What hasn't insurance covered for you?

Bubblegum5586 · March 2016

In my naivety when they say that prenatal care is covered with your insurance I assumed it was more then just the office copays. I did know that was a cost for delivery at the hospital, but I didn't realize that all the blood work and ultrasounds would get billed to me. Anyone else getting surprise bills?

jmw386 · March 2016

Yes! I just got an EOB showing that I'm going to be charged $900 for the Harmony blood test because it was not covered without "pre-approval" from insurance. I'm definitely going to be appealing this one. We didn't go straight for the Harmony because we were told insurance wouldn't cover it without some increased risk factor. But even then, the doctor described it as being a couple hundred dollars out of pocket if we went ahead with the test at that time. We opted against it. We only got the blood test after the PAPP-A testing revealed a higher risk of trisomy-21 (the blood work came back fine). When they called us with the PAPP-A test results, they had me come in the same day for the Harmony blood work. I had no idea I needed pre-approval from the insurance company and wouldn't have had time to get it anyway. Very frustrating!

ShanRum3 · March 2016

I've gotten bills for lab work that the insurance only covered about half of. I'm just waiting for a bill from my 15w ultrasound. Being AMA, my insurance might cover it, but I'm not holding my breath! I don't even want to think about all the bills I'm going to get. Just think about how much you or your employer pays for your insurance, and then think about all the more they cover! It's sickening!

bsckgb7 · March 2016

jmw386 said:

Yes! I just got an EOB showing that I'm going to be charged $900 for the Harmony blood test because it was not covered without "pre-approval" from insurance. I'm definitely going to be appealing this one. We didn't go straight for the Harmony because we were told insurance wouldn't cover it without some increased risk factor. But even then, the doctor described it as being a couple hundred dollars out of pocket if we went ahead with the test at that time. We opted against it. We only got the blood test after the PAPP-A testing revealed a higher risk of trisomy-21 (the blood work came back fine). When they called us with the PAPP-A test results, they had me come in the same day for the Harmony blood work. I had no idea I needed pre-approval from the insurance company and wouldn't have had time to get it anyway. Very frustrating!

Call Harmony directly. There are lots of ladies posting about contacting the bloodwork people directly (for the genetics tests) and they cut the bills by more than half or have some kind of max OOP. I bet thats why doc said "a few hundred".

runsoncoffee · March 2016

I have a high deductible plan so no copays... that being said we've already met our deductible with 2 bills, both for lab work ($575 and $670... something like that!). None of the actual prenatal care has been billed for yet. So we are now in our insurance covers 90%, we pay 10% period until we pay an additional $1k out of pocket.
I was previously on a plan with copays and was surprised when I had to pay for xrays from when I had bronchitis (I thought it was included in the copay for the appointment). I believe all that stuff is considered extra because even with the copay plan I still had a deductible. Your insurance company should be able to tell you all that if you get a customer service rep that is helpful! I asked for every last detail of what the max amount I would spend out of pocket would be!

ramoseecology · March 2016

@jmw386 We were also told our doctor didn't send in the pre-approval form (instead they sent a letter) but they said we have 90 days to appeal it and have the doctor send in the pre-approval form. We also called the testing company's customer service rep and they are honoring the original quote while they work on getting the pre-approval for the insurance. It was pretty frustrating. We had called insurance in advance to see what was needed and they had told us a letter not a form. Then when we called about this they said "that's why we have a 90-day appeal process". How about you just tell us the right steps in the first place?!

Hummingbird125 · March 2016

So far, I've been pretty lucky - but ONLY because I have both primary and secondary insurance - so I've only been charged about $200 OOP so far. However, I have a $500 bill I'm surrently fighting from October, when I went in for my annual appt, and the doctor ordered blood tests for my hormone levels since I mentioned I had very irregular periods. My insurance co. said it was not covered because "medical necessity was done demonstrated" or something like that - which is ridiculous because my doctor ordered it because of a problem. She also said that she's never heard of those tests not being covered. So yeah, fun stuff.

ashleym373 · March 2016

My first appointment is the only thing I pay for (same with DS1 and DS2), so $15 is all I have to pay. That includes all u/s (NST, AS, and I get one weekly from 36-40 weeks), blood work, office visits, labor and delivery.

lmtrmama · March 2016

I actually had great insurance with my first...I think i paid $235 to the doctor 4 months in a row just to cover
anything not covered. Then, after I had her, I got a $9000 bill from the hospital, and a $400 bill from the anesthesia. I literally had a panic attack right there at the mail box! I ended up calling and only paying a fraction of that, but the moral of my story is read your bills, ask for detailed statements, and don't be afraid to call and ask, especially if it is the hospital. There is a crazy high percentage of hospital billing errors that happen every day.

jmw386 · March 2016

@bsckgb7: Thanks. I actually spent a good chunk of my morning on the phone with my insurance company, then my doctor's office, and then the lab that did the testing. The lab is out of network and the test (or at least part of the test) is not covered without pre-approval. But it sounds like it should work out okay (I hope). I was told that, if insurance does not cover all or part of the testing, the max. out of pocket they will charge me is $130. I'm a little confused because my EOB actually splits the claim in two - part that was denied ($900) and part that seems to go toward my out of network deductible ($1,000). I am hoping that the $130 max out of pocket charge the lab described over the phone applies regardless of how my insurance company treats the claim.

@ramoseecology: Ugh. Sorry they're making you jump through hoops. I hate that the entire system seems like a game. My EOB says that this test should have cost over $4,000. After contractual adjustments, my "member responsibility" is the bargain price of $1,800. But wait... now I find out that, if insurance doesn't cover it at all, I only owe $130? Makes perfect sense.

charmedlifex3 · March 2016

@jmw386 My insurance needed "Post Pre Approval" on something before they covered it. I pointed out that was ridiculous, and the sentence didn't even make sense, but it worked and they covered it.

erinmarie86 · March 2016

I have yet to receive a bill for prenatal care. However it doesn't mean it's not coming. But oddly my insurance sometimes covers more than what they say (even if i call and ask them how much i should expect to pay).

On the plus side, we are in a new year with new deductibles and out of pocket max. So even if you/I have to pay for something like blood work or ultra sounds, it's just going towards that. Which means by the time you get to delivery you may not be paying as much. I know that i have a max out of pocket of $1,000. So i just figure on paying that much and then nothing more

take a look at your plan and see what your deductible is and your max out of pocket.

haboobjob · March 2016

I've only paid my initial visit co-pay, which is $20, and I'll need to pay like a thousand to hit my max OOP. One thing my insurance didn't cover and I didn't end up fighting (which I should have) was having a nurse assisting my doctor in the OR during my c-section. For some reason, my insurance doesnt find it necessary to have someone in there during the procedure, even though my doctor requires someone there. I ended up having to pay a few hundred dollars to settle the bill after months of the nurse's office rerequesting payment from my insurance company. Insurance claimed she wasn't in network but she was. It was annoying and unexpected. I am going to l have my doctor double check with my insurance to make sure it doesn't happen again this time around.

sdavis2189 · March 2016

Yep, I have had to pay for the lab work. I was also referred to a MFM, and since there isn't one in my city, I had to see one located about two hours away and out of network (but part of the OB practice I go to). The entire visit, including the ultrasound, was billed to me. It was over $2,000. I am in the process of appealing it now. Like the OP, I assumed all prenatal care was covered by insurance.

charmedlifex3 · March 2016

And yes, tests they ran last month the CO-PAY was $500. Which was 10%. My insurance is changing next month to where I pay 20% after the deductible, the deductible jumped to $500.00 and the OOP max to $2500 (5k for our family, so hopefully no one else will need anything major.)

katiedidthat · March 2016

I have to meet my deductible ($2500) then they'll cover 80%. So far we have paid for my ultrasound, two sets of blood work, a half dozen prescriptions, and we're paying completely out of pocket for Makena injections because my insurance won't cover them at all until the deductible is met. I'm hoping I'll get reimbursed for some of this once they get caught up on what all we've paid. Either way, I'm definitely hitting my $6k OOP max this pregnancy.

maryellenmchill · March 2016

I've received bills for ultrasounds and Labwork. My OB gave me a billing guide at my first visit saying that they don't bill for the office visits/hospital charges until after delivery. I don't know if that's just for my particular insurance or if it is office policy. So far it has been about $300 out of pocket.

Bookhousegirl · March 2016

I've had copays for my first two visits and then nothing since. I'll have to pay a $500 copay for delivery due to the hospital stay. I'm so grateful for our insurance this time around because with DS we had to pay over $5000 because of a ridiculously high deductible. Thankfully DH has changed jobs since than and his insurance this time around is amazing. It's so crazy how I never even really gave it a thought until I was pregnant and had a kid getting sick all the time and suddenly good health insurance is a huge factor.

Katm89 · March 2016

We had two insurances for this pregnancy. Our first two appointments were with my old insurance and then we switched to my work insurance. Our old insurance charged us 90$ for our blood work and 175$ for our dating ultrasound. Then our new insurance we paid a 3$ copay for something. My husband honestly didn't look to see what the 3$ was for. I called to find out how much the birth will be and we are responsible for 500$ total of the birth. We have a Point of Service Plan instead of a deductible, so the 500 covers our stay at the hospital as well as any procedures we have there... we are allowed a 72 hour stay with a regular birth and a 96 hour stay with a c-section... but we will most likely leave 24 hours after the birth. I believe we still have copays for things... I should call to find out how much our anatomy scan will be.

Curls919 · March 2016

Insurance has covered everything so far. I had a co-pay for my MFM appointment but I think that's the only co-pay and I'm paying for the visiting nurse who does my weekly shot but that goes towards my deductible then my OOP amount. I'll say, we definitely planned this right having all our prenatal care and the labor & delivery in the same calendar year. I don't even want to think about how expensive it would be if we had to split these costs between deductibles! I'm sure I'll hit my OOP max with (if not before) delivery.

Knottie1427415498 · March 2016

Curls919 said:

Insurance has covered everything so far. I had a co-pay for my MFM appointment but I think that's the only co-pay and I'm paying for the visiting nurse who does my weekly shot but that goes towards my deductible then my OOP amount. I'll say, we definitely planned this right having all our prenatal care and the labor & delivery in the same calendar year. I don't even want to think about how expensive it would be if we had to split these costs between deductibles! I'm sure I'll hit my OOP max with (if not before) delivery.

I think Harmony tries to over-Bill all of their patients. I got the same bill , called them and they seemed like it was normal procedure to change the bill to the correct cost (my doc said it would be $200 for both screenings )

karaszoo1 · March 2016

Well this is gonna sound so petty after reading what all you ladies have to pay but my damn Diclegis isn't covered, only Zofran for the nausea puking.well a)Zofran does to shit and b) the concern for birth defect is way higher with Zofran . Luckily my OB office is awesome and gives me sample bottles otherwise I would be puking myself to death. as it is, the diclegis only helps so much- 21 weeks and as of my appt tuesday have only gained 1 pound...

ashleymz · March 2016

I have gotten really lucky this time... I haven't even had a single copay. Including the genetic testing at 10 weeks.

ashleymz · March 2016

I've been really lucky this time around. I haven't paid a dime in copays or deductibles... even when I deliver it's covered at 100%. But it is kaiser, so you get what you pay for.

Last time with my son I opted to pay more for insurance and incur copays for a better hospital but with obamacare that plan "disappeared."

Jaspertheyoungturnip · March 2016

I feel so ungrateful! Not that I'm not so thankful to my midwife, just that I never really think about how lucky we are. I don't pay for any of my visits with her because she's been a long time family friend of my fiancés family. There's a women's clinic in my town too that does completely free ultrasounds for moms who need financial help, so I've paid nothing for my prenatal care. We are totally responsible for all the supplies we'll need for the home birth though. But my midwife also has a connection to a woman who teaches a labor class, and can get me in for free. However, we are only 19, and I think without this help, we'd be so lost financially. We've had some really great people offer to give us their hand me down baby items, and it's a life saver. I'm so sorry that you ladies have the play the insurance game! I can't imagine the bills if I'd had to use insurance! (My insurance wouldn't have covered a dime of a home birth)

Wolfie646 · March 2016

I have Kaiser in CA and haven't had to pay anything. Except for the DNA genetic test (Verify) I did... I got a bill for $45 in the mail (speaking of I need to find that and pay!). I read the only thing I'll have to pay for is the $500 copay for delivery.

JournoGrl23 · March 2016

I want to second what a PP said about checking hospital bills! I get an endoscopy every couple years just to check on my esophagus and stomach lining since I have gastroparesis/GERD. Last year the hospital charged me $10,000 when the insurance was saying I only owed $480. I asked for a detailed copy of the bill and they charged me for enough propofol (the drug that puts you to sleep for a few minutes) to put down a horse. So I knew they were charging me for things they didn't use. I had my insurance call them while I stayed on the line and the hospital admitted they were overcharging and I ended up paying just the $480. I never pay anything now without confirming with insurance.

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