Doc office changes billing practices mid-pregnancy

Re: Doc office changes billing practices mid-pregnancy

• mrs1374a member

  January 2015

  Something doesn't sound right, especially since your coverage did not change. I would not pay anything until your insurance gets this figured out.

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• ipumpkin member

  January 2015

  I agree with PPs, this sounds a little fishy and I wouldn't pay a single cent without some sort of documentation or bill. ALWAYS make sure there is a paper trail for everything!

   

  Also, I totally understand not wanting to change doctors, however, I don't know that I'd want to be going to a doctor that rips people off and sounds like scam artist. They're doctors, not car salesman!

   

  Good luck, OP. I hope it all works out in your benefit.

   

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• blamevcr member

  January 2015

  Thanks- my instincts told me this is just unethical, but it helps to hear that other people have the same reactions. I am going to have a private talk with my doctor before I switch, because she has been wonderful through my first pregnancy and this one. I wouldn't be entirely surprised if she didn't know the office manager was billing people in this way. I think I'm just stressed about making such a big change at the halfway mark  

  
  

  Thanks so much everyone. 

  
  

  And if anyone knows the legality of what I'm dealing with, I'd still like to know if this is just unethical or actually against the law!

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• jennygirlmt member

  January 2015

  Not exactly the same, but there were some issues with my copays, etc with my chiropractor. They tried to bill me $62 when I hand over my cc every appt and pay the copay they need from me.
  
  I told the front desk it was wrong and refused to pay it, they said my doc would review it and of course my chiro said "everything is even, don't worry about it." I'd definitely talk to your doctor first. She probably doesn't know and would want to address things like that make her practice look shady! I hope it works out, and if it's THEIR policy change that they work with you.

  

  
  

  
  

  
  

  
  

  
  
  

  
  

  
  

  
  

  

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• CivilMommy member

  January 2015

  You shouldn't have to pay a dime to them without them first billing BCBS and you getting an EOB from BCBS that matches with the bill the doctor is providing.

  IDK how a doc can start billing for a delivery that hasn't happened yet.

  Talk with BCBS.  IF they haven't processed a claim yet, you should not be getting a bill.

  If the doc is billing for prenatal appointments that have happened, those might be valid charges, but they still need to be processed through your insurance first.

  You get the BCBS negotiated rate for services, then you pay your portion of that. 

  IF the doc bills $100, but BCBS allows $70, and you owe 10% of that...then your bill is $7.

  make sure all BCBS papers match the doc bill before you start paying the doc.

  _________________________________________________________________

  DD 7/2010, DS 3/2012, #3 due 4/24/2015

  
  

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• blamevcr member

  January 2015

  Thank you. BCBS did confirm that standard practice is for a doctor's office to keep track of all prenatal appointments, delivery and antepartum visits and submit under one global billing code. Any other visits (if i'm sick, or whatever) would be billed separately under their own code. The doctor's office confirmed they are doing global billing but since they anticipate that I'll be responsible for at least the deductible plus 10% they need that money to begin getting paid down immediately. 

  
  

  I think it's just incredibly shady. I'm going Friday for a prenatal appointment I've already pushed back twice while I tried to navigate all this with my insurance company. It might be my last visit there, because I refuse to pay for medical service I haven't received, that hasn't been billed to my insurance company at all, with no paperwork. I think I just really needed the sanity check to make sure I wasn't just being unreasonable or didn't understand medical billing.

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• delujm0 member

  January 2015

  blamevcr said:

  Thank you. BCBS did confirm that standard practice is for a doctor's office to keep track of all prenatal appointments, delivery and antepartum visits and submit under one global billing code. Any other visits (if i'm sick, or whatever) would be billed separately under their own code. The doctor's office confirmed they are doing global billing but since they anticipate that I'll be responsible for at least the deductible plus 10% they need that money to begin getting paid down immediately. 

  
  

  I think it's just incredibly shady. I'm going Friday for a prenatal appointment I've already pushed back twice while I tried to navigate all this with my insurance company. It might be my last visit there, because I refuse to pay for medical service I haven't received, that hasn't been billed to my insurance company at all, with no paperwork. I think I just really needed the sanity check to make sure I wasn't just being unreasonable or didn't understand medical billing.

  If you have a high deductible plan (HSA or the like) prepaying is actually common practice right now. Usually they will estimate a bill and set up a payment plan for you. Basically if your deductible annually is $2k they know you'll owe them at least that. All of my friends with hra plans have had this arrangement (all different OB practices). It's possible that your office wasn't doing this when you had your last child but that they are now.
  
  However they should absolutely be billing you for this and you should pay them with an HSA debit or credit card to keep a paper trail in tact. Pay nothing without a bill, and contact your insurance first to make sure they're aware of this arrangement. Insurance has to know what you've paid toward your deductible so that they can calculate your coverage levels. They should be aware that this is going on.
  
  This happens for any expensive procedure of you have a high deductible plan. DH had to have an MRI two years ago and had to pay up front in order to even schedule it. They sent the bill through his insurance afterwards for their records. Had he overpaid, the insurance would have reimbursed him.

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• blamevcr member

  January 2015

  I'm on a low-deductible plan, $500. I wouldn't be totally against setting up a payment plan if they've changed their billing guidelines. But I am upset that they told me this was happening because my insurance coverage changed when it didn't. I'm also upset that they are not willing to negotiate the payment plan to something I can afford. And another very big thing to me is that I cannot get anything written down about this prepayment- there is no bill or statement or an explanation of the estimate they are creating. Oh- I don't have an HSA, it's a PPO plan. And the office only accepts cash or check.

  
  

  What happened with my daughter's birth was that i ended up owing the OB/GYN's office nothing because they billed my insurance company globally after her birth, and our out of pocket maximum had already been reached between ultrasounds/lab work/hospital costs and my husband's health expenses that year. Insurance company paid them in full, zero responsibility on my part.

  
  

  I understand that if I overpay now, I am entitled to reimbursement later. But without any documentation of this, I am not comfortable.

  
  

  But first and foremost, I'm 19 weeks pregnant and stressed and angry!
  

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