Pre-paying for Delivery

egraves4 · August 2015

I think similar things have been posted, but it's been awhile.

At my last appointment, my doctor gave me the totals for how much we need to pre-pay before baby comes. They say 3 payments of $950 on 10/1, 11/1, and 12/1 are what needs paid predelivery. from what I see, this is starting to become the norm.

However, with my insurance we have a pretty good amount in our HSA. From what I can tell, HSA doesn't kick in since we're supposed to be pre-paying, but we also don't want to wait months after the baby is born to get our refund or not be paid back for it all.

Does anyone have any experience with this? Would love some insight before I have to go discuss it with my doctor's office.

kbedfox · August 2015

Why wouldn't you be able to use the HSA to pre-pay? My OB has the same prepayment requirement and didn't say we wouldn't be able to use our HSA to do so. I am planning to ask if we could wait until next year and pay all at once though, so we don't make a bunch of payments just to have our deductible start over in January.

Sprinkles07 · August 2015

Is this required? I wouldn't like that. We pay by appointment.

egraves4 · August 2015

@natsfan84 I'm not sure honestly. This is my first baby so I've never had to use such large amounts of my HSA. Basically though, she gave me the sheet, but I wasn't sure if they were expecting me to just pay it straight out of pocket (because that's what it looked like on the sheet). I think my question is more that since I've never had to pre-pay something like this, I wasn't sure how HSA would cover it. I'm assuming the doctor will bill my insurance like they do everything else? The finance lady was just so happy smiley about it saying "okay so we expect you to pay $950 on October 1st!" and here I am thinking "um......"

I'm in a similar boat as you. I would like to pay two of my payments this year because that's how much my HSA will cover, but I wanted to hold off from the 3rd payment until at least January 1st so that my HSA starts over.

Ju111310 · August 2015

I had to do this last time, luckily I have 100% insurance coverage this time so no out of pocket. I had to pay all of what I was estimated to owe after insurance ($2600) by 20 weeks last time. My ob/gyn office doesn't bill the insurance for individual visits, they just waited till the end and billed insurance for the lump sum prenatal/delivery fee so it really screwed up everything with our high deductible plan at that time. Thank goodness for new insurance plan!

The problem with prepaying with the HSA (for mine anyway) is that the HSA will only pay out for medical expenses acquired in that calendar year. Because the delivery and subsequent billing for all of the prenatal care/delivery won't actually occur until next calendar year, many HSAs won't pre-pay like that.

egraves4 · August 2015

@Ju111310 Yes this is why I am so confused! Because you would think that since so many people have HSAs that they would have mentioned it to me, but I guess since it's screwy, they just don't plan to. I'm having my mom go to the next appointment with me just because she understands this stuff a little better than I do, but even she is very confused, delivery was NOT EVER prepaid that long ago!

With that said, I've considered leaving my OB for a place that isn't going to make us pay in advance... but I'm not even sure if any places now a days offer it like that.

NoelBird · August 2015

I have had to prepay at some point with both pregnancies. Last time I had a hsa. They quoted me a cost without the hsa but when I talked to the billing staff they had me pay the remainder and after the insurance was actually billed I used the hsa. The billing staff are usually very helpful and can give you options. This time I have a deadline, I think it is 8 months pregnant to pay but they don't care how I pay. They will do monthly payments or a bulk payment. I actually like this since I get an annual bonus in October so I can just pay it then instead of multiple small payments.

egraves4 · August 2015

All of this has been really helpful ladies, thanks so much.

I think what we've decided is to talk to billing. I would prefer to pay all of my payments next year so that I am eligible to use the HSA next year if I can't this year. However, they did tell me that technically all of mine is due by 12/1, but my due date isn't even until February 13th! I guess the best thing to do is wait and see at my next appointment, and if their inflexible, we may decide to go to a different practice.

In other news, I had to go in today to get a form signed and they charged me TEN DOLLARS. Made me so mad.

Achae · August 2015

This is confusing to me, I've never heard of pre pay delivery. What if you end up having to deliver elsewhere? And is the doctor prepaying or is that just the hospital? I'm glad mine doesn't require this and just bills per appointment. I mean if you don't pay by the deadline what will they do, not deliver your baby? Charge you interest?

inomniaparatus · August 2015

That's crazy re: pre-paying. I never heard that.

BBEA2006 · August 2015

I've had to prepay with all of mine, including g this one too. I'm due 1.31 and my payment is due 1.1. I was going to ask if I could pay in jan anyway to have it apply to 2016 deductible. I think this is a very common practice.

egraves4 · August 2015

Maybe it's just in certain areas? Like I think it's common for the hospitals around our area. And I think it's more the hospital's doing than it is the doctor's office, which is why I'm nervous about trying to find a different practice.

It is confusing though... When she gave me the information sheet I was all sorts of confused. And then of course everything I owe before 2016 doesn't cover baby, labs, and ultrasounds.

inomniaparatus · August 2015

Do you guys have regular ppo insurance plans? Just curious- I haven't heard of it but this is my first. I don't have any charges for my pregnancy besides a one-time $25 co-pay and $500/night for my hospital room for prob 2 nights . I figure it's like the cost of a nice hotel lol ... But no one mentioned pre-paying.

egraves4 · August 2015

@inomniaparatus we have BCBS. We're apparently supposed to have all appointments covered. What isn't covered are lab fees, ultrasounds, and delivery at least for me.

inomniaparatus · August 2015

Hm that's weird - is it a ppo?

michelle_bird · August 2015

I'm not a certified medical coder, but do work I'm the healthcare billing industry. I'm fairly confident that pregnancy in the US is always considered a global service, which means that the doctors charges (ultrasounds, appointments, and delivery fee from the doc) are all billed together at the end to the insurance company. Because doctors get burned, especially with HDHP, many of them now require patients to go on payment plans if their insurance won't be paying for a large chunk of it.

I have a HDHP with an HSA and have been asked to start paying $100 a month. This does not include any lab fees or the hospital fees at all. We won't be using our HSA because my husband did a bunch of research on early retirement and it's better to leave that money there for us right now. So we'll just pay from our normal checking!

cMichelle0423 · August 2015

I'm using a midwife who's out of network with our insurance. So we're paying out of pocket for the whole thing because it'd be cheaper. We're required by the midwife group to have $2500 paid before delivery, then we work out a payment plan for the rest after delivery. The whole thing is estimated to be about $4600 total.

egraves4 · August 2015

@inomniaparatus yeah it's ppo!

egraves4 · August 2015

And maybe I'm wrong but it was kind of a shock to my system when I was told 3 payments of $950 - I wanted to cry lol. In my mind, I knew we were paying a lot, but it was different hearing it.

With that said, how much more am I going to end up paying for the baby? I knew she will have her own bills.

And yes @MichelleAG05 you're definitely right about the global... Or I remember them saying that. On top of my payments they told me to be prepared to pay for labs and ultrasounds separately up to 1000-1500. We already got a bill for one and my HSA covered it in full.

inomniaparatus · August 2015

egraves4 said:
@inomniaparatus yeah it's ppo!

So weird . I have the Oxford freedom ppo And it covers almost everything. I always pick the most expensive plan my job offers for that reason.

egraves4 · August 2015

@inomniaparatus that's definitely smart! Our plan has always been fine, but I'm just really scared we're going to have to pay a lot more out of pocket than I prepared for. I'm not going to be working from January-May so I'm just trying to find out the best way possible. HSA is going to help us big time, we just have to find out how.

Adyer7 · August 2015

I would think twice about pre paying with the HSA from a tax perspective . If you use and don't have deductible medical expenses for that amount in that year you will be taxed on those funds.

NoelBird · August 2015

I know for my doctor it is a global fee, all visits and a vaginal birth are included in the one fee. If you have complications and require extra care than that is extra. If you deliver early or by another doctor than you are reimbursed the difference. I have a PPO plan and what I end up paying is my deductible plus 20% afterwards. They contact the insurance to find out a good estimate of what my portion of the payment is. Everyone's payment even through the same practice would be different and depend on their insurance. I know in my area it is common, Doctors run a business too and I'm guessing they got tired of patients not paying for their bills.

What sucks is all of the bills after delivery. I kept getting different bills months later from the hospital. I swear every doctor who even talked to me billed me from a different practice. A pediatrician will bill you for checking out your baby, every test given to the baby was billed, the anesthesiologist was billed (my EPI was the best $600 ever spent lol) and then the hospital stay itself. It is hard to plan for all of these expenses since you won't have any idea what sort of care you will receive until after the birth.

ashtonchasemom · August 2015

We have to pre pay as well...they figured that after all my insurance we will owe around $500 out of pocket so they split that up in monthly payments starting next month till I deliver...talk with billing.I am sure they will find a payment plan that works for you.

CuriousKiddosMama · August 2015

NoelBird said:
I know for my doctor it is a global fee, all visits and a vaginal birth are included in the one fee. If you have complications and require extra care than that is extra. If you deliver early or by another doctor than you are reimbursed the difference. I have a PPO plan and what I end up paying is my deductible plus 20% afterwards. They contact the insurance to find out a good estimate of what my portion of the payment is. Everyone's payment even through the same practice would be different and depend on their insurance. I know in my area it is common, Doctors run a business too and I'm guessing they got tired of patients not paying for their bills.

What sucks is all of the bills after delivery. I kept getting different bills months later from the hospital. I swear every doctor who even talked to me billed me from a different practice. A pediatrician will bill you for checking out your baby, every test given to the baby was billed, the anesthesiologist was billed (my EPI was the best $600 ever spent lol) and then the hospital stay itself. It is hard to plan for all of these expenses since you won't have any idea what sort of care you will receive until after the birth.

This last part was the absolute worst. I remember last time those bills kept coming forever. And the most expensive one was the second dr called in for my c section (they have to have 2 I guess). He was out of network, and cost more than the ob I had been seeing the entire pregnancy. I thought that was pretty insane. Plan more than you think for all these things. My insurance is deductible plus 20%, and yet it still got expensive. Plus with a c section you spend extra time in the hospital. And generally baby is billed separately. So you get a bill for your hospital stay, and then one for babies hospital stay.

egraves4 · August 2015

I'm stressed to the max about this haha. I can say all I want that "I'm not going to get a epidural, I won't need a c-section" but you really never know.

I would like to get things squared away with my doctor, the less I'm spendinG out of pocket right now, the more I will be presided for unexpected costs.

It really is mind-boggling, and I still don't understand all the costs. There's lab fees, ultrasounds, appointments, delivery, your actual hospital stay, the baby's health, the baby's stay, a pediatrician. It hurts my brain.

Aussiechicka · August 2015

I just went through the same thing this week and I talked to both my HSA company and our accountant and this is what I was told.
To use the HSA for medical treatment you are supposed to have a invoice to match it to for tax purposes and they recommended against using the HSA for things that haven't happened yet.

Additionally the Drs office (or at least mine) is supposedly just holding the money until delivery and I can expect a request for prepayment from the hospital as well probably in the next month or so. The thing is if the hospital bills my insurance before the Drs office does then I owe the hospital the bigger amount of the copay, not the dr but they are going to both as for prepay for the same amount given I haven't met my deductible for 2016 yet.....which I obviously can't do.

We are pushing back saying we've been recommended by both HSA and Accountant not to prepay in 2015, that we are happy to do it in Jan 2016 etc. I'm not sure if we'll be successful or not but I don't want to prepay in 2015 at all.

blueberrymomma · August 2015

This all gives financial anxiety. With my first I had awesome insurance(I was still on my dads) and didn't pay anything because I met my deductible. This time we have BCBS and like many said its deductible then 20%. All prenatal appointment are cover and then I pay 20% of labs. No one has said anything to me about prepaying. However to pp my mom had to prepay for my sister in 1990 so I think it varies by state and isn't a new thing.

inomniaparatus · August 2015

Do you guys have deductibles because you're going out of network? I'm surprised... If I stay in network, I don't have a deductible. Maybe you can upgrade your plan at the start of the year?

Aussiechicka · August 2015

inomniaparatus said:
Do you guys have deductibles because you're going out of network? I'm surprised... If I stay in network, I don't have a deductible. Maybe you can upgrade your plan at the start of the year?

I'm going in network and I pay 20% until my deductible is met. I need to look into other plan options I guess and see if another one is better.

egraves4 · August 2015

@baya5 I'm still on my parents as well. But we have BCBS and it's exactly what you said deductible plus 20%. But my deductible is SO high. Although my mom needs to check into that because it seems higher than We expected.

Also, since you are on your parents, how did you deal with baby's insurance? It's a tough situation because my SO technically has insurance we can put her on from February to May, but then he will be doing an internship and he won't get insurance. And I won't start my full time job until June so we will have a month gap with nothing... But I know for a fact I don't qualify for Medicare, and we're pretty sure he doesn't either. Not sure if qualifications are easier to get if its for the baby. Neither of our insurances (like many) count grandchildren as dependents through our parent's insurances.

CuriousKiddosMama · August 2015

inomniaparatus said:
Do you guys have deductibles because you're going out of network? I'm surprised... If I stay in network, I don't have a deductible. Maybe you can upgrade your plan at the start of the year?

This baby is going to cost me probably double what my first child did. (Basing this just off the costs of the ob alone, assuming the rest is going to cost much more too.) Our insurance cost has gone up, the plan has supposedly stayed the same, but obviously hasn't. Our insurance used to be very good. Now I'm getting nailed for copays for everything. It all adds up quickly. We used to have very good insurance, not so much any more I'm finding out.
And not all companies offer plan with 0 deductible. Ours is low at $500, but I remember one of the options was like $2500 before your insurance really kicked in. Yikes!!!

mrsc12414 · August 2015

We have good Ppo insurance but the way it was explained to me is as some described by above.. The ob has a global charge which your insurance will deduct with their "discounts" (the price is different depending on plan etc) but I was told labs sonos sick visits etc are subjected to copays. We were told this is only the dr side and to expect the hospital to have us prepay some amount they will send us in near future .. We do not have a very high deductible and it's almost met for this year we then switch to 80/20 till we meet out of pocked max then it's 100%

blueberrymomma · August 2015

egraves4 said:
@baya5 I'm still on my parents as well. But we have BCBS and it's exactly what you said deductible plus 20%. But my deductible is SO high. Although my mom needs to check into that because it seems higher than We expected.

Also, since you are on your parents, how did you deal with baby's insurance? It's a tough situation because my SO technically has insurance we can put her on from February to May, but then he will be doing an internship and he won't get insurance. And I won't start my full time job until June so we will have a month gap with nothing... But I know for a fact I don't qualify for Medicare, and we're pretty sure he doesn't either. Not sure if qualifications are easier to get if its for the baby. Neither of our insurances (like many) count grandchildren as dependents through our parent's insurances.

Just to clarify I'm not on my parents anymore, that was for my first. But with theirs it covered everything in the hospital including baby(I was surprised by that). My deductible was only $300 for it and I met that before delivery)
I believe most insurances have it so you call to add a dependent. So we just called and added her to DHs insurance after she was born.
We got a plan thru the affordable care act last year which covers all of us. Maybe one of you could do that then the baby is covered?

brushesnbrunch · August 2015

inomniaparatus said:

Do you guys have deductibles because you're going out of network? I'm surprised... If I stay in network, I don't have a deductible. Maybe you can upgrade your plan at the start of the year?

I am in in network and have to pay a deductible. Also in my area, you can only change plans during open enrollment which we just had in July.

NoelBird · August 2015

inomniaparatus said:

Do you guys have deductibles because you're going out of network? I'm surprised... If I stay in network, I don't have a deductible. Maybe you can upgrade your plan at the start of the year?

it is very common to have some sort of deductible even for in network doctors. I do have the option to buy a no deductible insurance but when i analyzIed the costs it is in my interest to pay lower monthly premiums and a deductible. Most years I save thousands of dollars and even this year with the pregnancy I will save money. Having a deductible isn't a bad thing and if you use the doctor infrequently it may allow you to pay less on your monthly premiums.

ohbaby714 · August 2015

We get billed for each individual appointment and the bill is due the following month. They've never mentioned about prepaying anything and I didn't have to with DD. I'm really glad they don't, that would stress me out! Also I think it's more common to have a deductible than not? We just switched plans at the beginning of the year and I sort of wish we didn't. This one is a cheaper in the long run when all is said and done but is such a pain. It's a high deductible plan of $6k but then you get $4400 put in a HSA for you. But now I have to fill out a form and submit every single bill to get reimbursed for it. I would almost rather pay a little more and do less of the paperwork.

michelle_bird · August 2015

Having a child is considered a life altering event which, in the US, allows you to update your coverage outside of open enrollment. This is regardless of where you live, unless it's not in the US.

Many insurance plans don't cover pregnancies for dependents either, some of you ladies parent's have great plans! I recommend looking into either an ACA or Medicaid for your child if you have no other cover options.

Medicare is only for the disabled or elderly, so you're unlikely to qualify.

egraves4 · August 2015

@michelleag05 LOL I kind of always forget about the difference between the two.

However, I think my SO has decided to a man up and not be claimed by his dad anymore lol. He will be able to get Medicaid as an independent as well as claim our LO when she is born. This will be good enough for us until either I get insurance through my company or he does.

sweetpea216 · August 2015

My doctors office said the same thing at my last appointment. I owe ~600 on 10/1, 11/1, and 12/1 (I owe them the remainder of what I haven't met for 2015 deductible). They said it must be paid in full by the 7th month or I will be dropped as a patient. I've been stressing about it cause I thought that pretty much guaranteed I would have to pay my deductible of $3000 in 2015 and 2016. The lady was like "worst case scenario you'll pay your deductible twice and then the babies deductible." Oh really? Just like $8,000? Oh ok, no problem!

The way you guys are explaining it makes me think you will officially be billed in 2016, so you would only be charged the deductible once? I have an HSA account as well and hadn't considered the issue with using the funds in 2015 if your aren't officially billed until 2016. That probably wouldn't work out so great come tax time.

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