Doctor Cost?

MrsCarb · April 2014

Hello! I finally got to have my first doctor visit on Monday. It was great to know that yes, officially I am pregnant. But, I was very suprised how much my doctor visit cost me... and was hoping for advice. They charged me $160 on the way out. I asked if they used the insurance and they said yes, that was after the insurance. I asked if that was going to be normal (apparently I have 15 more visits...) and they said they'll call my insurance and figure it out and go over that with me next time...

I have a PPO and normally have a $20-30 copay, so I thought my insurance was good, and this doctor is through my network.... is this normal, or did I accidentally choose a fancy place in Orange County (CA)?

CountryMama1114 · April 2014

Ob appointments can cost more because they are considered a specialist.

My insurance charges me for the first appointment and then everything else is covered. I don't have to pay a single cent more until after my 6 week PP checkup.

Did you get an ultrasound? That can cost more than a regular checkup.

jlove253 · April 2014

Check with your insurance. That doesn't seem right.

mb314 · April 2014

It sounds like an issue with your insurance and what they cover. Did they charge you for lab work or an ultrasound anything else on the way out? Was your $160 a copay? I would ask your doctor for an itemized bill of what the $160 went towards and check with your insurance about what they cover. I think all insurance plans have to cover maternity care now with the Affordable Care Act, but I could be wrong. Not long ago, many people needed a special rider on their insurance for prenatal and maternity care to be covered.

Are you sure you have a co pay? I have an 80/20 plan, so I have to pay 20% of the costs of the doctors' visits (up until a certain point). A $160 bill wouldn't be abnormal for me if it covered the visit, labwork, and tests like an ultrasound.

ShelleyElla22 · April 2014

That seems a little pricey to me. I would check your policy information to see what they say about maternity coverage. I was on a PPO when I lived in AZ and had to see a specialist (in Scottsdale) because I was high risk and I only had a $30-$40 copay for each visit. I did have my insurance try to unneccesarily bill me for things they were supposed to cover and had to battle them about it. But in the end they covered everything but my copays

marajay6 · April 2014

That's about what I paid for my first appointment. But I don't have a copay. I have high deductible insurance with an HSA. I assume that I will hit my out-of-pocket max of $5000 this year, all paid with my HSA. We had been planning on having a baby, so I have been maxing out my HSA contributions.

Check out your out-of-pocket max and expect to pay that by the end of the year.

momtojad · April 2014

That doesn't' sounds right. I have a midwife which is usually cheaper but still for my entire pre natal care and birth my bill was $453

PineApple85 · April 2014

If your plan pays a specialist after your deductible then you have your co-insurance then that sounds exactly right to me if you haven't met your deductible yet - even if they didn't charge you for the US. As a first visit it was probably a long one with lots of questions and therefore billed at a higher level of service. Check your plan. As for prenatal care, FYI: covering is not the same thing as paying. My HSA plan "covers" prenatal care, but it's deductible then co-insurance.

missnacholover · April 2014

Was your doctor at a hospital? My diabetes doc is a "hospital based clinic" so until I meet my deductible, each appointment is like $250. Luckily, with all my shit, I reach my deductible after about 10 seconds, but still stings!

pennyandandy · April 2014

Huh, that doesn't sound right. We did have to pay a small percentage of our prenatal stuff last pregnancy, but ours waits until after the baby is born and then bills the whole thing together. I think it was less than $400 total. (Not the hospital, just the prenatal visits.)

MrsDL · April 2014

1. If you have a PPO, is this doctor in-network (check your insurance). If the doctor is out of network, then many times they'll "take" your insurance but there is no contract negotiation in terms of fee so you'll pay their full fees less what your insurance will pick-up for out of network providers. It can be that high.

2. There is a co-pay and deductible. You pay the co-pay no matter what, but you have to meet your deductible before your insurance picks up at 100% (or whatever the % is). So you may be charged a higher fee up front until your deductible is met. Check with your insurance to see the % they cover to total charges for OB visits. The last thing to check is some OBs coordinate your coverage for delivery from the beginning. So if you have a 3K deductible for a family plan, as an example, and your provider "estimates" that visits AND delivery charges with be $3500, they sometimes divide that per visit, sort of a payment plan. It makes no sense to me as you are likely using other services to meet your deductible, but I have seen some offices charge like this up front, then when your deductible is met you are not charged at all or credited. Always good to check with your practice's policy and check that with your insurance company from the beginning so you know what's going on.

atok · April 2014

Last time my dr required his whole bill to be paid by 6 months. We owed whatever the insurance didn't pay and it was about 1500 dollars so yes the office visits were a couple hundred so that total would be paid in time.

runningmama14 · April 2014

I paid the total of what I would owe the midwife's office at my first visit.

ProcessofBecoming · April 2014

That seems high to me, but every health plan is so different, I really don't know. For me, I was on my company's insurance with my son, and paid $20 for the first visit, then nothing again until the $100 in-patient copay when I went into the hospital on bedrest with my son (stayed until I delivered--the bill that came to my house was an inch thick and amounted to $33k. Thank God for insurance). But I had $20 copays on all bloodwork and labs throughout my pregnancy.

This time, I'm on my husband's insurance and had a $20 copay at my first visit, and I think I'm covered until I deliver (I think I will have either a $50 or $100 copay when I am admitted to the hospital). Labs are covered too, and my Crinone is covered, which is awesome. But I'm a little nervous about the hospital stay, namely the anesthesiologist if I have another c-section). I'm hoping everything will be covered like it was the last time.

RachelC79 · April 2014

Hm. That does sound a little strange. I have a PPO as well, and my first OB visit was a $30 copay (for a longer appointment with u/s). At my blood draw in three weeks we're going to go over the rest of the payment plan, but when I called my insurance they told me that after the copay, everything would go towards my deductible until I hit that. I guess we shall see...

carcrashheart · April 2014

i've never received a bill for a prenatal appointment. my impression was that they were "free" so that people would opt out of medical care for the child due to lack of funds. the only thing we paid for OOP last time was the NT scan.

missnacholover · April 2014

carcrashheart said:

i've never received a bill for a prenatal appointment. my impression was that they were "free" so that people would opt out of medical care for the child due to lack of funds. the only thing we paid for OOP last time was the NT scan.

Do you mind sharing approx how much this was? We're getting it done regardless, but want to be prepared in case it's not covered by ins. I tried to call but they couldn't tell me without the billing code. =(

krgriffin26 · April 2014

I don't have a co-pay just a deductible and out-of pocket amount. Total for me starting now to the end of the year will be $1,750 but depending on how much the baby needs after birth and in the hospital our out-of-pocket could go from $1,750 (my individual amount) up to $5,050 (family amount).

We purposely tried to get pregnant early this year so we could have the baby in the same calendar year. Other wise we could have been responsible for 2 years of deductibles and out-of-pocket maximums.

sunflwra · April 2014

If you're under a PPO type plan with co-pays, I'd definitely check with your insurance provider on how this is being handled. I've always paid copays for the first visit or so when pregnancy is confirmed and then from there, my doctor lets me know what the estimated bill will be for my pregnancy and it usually has to be paid by 26 weeks.

You'll also want to keep in mind that I'm guessing you will have a hospital bill and a separate anesthesiology bill (if needed). Once you register with the hospital, they should be able to give you estimates on those as well.

tlc35 · April 2014

Do you mind sharing approx how much this was? We're getting it done regardless, but want to be prepared in case it's not covered by ins. I tried to call but they couldn't tell me without the billing code. =(

@missnacholover I just looked up the billing code. It is 76813 if you want to ask them
ETA: I found it on this link
https://www.maternalfetalcarecenter.com/healthcare-providers/ultrasound-services/ultrasound-cpt-codes

missnacholover · April 2014

lissydee said:

missnacholover said:

carcrashheart said:

i've never received a bill for a prenatal appointment. my impression was that they were "free" so that people would opt out of medical care for the child due to lack of funds. the only thing we paid for OOP last time was the NT scan.

Do you mind sharing approx how much this was? We're getting it done regardless, but want to be prepared in case it's not covered by ins. I tried to call but they couldn't tell me without the billing code. =(

the u/s that I've had done previously (NT, anatomy scan) were all around the $800-1000 range, mostly because a radiologist has to read it. The NT scan also has blood work which is an additional cost. Most of my labs have been around $40-80.

Yikes. I definitely need to call. Thanks for the code @tlc35

KatzKiss · April 2014

With this pregnancy and our last, we just pay after the baby is born. I think it's around $1800 after insurance this time.

KatheTravis · April 2014

I have to pay around 1100 total (as of right now). That's after my deductible of 500 and then 80/20 after the deductible. I pay 200 every appt until my bill is paid.

KitKat099 · April 2014

MrsDL said:

1. If you have a PPO, is this doctor in-network (check your insurance). If the doctor is out of network, then many times they'll "take" your insurance but there is no contract negotiation in terms of fee so you'll pay their full fees less what your insurance will pick-up for out of network providers. It can be that high.
2. There is a co-pay and deductible. You pay the co-pay no matter what, but you have to meet your deductible before your insurance picks up at 100% (or whatever the % is). So you may be charged a higher fee up front until your deductible is met. Check with your insurance to see the % they cover to total charges for OB visits. The last thing to check is some OBs coordinate your coverage for delivery from the beginning. So if you have a 3K deductible for a family plan, as an example, and your provider "estimates" that visits AND delivery charges with be $3500, they sometimes divide that per visit, sort of a payment plan. It makes no sense to me as you are likely using other services to meet your deductible, but I have seen some offices charge like this up front, then when your deductible is met you are not charged at all or credited. Always good to check with your practice's policy and check that with your insurance company from the beginning so you know what's going on.

What she says in #2 is true for me. However they start my payments in the second visit. Payment is devised up by month so that it is paId in full by the 7th month.

icaughtfire · April 2014

It really depends on your insurance. Last time around we had to pay quite a bit out of pocket each visit and then were refunded about 25% of it towards the end. That's just for prenatal care, not including hospital bills (which I believe came to about $4k after insurance covered their part). This time around, I pay a one-time $30 copay and nothing else for the rest of pregnancy. Hospital bills will probably be about the same.

KLKilgore · April 2014

I have a $200 fee for all prenatal, delivery, and postnatal appointments, plus my $200 deductible. I have to pay 3 payments of $133.33 and that's it for the entire pregnancy. Maybe they do something that.

carcrashheart · April 2014

missnacholover said:

carcrashheart said:

i've never received a bill for a prenatal appointment. my impression was that they were "free" so that people would opt out of medical care for the child due to lack of funds. the only thing we paid for OOP last time was the NT scan.

Do you mind sharing approx how much this was? We're getting it done regardless, but want to be prepared in case it's not covered by ins. I tried to call but they couldn't tell me without the billing code. =(

Call the dr and get the billing code. That's what I had to do. Though, it actually wasn helpful. The insurance said it wasn't covered when I gave them the code. OOP it was $400. Then the dr office checked for me and said it was covered but subject to my deductible. I had fulfilled my deductible by then and was on a 90/10 coinsurance so we paid $40 when it was all said and done. I guess I should find out if I have fulfilled my deductible yet so that we know what we are doing for the nt scan.

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