Payment for delivery before birth? Please Help!!

Alexandra1513 · December 2013

I just got a call from my possible OB's office saying they contacted my insurance and that they could charge $1900 for my delivery and that they would require payment in full by my 20th week. They said they would break it into 3 payments and that I would owe $650 on Monday at my very first appointment with them. I have not even met this doctor yet. Has anyone ever heard of anything like this before?

becomingmommyagain · December 2013

This is common unfortunately. It drugs on your physician, insurance, hospital, etc.
I've met my personal deductible for the year, but we are still working on family deductible so my insurance only pays 85%. I have to bring $500 to my next appt to cover the estimated costs.

galv0515 · December 2013

Yes it's a common practice, but unfortunately not alway right! My ob office tried to do the same thing to me on Friday. I explained to them that I am not paying for two reasons:
1. I have an HRA fund that as of Jan 01 will have 1450 out of 1500 of my deductible-they were charging the full deductible for nxt year and
2. It is a pain in the ass to get a refund if/whn the hospital bills first. The insurance will apply the deductible to whichever bill is submitted first causing you to wait 6 weeks for reimbursement from the doctor!

I work for my insurance company, so if you are not familiar with all the details of maternity coverage, deductibles, coinsurance, etc I recommend calling them to get all the details. They will also sometimes call to ur dr on your behalf and ask them to refrain from collecting upfront, however they can't force them to accommodate!

mamato3girls · December 2013

My practice requires the full estimated payment during pregnancy as well (by 36 weeks actually). I don't mind so much but like pp said the hospital always bills for the birth first which means I have to wait a long time to get my refund from my midwife practice.

allardr · December 2013

That's strange. Ours gives you a letter in the mail shortly after first appointment it outlines what they found from your insurance then give you the option to pay as you go or with one big bill at the end. I just said wait til the end (but that's only for doc visits), so I still got lab work, u/s, etc billed as you go so it was a nice balance for us. PS I envy that total lol ours will cost us nearly $4,000 (our deductible)

JKGordon · December 2013

That's a lot! My doctor also does global billing for their fees, but I'm only paying 4 payments of like $180. I'll get a hospital bill too that they are estimating to be at $1500, but that's after delivery.

acciovino · December 2013

My OB is going to cost me $550 and I don't have to pay until 32 weeks.

Blackvelvet · December 2013

The first time I has to pay each month and they would drop you as a patient if you didn't pay on time. I lost my job and had to go on DH's insurance midway though and so it sucked as I paid the deductible for both due to how it worked out it kinda sucked. I'm not sure this time had my first appointment but they didn't say anything about paying. They were really glad I had insurance as almost all the patients are on medicaid we are in a welfare town everyone seems to be on some kind of aid.

LadyMacaron · December 2013

Yup. I had to pay $2,000 at the second appt. as a deposit for delivery. This does not include hospital charges, any anesthetics, or co-pays. Unfortunately, it's so high because we hadn't met our full deductible yet, and our insurance only covers 80% of birth.

argonne · December 2013

Yes. My office does this. They have a global fee and they calculate what you'll owe after insurance. We owe $1500, but it doesn't have to be paid prior to 20weeks. Just before birth. I will probably overpay since they'll let the hospital bill first, but they refund quickly. I think my deductible is $1500. After deductible is met, I pay 10% of the bills until my out of pocket is met, which I think is 5500. If I have an uncomplicated birth, I shouldn't meet my out of pocket max.

kboydbowman · December 2013

...And this is yet another reason we're using midwives and a birthing center. The cost of the whole birth is less than $2000 and we'll probably only pay $300 to $400 out of pocket after insurance. And they do payment plans that can go up to several months post-birth.

kboydbowman · December 2013

GhostMonkey said:

kboydbowman said:

...And this is yet another reason we're using midwives and a birthing center. The cost of the whole birth is less than $2000 and we'll probably only pay $300 to $400 out of pocket after insurance. And they do payment plans that can go up to several months post-birth.

1. Not all insurance plans cover midwives.

2. Not everywhere has birth centers.

3. Not everyone can deliver at one.

I'm aware of that, just expressing that finances are one of the reasons (other than being generally crunchy) that we are choosing a birth center.

argonne · December 2013

GhostMonkey said:

kboydbowman said:

...And this is yet another reason we're using midwives and a birthing center. The cost of the whole birth is less than $2000 and we'll probably only pay $300 to $400 out of pocket after insurance. And they do payment plans that can go up to several months post-birth.

1. Not all insurance plans cover midwives.

2. Not everywhere has birth centers.

3. Not everyone can deliver at one.

I'm aware of that, just expressing that finances are one of the reasons (other than being generally crunchy) that we are choosing a birth center.

You do also realize that your perfect birthing center birth can go wrong real fast and, all of a sudden, those plans go out the window.

FemShep · December 2013

OP, talk to your doctor about whether they can modify the payment plan. While they may still require some payments over the course of your pregnancy, many offices can be very flexible with you.

Another alternative is to ask if you can have an initial consult with the doctor to find out more info about their practices, affiliated hospital, etc before you commit to them being your care provider for your entire pregnancy. You may have to pay a significant fee for the initial visit, but if you decide to continue with the doctor, they'll probably apply it to your overall costs.

Good luck!

ASmallWonder · December 2013

RedheadBaker said:

GhostMonkey said:

kboydbowman said:

...And this is yet another reason we're using midwives and a birthing center. The cost of the whole birth is less than $2000 and we'll probably only pay $300 to $400 out of pocket after insurance. And they do payment plans that can go up to several months post-birth.

1. Not all insurance plans cover midwives.

2. Not everywhere has birth centers.

3. Not everyone can deliver at one.

I'm aware of that, just expressing that finances are one of the reasons (other than being generally crunchy) that we are choosing a birth center.
So how does your sanctimonious response help the OP if she can't birth at one, whether due to lack of access or risking out of birthing at one?

Seriously. That response is no better than "Sucks to be you. Thankfully I have lots of money to cover my bills!" It offers zero help and a brag of not facing the same struggle.

BlckRoses · December 2013

galv0515 said:

Yes it's a common practice, but unfortunately not alway right! My ob office tried to do the same thing to me on Friday. I explained to them that I am not paying for two reasons: 1. I have an HRA fund that as of Jan 01 will have 1450 out of 1500 of my deductible-they were charging the full deductible for nxt year and 2. It is a pain in the ass to get a refund if/whn the hospital bills first. The insurance will apply the deductible to whichever bill is submitted first causing you to wait 6 weeks for reimbursement from the doctor! I work for my insurance company, so if you are not familiar with all the details of maternity coverage, deductibles, coinsurance, etc I recommend calling them to get all the details. They will also sometimes call to ur dr on your behalf and ask them to refrain from collecting upfront, however they can't force them to accommodate!

How did that conversation go with your doctor? I'm in the same situation as you, and I really don't want to have to try to get a refund at the end. I have heard that the hospital bill will usually post first and that will cover my whole out of pocket costs, so I shouldn't have to pay anything to my OB. I work in HR in my company, so I'm more familiar with how my insurance works than some of my employees, but I also don't want to be bullied by the OB's billing department.

BP607 · December 2013

I also had to pay upfront for DS birth at the OB, even though I had already met my deductible. They basically just held the money until after the delivery and then had to refund us. It was dumb.

Frannavaldez9399 · December 2013

We had to pay full OB bill by 7 months... And the hospital just sent me a letter with our estimated cost. If we paid before I get admitted, it's a 10% discount. We called and paid. Barring all little costs, and any emergency costs... I'm fully paid. I've only known the OB's here to demand payment before delivery. Every office I looked at required payment by 7 months. I was just surprised that the hospital contacted my insurance and gave me a soft quote. And pretty happy to get a discount. Very VERY blessed to have baby money in the bank to cover... A year ago, not so much.

rowanthefrog · December 2013

Pretty common really, but you can certainly call their billing person and talk to them about making an arrangement that works best for you.

You'd be surprised how many people try NOT to pay their medical bills. I think that the way the OB office sees it is that it's easier for you to pay in several payments leading up to the birth, rather than getting a huge bill at the end.

However I think most offices are pretty flexible, so if you tell them you'd rather pay $200 a month or whatever then they will work with you.

A

Whalent1990 · December 2013

Canadian lurker here.. Reading the charges the hospital and doctors collect from you ladies makes me absolutely cringe!! It actually upsets me that the costs are so high and I won't be paying a thing when my child is born. I'm not being sarcastic. I'm honestly outraged they charge pregnant ladies that kind of money to have a baby!! It's just not right!

PrimRoseMama · December 2013

Yes. It's common. Sorry.

IBackBevo · December 2013

I had a doctor try to make me pay in full by week 17...they wanted $3k on top of the $500 I had already paid. Oh, and let me add that in 3 weeks my maternity coverage kicked in and my deductible was only $1200. They would not wait the three weeks for my insurance to kick in so I found another doctor.

Not every office does this. I actually understand them requiring payment by about week 25 or 26 (in case you go early), but not by week 17...or even 20. You aren't even at viability then. If you aren't comfortable with it, look for a new doctor. My current OB (who was also my OB with my DS), did not require anything of this sort. I don't think I made my final payment until after DS was born and I don't think anything at all was even brought up until I was about 28-30 weeks.

bhead81 · December 2013

It is very common practice to have payment in full before delivery. My OB allows me to break it up into whatever payments I need as long as it is paid by 20 days prior to EDD. I am not paying anything until next year when I have my FSA funds available.

I would talk to the billing department if they are demanding payment just to meet with the dr. I can understand that they would like to have payments start shortly if you have a large deductible and/or estimated OOP but I would not be comfortable paying at first visit with a new dr.

Blackvelvet · December 2013

LoisLayn23 said:

It's not about viability, it's about billable services. Every lab, u/s, doctor's office visit is billable whether the fetus is viable or not.

This is true cost me more OOP for my loose then I did for my DS. I was horrified that it cost so much.

IBackBevo · December 2013

LoisLayn23 said:

It's not about viability, it's about billable services. Every lab, u/s, doctor's office visit is billable whether the fetus is viable or not.

In my case, I was being billed for a repeat c-section and I would not be having a rcs if I miscarried between 17-19 weeks or if the baby died in utero between 17-19 weeks. Nor would the OB have incurred the full $3500 cost of supervising a pregnancy or all of the labs, ultrasounds, etc. that go with it at 17-19 weeks. Honestly, I can't see any justifiable reason my OB was not willing to wait until 20 weeks for my maternity insurance to kick in at the first of the year and would not just let me pay for services rendered prior to that...hence, why I changed OB practices to one that did allow me to "pay as I go" until my maternity coverage kicks in January 1st. (FYI, I am in a state--Texas--where you could not even get maternity coverage on a private health insurance policy prior to the ACA...hence why I currently have health insurance, but no maternity coverage until January 1.)

I guess my point was just that I can understand why OB's want to collect the charges for delivery prior to delivery. I don't understand why they want to collect charges for a delivery 4-5 months before the expected delivery other than that makes potentially switching OBs should you be unhappy with the medical services they render that much more difficult.

IBackBevo · December 2013

Blackvelvet said:

LoisLayn23 said:

It's not about viability, it's about billable services. Every lab, u/s, doctor's office visit is billable whether the fetus is viable or not.

This is true cost me more OOP for my loose then I did for my DS. I was horrified that it cost so much.

That is awful! I am so sorry for your loss.

galv0515 · December 2013

BlckRoses said:

galv0515 said:

Yes it's a common practice, but unfortunately not alway right! My ob office tried to do the same thing to me on Friday. I explained to them that I am not paying for two reasons:
1. I have an HRA fund that as of Jan 01 will have 1450 out of 1500 of my deductible-they were charging the full deductible for nxt year and
2. It is a pain in the ass to get a refund if/whn the hospital bills first. The insurance will apply the deductible to whichever bill is submitted first causing you to wait 6 weeks for reimbursement from the doctor!

I work for my insurance company, so if you are not familiar with all the details of maternity coverage, deductibles, coinsurance, etc I recommend calling them to get all the details. They will also sometimes call to ur dr on your behalf and ask them to refrain from collecting upfront, however they can't force them to accommodate!

How did that conversation go with your doctor? I'm in the same situation as you, and I really don't want to have to try to get a refund at the end. I have heard that the hospital bill will usually post first and that will cover my whole out of pocket costs, so I shouldn't have to pay anything to my OB. I work in HR in my company, so I'm more familiar with how my insurance works than some of my employees, but I also don't want to be bullied by the OB's billing department.

It actually went really well! The billing girl stuttered at first, paused, and then just asked that I bring a printout of my HRA fund to my next appointment. My husband thought it was hilarious-I didn't mean to be rude, but I do feel like drs try bullying patients and get away with it because most ppl don't really know how their plan works (I know I didn't before this job). I'd say give it a try, maybe a little nicer, it wouldn't hurt to bring up you concerns!

IBackBevo · December 2013

WhoCanItBeNow said:

IBackBevo said:

I had a doctor try to make me pay in full by week 17...they wanted $3k on top of the $500 I had already paid. Oh, and let me add that in 3 weeks my maternity coverage kicked in and my deductible was only $1200. They would not wait the three weeks for my insurance to kick in so I found another doctor.

Not every office does this. I actually understand them requiring payment by about week 25 or 26 (in case you go early), but not by week 17...or even 20. You aren't even at viability then. If you aren't comfortable with it, look for a new doctor. My current OB (who was also my OB with my DS), did not require anything of this sort. I don't think I made my final payment until after DS was born and I don't think anything at all was even brought up until I was about 28-30 weeks.

If you go into labor at 20 weeks, you are going to have some pretty significant bills.

You get billed whether you take a baby home or not.

Yes, I understand that. However, I think that would have technically been covered by my insurance because it does cover complications of pregnancy. It just doesn't cover normal delivery charges. My old office was wanting upfront payment for a RCS. My issue was that by week 20, my maternity insurance was going to kick in. (I realize that this isn't the OP's situation so I may have made a mistake in trying to compare her situation to mine.) But all I was wanting to do was pay for services rendered up until my maternity insurance kicked in on January 1st. They were not willing to let me do that so I went back to my old OB (the one I had with my DS) and she is allowing me to pay only for services rendered until my maternity coverage kicks in on January 1st.

My previous post was poorly worded, but my point was just that not every practice requires full payment for all pregnancy and delivery charges by week 20 so if the OP is uncomfortable with this idea, she might look elsewhere.

tealowl · December 2013

GhostMonkey said:

rowanthefrog said:

Pretty common really, but you can certainly call their billing person and talk to them about making an arrangement that works best for you.

You'd be surprised how many people try NOT to pay their medical bills. I think that the way the OB office sees it is that it's easier for you to pay in several payments leading up to the birth, rather than getting a huge bill at the end.

However I think most offices are pretty flexible, so if you tell them you'd rather pay $200 a month or whatever then they will work with you.

A
That, and if they have to send you to collections, they end up taking a huge hit in the amount they collect (sometimes less than 40%).

A lot of places if you make an arrangement up front and are making good faith payments, they will usually work with you.

All of this.

I've worked in medical billing/health insurance/financial assistance for years, and we'd rather take a lower payment plan then send you to collections.

My midwife office global billed me after I was seen for my pregnancy earlier this year and it was almost $800, and they wanted it paid by a certain due date, and they wanted $100 a month, which I could not do at that time. I was going to call them to discuss other arrangments, but I had a m/c before I could.

I might have to do the same thing this time around w/this pregnancy, I'm not sure I could do another large payment plan like that right now. Hopefully they will take a lower amount!

kboydbowman · December 2013

Agreed. Maye someday we'll move out of the Stone Age and have actual socialized medicine and paid maternity leave.

Whalent1990 said:

Canadian lurker here.. Reading the charges the hospital and doctors collect from you ladies makes me absolutely cringe!! It actually upsets me that the costs are so high and I won't be paying a thing when my child is born. I'm not being sarcastic. I'm honestly outraged they charge pregnant ladies that kind of money to have a baby!! It's just not right!

AndreaKae27 · December 2013

Im waiting for my ob to do that too... my deductible is $4800. Talk about stressing out.

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