Odds are your MFM will get the remainder of that money at some point, so who really care if they get it now or later? Yes, $400 would buy nice cribs, but you're never going to have that $400. With having coinsurance I can guarantee that you will meet your maximum OOP by the time you guys leave the hospital with your babies.

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