Let me add to the whole insurance mess...

RobinettMomma · October 2014

I went in for my doctors appointment this morning and i let them know that my secondary insurance got dropped and that i only had my primary. They figured everything up and i have to pay 776.00 a month for the next 3 months in order to meet my deductible so my insurace will pay the other half of my delivery. That is more than my house payment and home owners insurance put together!! I cannot afford this!! If i fail to comply with them then i will be discharged from their practice so then i will have no doctor which is not okay because im high risk and i have to be seen... im so beside myself idk what im going to do... i want to scream!!

AllTheTeaInChina · October 2014

Call the billing office and work out a payment plan. Tell them what you can afford each month and when you will have it paid off. They should be able to work with you.

RobinettMomma · October 2014

AllTheTeaInChina said:
Call the billing office and work out a payment plan. Tell them what you can afford each month and when you will have it paid off. They should be able to work with you.

What billing office? This is what my drs office is requiring me to pay in order to even be seen. They are the ones that set this up and i asked if there was anyway i could make smaller payments and the lady told me the smallest we could go is 194.00 a week which will still be 776.00 a month cause i have to meet my half of the deductible before my insurance will start paying for any expenses.

AllTheTeaInChina · October 2014

Do you go to a small, independent clinic? Most practices that I have experience with have a billing dept that handles claims, billing etc.

You might want to check with your state's office of insurance. What they are doing might not be legal.

harrow160 · October 2014

Thank you Ontario for free health care.

Drgn30 · October 2014

i'm so sorry you're dealing with this.

on an unrelated note - your mortgage and insurance is less than $800/mo? i'm amazed. that would get you a janky studio apartment where i live.

[Deleted User] · October 2014

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bowlwoman · October 2014

If you had known about the insurance issue from the beginning, then your cost would have been the same but you would have spread the payments out over three times the amount of time. Plus, you may have made some different decisions as to more elective tests and procedures in terms of cost savings. It's ludicrious for them to expect you to come up with that amount of cash at this stage in the game.

Call them back, explain that it's just not economically feasible, but that you do have every intention of paying the full bill. And if they balk, then yes, call the state insurance commission.

You might also ask about their costs if you don't have insurance. Most offices will direct bill patients less who are paying fully out of pocket, so it's possible that those rates may actually be cheaper than your part of the insurance billing.

And this sucks major. I'm so sorry it's an issue this late in the game.

Cheekers2010 · October 2014

Blah, mama! I agree with the others. You need to tell your doctor's office what you can afford per month and go from there.

Or, are you saying that you have to pay $2328 by January 1st to meet your deductible?

RobinettMomma · October 2014

Drgn30 said:
i'm so sorry you're dealing with this.

on an unrelated note - your mortgage and insurance is less than $800/mo? i'm amazed. that would get you a janky studio apartment where i live.

Lol oklahoma has pretty decent mortgage rates. We pay that for 40 acres and a 3 bedroom 2 bath double wide.

RobinettMomma · October 2014

bowlwoman said:
If you had known about the insurance issue from the beginning, then your cost would have been the same but you would have spread the payments out over three times the amount of time. Plus, you may have made some different decisions as to more elective tests and procedures in terms of cost savings. It's ludicrious for them to expect you to come up with that amount of cash at this stage in the game.

Call them back, explain that it's just not economically feasible, but that you do have every intention of paying the full bill. And if they balk, then yes, call the state insurance commission.

You might also ask about their costs if you don't have insurance. Most offices will direct bill patients less who are paying fully out of pocket, so it's possible that those rates may actually be cheaper than your part of the insurance billing.

And this sucks major. I'm so sorry it's an issue this late in the game.

Thank you i will try this. I have a call into my husbands work to speak with the lady that handles the insurance so i can see if there is anyway i can be dropped off of his insurance so i can get back on the program i was before i was added to his plan. We shall see.

[Deleted User] · October 2014

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JunkieBrewster · October 2014

Depending on your state, you may be eligible for medicaid. Pregnant woman medicaid has really high income limits. Worth checking out!

Worst case, tell them you plan to homebirth, and then just show up at the hospital in labor. They can't turn you away, though you won't know the Dr delivering.

JunkieBrewster · October 2014

WRONG POST.

Beevol · October 2014

If your OBs office will not work with you on coming up with a payment schedule that you can afford, I would look for a new OB - that's poor customer service and puts your health and that of your baby at risk.

This is the sort of situation where you can sometimes get a lot done if you can talk to the right people - call your State's insurance board and/or consumer advocacy agencies, call your insurance company, call your hospital, if you can find the right person (assuming the "right person" exists in this case) then you should at least be able to get on a suitable payment plan.

But, this situation is exactly why I want universal health care - no one should have to go through this sort of BS.

weezy29 · October 2014

Have you checked to see how much you will owe after meeting your deductible as well? Don't forget that many insurance companies have a deductible AND an out of pocket expense. Your situation does suck and I feel your pain because in all, I will be out around $3000 but I knew in advance.

Do you have savings you could use and then slowly pay yourself back? I know that is NOT ideal but you really need care right now. Some Dr offices are willing to work out a payment plan but obviously they have to get paid, too. Now the hospital, I think is a little more lenient on payment.

I wish you luck and hope you find a solution soon!!!

Pros521 · October 2014

I think you mentioned the dr was out of network. It may be a good idea to find a new dr. It stinks this late in the game, but it will make a difference

HorseFeathers3 · October 2014

RobinettMomma said:

Drgn30 said:
i'm so sorry you're dealing with this.

on an unrelated note - your mortgage and insurance is less than $800/mo? i'm amazed. that would get you a janky studio apartment where i live.
Lol oklahoma has pretty decent mortgage rates. We pay that for 40 acres and a 3 bedroom 2 bath double wide.

You mean the land is super cheap in Oklahoma! Wow! 40 acres where I live would be at least 2-3 million!

hollieandaaron2012 · October 2014

I am alittle confused on why you have to pay the Doctor now. I have a high deductible( 7000 ) and had to switch to this insurance in august so I basically have had 4 months to save up which I am doing through a hsa account and basically hardly get a paycheck but besides my ultrasound I haven't had a bill yet. They all come at delivery. See if you can find an OB that bills after the delivery then work out a payment plan.

drpayne · October 2014

A lot of people seem to be missing the point. A payment plan won't help if the issue is meeting a deductible by a certain date.

drpayne · October 2014

hollieandaaron2012 said:
I am alittle confused on why you have to pay the Doctor now. I have a high deductible( 7000 ) and had to switch to this insurance in august so I basically have had 4 months to save up which I am doing through a hsa account and basically hardly get a paycheck but besides my ultrasound I haven't had a bill yet. They all come at delivery. See if you can find an OB that bills after the delivery then work out a payment plan.

This sounds really odd and usual.

[Deleted User] · October 2014

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RobinettMomma · October 2014

ashtonkitty1 said:
There's something that is bothering me about your posts. While it isn't clear, it sounds like your family has employer funded health care through your husband. When you got put on his health care plan, you didn't verify your OB was in network?? And now you're blown away with the costs associated with an out of network doctor and delivery and want to go back on Medicaid so it's free for you? Rather than just see an in network OB through your husband's plan?

I have a problem with that. State funded health care is not intended for this purpose. I get it, this is all a surprise to you right now and it's scary and it sucks. I'm not sure that losing a secondary insurance counts as a qualifying life event for special enrollment (divorce, marriage, adoption, birth, etc).

Again I could be misinterpreting some of this b/c you haven't come back to it since people have asked about the in network option on two different threads.

With all that being said, I'm sorry that you're going through something so stressful right now. As many other have recommended, finding an in network OB should decrease your costs.

I was already with my ob when i got put on my husbands insurance and i didnt and still dont understand the whole insurance crap so i didnt know she was an out of network doctor at the time. My husband did everything for the insurance so i didnt know there were certain questions to be asked etc. Ive never had to deal with insurance nor have i ever had to go through any of this because i was on medicaid and they paid for everything. Im looking into another ob right now that is in network and works with high risk patients so im going to try and get on with her asap.

RobinettMomma · October 2014

Im not "mooching off of you tax payers" nor am i trying to get a "free ride!" I've never had to go through any of this crap and the only insurance ive ever been on is my medicaid so im still learning all this.

RobinettMomma · October 2014

Thanks to those of you that have offered helpful advice im going to try and figure this all out.

weezy29 · October 2014

Yeah, I don't think you can just choose to go back to Medicaid because you don't like your primary care insurance. I get it, some insurance plans SUCK but it sucks a lot more to have to pay out of pocket for everything rather than a couple thousand dollars.

As for OB's requesting payment up front, that's all I've ever known. My current practice and former OB's required their portion to be payed in full by 24 weeks of pregnancy. Of course, the insurance lady had this conversation with me in the 1st trimester so it was no big surprise. I ended up having two ER visits and met my deductible that way so I ended up not having to pay my OB and insurance will cover all that instead.

And OP, I get how much this sucks but this will probably only be one of many surprise bills in the future. Kids are stinking expensive!!!

RobinettMomma · October 2014

Cheekers2010 said:
Blah, mama! I agree with the others. You need to tell your doctor's office what you can afford per month and go from there.

Or, are you saying that you have to pay $2328 by January 1st to meet your deductible?

Im assuming thats what their saying. They said i have to have this $2328 paid by the time i have gracie and if i dont make the $776.00 a month and pay it at each appointment than i will be discharged from their practice

alanier18 · October 2014

Bc you are married you have to include your hubby's income. With that being said you probably aren't eligible for medicaid anymore. So this seems like something you have to figure out right now before you shell out money to meet the deductible. If you think you can make that 700 payment this month but not next month, I'd find another doctor in network to lower your costs. My income has decreased since I've become pregnant since it's harder for me to work longer shifts. It's been hard financially Bc I pay my premiums out if pocket each month plus whatever my copay is for my doctor fee for delivery. (I'm having an issue getting that together :-( thankfully my office lets you make monthly payments for that) plus whatever OB bills I get for ultrasounds and whatnot. It's downright expensive. I'm sure I qualify for mediciad but I'm trying to do it out of pocket Bc I know it's my responsibility. It's hard tho Bc it's just me. I know a financial curveball this late in the game sucks but it's life. Good luck with everything.

RobinettMomma · October 2014

I just signed my paperwork to release my medical papers to this new ob i should hear back within a few days of she is going to accept me. She is willing to work out a reasonable payment plan. Everything is.going to fall into place....

[Deleted User] · October 2014

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RobinettMomma · October 2014

Well the dr office i was trying to switch to called and they said i have the worst healthcare insurance becasue they only pay 50/50 and that i would be paying my delivery and everything in between. They also said i would have to bring in $750 at my first appointment and that we would figure out a payment arrangement for the rest then. Only problem is coming up with that $750...

weezy29 · October 2014

Also, when you contact your insurance company, find out what your out of pocket max is. Surely, you will meet your max at some point and not have to pay 50% of everything because hospital bills add up quickly, especially if a section is needed.

I do understand that some insurance companies just suck! My BF has decent insurance through her husbands job for normal care but they cover nothing for maternity.

Worse case scenario: can you put it on a credit card until you make other arrangements?!

erynpdx · October 2014

I'd really second looking into Care Credit. It's a zero percent credit card for health care expenses. It's the ONLY way I was able to get all the dental work I needed done a couple years ago.

Totally sucks that this is all a surprise so late in the game, but you're not alone when it comes to paying lots of money for these babies. I figure we'll be out about $4500 by the time it's all said and done.

hollieandaaron2012 · October 2014

drpayne said:

hollieandaaron2012 said:
I am alittle confused on why you have to pay the Doctor now. I have a high deductible( 7000 ) and had to switch to this insurance in august so I basically have had 4 months to save up which I am doing through a hsa account and basically hardly get a paycheck but besides my ultrasound I haven't had a bill yet. They all come at delivery. See if you can find an OB that bills after the delivery then work out a payment plan.
This sounds really odd and usual.

I have never been pregnant before and don't know how other offices work but on my first visit I sat down with the finance office and they told me besides a few test I won't get a bill until delivery. Therefore, I won't be anywhere near my deductibe until I actually give birth then I just get one bill from the doctors office and of course many more from the hospital.

felt0061 · October 2014

It is really crappy your provider is requiring this. Unfortunately it's becoming more of a common practice for providers to require the expected patient responsibility up front. The insurance commission won't do anything on this as it is a legal practice and they govern insurance companies not providers, so I wouldn't waste your time there.

I would call and try to work out a payment plan given the late notice. If they won't budge tell them you'll have to change OB's to one with more reasonable billing practices. Usually providers will be willing to work with you, especially if they can set up an ACH withdrawal.

I feel your pain, I have an $8000 out of pocket maximum, but luckily my provider isn't requiring it be paid in advance.

RobinettMomma · October 2014

Ainslie325 said:
OP, do you have an HMO or PPO? Did you find this new provider through your insurance company's directory? If not, that's where I would look for in-network providers. Are you saying that your insurance company will cover 50% of all prenatal care, but that you are 100% responsible for L&D? (What is "everything in between"?)

I can't understand if this is what your insurance policy covers for maternity for in-network providers, or if maybe you still haven't found a provider who is covered to the highest extent your policy provides for (in-network). As much as you're probably sick of doing so, if you haven't already, you need to call your insurance company and ask. Call insurance and ask if this provider is in-network or not. Just because a physician "takes" your insurance doesn't mean he or she is in-network. Your insurance company is the expert on the benefits and networks accessible to you, not the doctor.

I hope it doesn't sound as though I'm talking down to you. I don't intend to. I just know that you've said you are (and you sound) confused by insurance matters. Your insurance company is the only one with the information you need to find some clarity.

What is HMO & PPO? I called my insurance and the doctor that i called is the doctor they referred me to because she is in network but the cost is still the same as the out of network provider. The lady at the doctors office said that i will be paying for everything such as ultrasounds, injections, labs, hospital fees etc. Im guessing they dont have any maternity coverage. She said that i have to pay 2800.00 plus half of the delivery because my insurance only pays half.

Manateearmz · October 2014

Find your benefits booklet for your insurance. If you don't know where to find it ask your husbands HR person and have them provide you with one.

Then flip to the section about maternity care and read it. Educate yourself and be an advocate for your care and what you expect to pay. Stop relying on the office to do it for you.

Carandkam · October 2014

Who is your insurance company? I would call and ask to speak with a case manager to answer all your questions regarding maternity care. It's not the same as some customer service rep, but someone who will really explain your entire plan. The baby will most likely be on this plan and you have a right to know what is going to be covered in her care.

Mrw218 · October 2014

Another thing to note is that in the United States with the traditional copay based insurance going away and many companies opting for the cheaper deductible and percentage of bill based coverage with an out of pocket max, ppl are going to have to 1 start budgeting for healthcare based on their plan so I'm thinking you should have done all this leg work before getting pregnant so u knew it would cost x dollars approximately. 2- ppl are going to have to start being advocates of their own healthcare and force real conversations with their doc instead of the old days get whatever service wherever the doc tells you to go. For instance, do I need to get that extra ultrasound? What is that gaining us? How much does it cost? Obviously if it means life or death for your baby, you suck it up and accept the cost. If it's a nice to have but not 100% medically necessary you may have to make that choice based on your financials. Also, consider asking for prices up front like do I have to go to this ridiculous expensive top notch care hospital or facility for this procedure or can I go to my local facility and get more affordable care but just as safe? Would depend on the type of procedure and what it's for. I mean it totally sux and scares me a little but that's where this country is going. Remember you don't have to agree to the stuff your doc wants you to do. You have every right to tell them no I'm not going to get that procedure. They may advise against it and many docs may even (unethically imo) try to strong arm you with scare tactics bc they want you to go to their buddy's specialist practice or whatever. Ex. Before I got pregnant my Gyn said due to my uterine anomaly I should go to reproductive endocrinologist to find out what if anything I should do before getting pregnant. Sounds expensive but I had good insurance so I did it. If I thought wow I can't afford this with shitty insurance I could've said thanks for the advice but what is this guy gonna tell me. I can let nature run its course. When I went to him he ordered an arsenal of I'm sure very expensive tests and suggested I go to the city ( top notch hospitals bc I live near a major metro area) and go to one of the best hospitals state of the art machines for these tests. Again, I did that, good insurance. However if I didn't have that insurance I would be questioning why go to this crazy expensive place. Can I go local, get a much cheaper rate, and obtain the same results? Do I need the rolls Royce or will the Prius get me where I need to go? In the end ppl would probably say I just cost my insurance all this money for no reason bc it wasn't medically necessary to my health to get that testing done.

allfalldown14 · October 2014

I get not knowing anything about insurance and how it works. I was a spoiled young adult and my mom did everything for me. When I moved out when I got married I also didn't have to deal with any of it as my husbands secretary did all of it. Now that I'm on my own I just had to call my insurance company and say "you know what, I know nothing about how this all works but here's my problem..." and they were super nice and explained it all in detail to me. Good luck and I hope you can get it sorted out sooner rather than later!

leoandethansmom · October 2014

I know I'm late to this party but I'm just having some trouble wrapping my head around the fact you didn't think you would be responsible for paying for your medical bills. I understand you were on medicaid but once you get married to someone whose job offers medical insurance you don't receive state funded assistance. As part of an adult's life comes paying bills. You got married and are now on your husband's plan, which sounds like it has a high deductible and OOP max, but that's how life works. My deductible is $2000 and my OOP is $4000 so I'm going to be out a lot of money as well but that's something we knew going into this. I am having a hard time grasping that nobody spoke with you about this until 7-8 months pregnant. As several other pp's have said, you really need to educate yourself and stop relying on your husband and medical offices to provide you with information. There are several resources available from every insurance company and also google. Please, for yourself and the future of your child(ren), get educated on healthcare.

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