Anonymous
So GW MFA informs me today they're now doing a "global" maternity fee, which is cute. Basically they bill a flat fee to insurance after the birth. Except they charge the PATIENT 4 months before birth, via a giant guess at how much they'll owe. Has anyone else encountered this? Is this unique to GW MFA? This doesn't work for me for a multitude of reasons - I have a deductible, co pay, coinsurance and low OOP max. Which means they couldn't even begin to guess 4 months before birth what my insurance will cover and what I'll be on the hook for 4 months later. It's likely I'll hit my OOP max before the full charge for the global maternity fee. It's nearly certain I'll hit it completely before the fee if the anesthesiologist, hospital bill, etc all come in before the GW MFA bill does. But 4 months before birth, it's possible I'd still have the deductible to eat through. But my insurance goes by order of billing, in terms of knocking out the deductible, OOP max, etc. So the only way for any doctor to have any idea what I will owe them is to bill insurance first. So GW MFA wants to bill me for some portion in excess of what I'll likely owe (and that's even assuming they're allowed to bill for the full global fee they want to - I've never see a doctor bill insurance where the negotiated rate, and thus my co insurance portion, hasn't been less than what they billed). This seems to be a fishy scheme to me, and is sufficient for me to look elsewhere. Otherwise I'm stuck with a 1k or more bill, that my FSA won't cover (since insurance hasn't yet been billed) for services that haven't been fully provided, and means I'll be paying well more than I should be responsible for under my insurance plan (and getting money back from them is a nightmare, I know from experience). Has anyone else dealt with this, had success convincing them they don't actually have the faintest idea what insurance will cover and can bill in excess of what the patients responsibility is, or anything else? Is anyone else encountering this issue elsewhere (so I know where to avoid)?
report
Anonymous
I recently left GW for other reasons and did not have to pay anything OOP (for a baby not due for 2.5 more months).
report
Anonymous
huh - I have BCBS and am a GW MFA patient. I haven't paid anything beyond my $20 co-pay at my first visit and they've never mentioned this payment to me (I am due in 8 weeks). Just out of curiosity - how much were they trying to bill you??
report
Anonymous
About $1k. I should caveat that I'm one of those lucky people whose health plan is not subject to the ACA and thus I do not have 100% prenatal coverage. So I'd guess for some others they have 100% coverage regardless. Its a BCBS plan. The other beauty here is will have a chance to switch plans in between when they want to bill me and when they will bill insurance so I could switch to a totally different plan making their guess as to my responsibility even further off.
Anonymous
I'm not sure if it's my insurance or my OB (fox hall) but this is the case for me except I'm billed after baby is born.
report
Anonymous
I am GW MFA (MW patient) due next week. I haven't gotten anything like that. It is global billing (except for labs, etc. which for me have been covered at 100%), but that just seems weird. Was it some kind of preauthorization for delivery? Have you talked to your insurance company?
report
Anonymous
I'm with the MCA midwives and they do this. They estimate your delivery costs and you pay monthly so that you're fully paid by about 7 months. I just paid out of my HSA account and will reconcile it when the actual bills come. It's a pain, but everything related to medical insurance is a pain.
report
Anonymous
Anonymous wrote:So GW MFA informs me today they're now doing a "global" maternity fee, which is cute. Basically they bill a flat fee to insurance after the birth. Except they charge the PATIENT 4 months before birth, via a giant guess at how much they'll owe. Has anyone else encountered this? Is this unique to GW MFA? This doesn't work for me for a multitude of reasons - I have a deductible, co pay, coinsurance and low OOP max. Which means they couldn't even begin to guess 4 months before birth what my insurance will cover and what I'll be on the hook for 4 months later. It's likely I'll hit my OOP max before the full charge for the global maternity fee. It's nearly certain I'll hit it completely before the fee if the anesthesiologist, hospital bill, etc all come in before the GW MFA bill does. But 4 months before birth, it's possible I'd still have the deductible to eat through. But my insurance goes by order of billing, in terms of knocking out the deductible, OOP max, etc. So the only way for any doctor to have any idea what I will owe them is to bill insurance first. So GW MFA wants to bill me for some portion in excess of what I'll likely owe (and that's even assuming they're allowed to bill for the full global fee they want to - I've never see a doctor bill insurance where the negotiated rate, and thus my co insurance portion, hasn't been less than what they billed). This seems to be a fishy scheme to me, and is sufficient for me to look elsewhere. Otherwise I'm stuck with a 1k or more bill, that my FSA won't cover (since insurance hasn't yet been billed) for services that haven't been fully provided, and means I'll be paying well more than I should be responsible for under my insurance plan (and getting money back from them is a nightmare, I know from experience). Has anyone else dealt with this, had success convincing them they don't actually have the faintest idea what insurance will cover and can bill in excess of what the patients responsibility is, or anything else? Is anyone else encountering this issue elsewhere (so I know where to avoid)?
P&M did this for both of my pregnancies - this is not some sort of scam.
Tell them you will be happy to pay what is usual and customary (you can get this info from your insurer) minus everything else - co pay, deductible, etc. Or - tell them ALL of that, and let them know you will give them $500 (or whatever you deem reasonable, given the variables) toward the global fee, and will settle the rest of the bill once the dust settles.
FYI, my insurance company told me not to overpay ANYTHING - including the hospital, because you will never get your money back.
report
Anonymous
NP. This is so confusing to me especially when you're pregnancy covers 2 insurance years. If your prenatal starts in 2014 but ends in 2015, my insurance told me that they will use the 2015 date for OOP Max. If I got a bill in 2014 wouldn't that prevent me from claiming it as OOP Max for 2015 delivery.
report
Anonymous
They are trying to bill you before the birth? That's so weird. I just gave birth with GW midwives - I got all the bills afterwards. And boy did they add up. Thanks Cigna, for basically doing nothing.
report
Anonymous
Anonymous wrote:NP. This is so confusing to me especially when you're pregnancy covers 2 insurance years. If your prenatal starts in 2014 but ends in 2015, my insurance told me that they will use the 2015 date for OOP Max. If I got a bill in 2014 wouldn't that prevent me from claiming it as OOP Max for 2015 delivery.
How is this confusing? Anything that gets billed in 2014 counts to 2014, anything that gets billed in 2015 counts that year.
Yes, a bill you got in 2014 would not count toward 2015. Pregnancy isn't special - people have medical issues that span years all of the time. The year of the BILL is when it counts.
report
Anonymous
Global billing is standard for maternity care. It isn't "cute", it's standard practice.
report
Anonymous
Well, pre-billing is cute, that's for sure. The issue with OOP maxes and crossing plan years is that you the patient are likely billed in 2014, but your insurance isn't billed until 2015. It'll ultimately count towards the 2015 OOP max, unless you've already hit it/hit it partway through the bill, in which case you then paid in 2014 way more than you actually owed. And good luck getting them to refund it.
report
Anonymous
Anonymous wrote:
Anonymous wrote:NP. This is so confusing to me especially when you're pregnancy covers 2 insurance years. If your prenatal starts in 2014 but ends in 2015, my insurance told me that they will use the 2015 date for OOP Max. If I got a bill in 2014 wouldn't that prevent me from claiming it as OOP Max for 2015 delivery.
How is this confusing? Anything that gets billed in 2014 counts to 2014, anything that gets billed in 2015 counts that year.
Yes, a bill you got in 2014 would not count toward 2015. Pregnancy isn't special - people have medical issues that span years all of the time. The year of the BILL is when it counts.
You are incorrect. With global billing you're supposed to get one bill for all OB services within same billing year.
report
Anonymous
I wonder if it's based on insurance plan?
report
