Insurance question

treeofcheem · April 2018

I'm getting more and more frustrated with our insurance situation.

I was told by the billing department for my provider last month - actually, over a month ago - that my initial pregnancy visit was coded as a regular OB visit, which in turn meant that my insurance didn't pay for it (it's subject to my deductible if not considered preventative care). Since they did an ultrasound as well as an exam/consultation, the bill is over $500 for something that should have been completely covered. They said they would send it for review.

I just found out that they say they coded it correctly since it was for "confirmation of pregnancy" and therefore not a prenatal visit. Has anyone else had this happen? Any advice for getting it revised?

nlc8424 · April 2018

So in the pregnancy packet given by my OBs office they explicitly state that the first visit is not included in the OB global care billing. They also state that all ultrasounds are billed separately. I expected this and it gets applied to my deductible, my H's company also contributes $1500 out of our $3100 family deductible. If that's their policy for how they bill, I don't see how it would get revised, but they may have a payment plan available. Have you already talked to your OBs billing staff?

nackie · April 2018

My first appointment was pregnancy confirmation as well and was billed separately. I’m pretty sure ultrasounds and labs are also separate. Thanks to DS’s ER trip in January, We hit our 3k deductible right after that first appointment though, so I wasn’t too worried about the bill since it was pretty much the last one we’ll get.

klj0228 · April 2018

This is pretty standard practice. They pretty much always call it a confirmation appointment and don’t bill it with the other prenatal appointments. As others have said, you will likely be billed separately for labs and ultrasounds. You will very likely hit your deductible pretty early this year, but don’t forget you will still need to meet your out of pocket for the year which can sometimes be really expensive.

I would call your Ob office and ask if you can setup time to meet with their financial person. They will usually call your insurance to verify what your benefits are and then can help set you on a payment plan so you aren’t hit with a huge bill after the birth.

DanyTargaryen · April 2018

My office also bills the initial appointment, labs, and ultrasounds separately from everything else. I've had to pay those as I go where I won't pay for prenatal care and delivery until baby is here at which point I'll only be responsible for whatever portion of my deductible is left.

treeofcheem · April 2018

The billing staff are the only ones I've talked to. I was with this office a few years ago and it wasn't the same, but I guess policies can change. They don't have any sort of written policy that I've been given, though.

It really bothers me on principle that they do it this way with no warning or discussion. I didn't ask for pregnancy confirmation - I knew I was pregnant. I didn't ask for an ultrasound at the first appointment, they didn't ask if I wanted it (I did, but you know, the principle of the thing), they just did it. This is completely different from my last pregnancy. Every single thing - we didn't do the 1st/2nd tri screening/NT scan that time - was considered part of the preventive prenatal care. And it was the same office. I don't think my NT scan was covered at all, either, and they had told me it would be.

Labs have all been billed separately but they’re done at an offsite lab. And they’re all covered 100% so far. I think that’s ACA policy.

Thank you for the feedback! This was super unexpected for me, and pregnancy hormones don’t help with how I handle the unexpected right now.

nackie · April 2018

@treeofcheem how long ago was your last pregnancy? It sounds like your policy has changed a fair bit since then.
None of my labs are covered at anywhere near 100%, so I’m pretty sure that’s not part of the ACA. I’ve gotten $500 bills just for blood work.

treeofcheem · April 2018

@nackie My pregnancy with my daughter was 4 years ago. But I was pregnant last year and unfortunately miscarried; I was seen at a different office but I wasn’t billed as if it was a normal non-pregnancy related visit then either. It was covered as prenatal care.

I’m seeing that this isn’t uncommon, but I don’t understand how a basic pregnancy-related visit isn’t considered prenatal care.

DanyTargaryen · April 2018

@treeofcheem - Basically insurance sucks. It seems like the initial visit should be included once they confirm you are in fact pregnant.

Wishilivedinflorida · April 2018

Interesting. I never got billed for my first visit (besides labs), but then again, they did nothing to confirm I was indeed pregnant. Just ordinary prenatal stuff and a Pap. I did have a dating ultrasound at a separate visit at my insistence to prove I ovulated late like I thought, to the tune of $160.

I’m super happy this time all my care will be in the same calendar year. Last pregnancy, I met my deductible, and then the year switched over and I was on the hook for delivery and all that Jazz because I didn’t meet the deductible yet.

nackie · April 2018

@Wishilivedinflorida DS was born in January. I was so annoyed that we had to pay the full deductible twice. Here’s to September babies!

jhjocelyn · April 2018

Oh man, +1 to the happy this one’s contained in the calendar year!

Dd was born in Jan, then I did not return to work so got new insurance, then open enrollment came for dh’s insurance... we paid out out of pocket max 3x thanks to dd’s birth, meds, and first hospital stay... thankfully we got smarter after that. Most years her oop is hit by feb/march, cf life is expensive.

Wishilivedinflorida · April 2018

@jhjocelyn Man oh man that sucks to pay OOP max x3!!!

People always wonder why I sign up for the best/most expensive plan my company offers for my “healthy family.” Um, because even routine preventative stuff is expensive! And so are babies! And you never know when you need something done.

DanyTargaryen · April 2018

nackie said:

@Wishilivedinflorida DS was born in January. I was so annoyed that we had to pay the full deductible twice. Here’s to September babies!

That was one of my first thoughts after I found out I was pregnant! DS was September too but I was on a standard co-pay plan then. I'm on a high deductible now so yay to only paying it once related to baby!

yogapants247 · April 2018

+1 to being thrilled this baby is due in September!

With my last pregnancy, my insurance billing year started in March, and I was due in August. Luckily, they carried over prenatal stuff for the 3 months before the new billing cycle began so it all worked out ok, but I was very stressed out before I figured out that was the case! Of course, I have a higher deductible and MUCH higher premiums this time, and if this continues my next baby will be had without insurance >(

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