Pregnant? How four Nashville-area practices bill for delivering your baby
How to avoid billing surprises
Medical bills can be confusing, and the many bills you receive after pregnancy can be especially complicated.
An issue we frequently run into at Bernard Health is patients who are asked by their OB/GYN to pay their deductible upfront and in full before the baby is born. Most women believe — and understandably so — that their deductible has been paid. But after the baby is born they often discover that from the insurer's perspective, the deductible is still unpaid. What is going on here?
Let's look at a common scenario.
Julie is pregnant and receives prenatal care from Dr. Robert. At about 20 weeks, Dr. Robert’s practice asks Julie to pay what remains of her deductible — $1,500. Julie pays it and continues receiving care.
Months later, after the baby is born, Julie receives two bills. First she receives a $3,000 bill from the hospital where she delivered the baby, then she receives a $2,000 bill from Dr. Robert. Dr. Robert’s bill shows that it has been paid in full by her insurer. The hospital bill, however, shows that she owes her $1,500 deductible to the hospital.
Julie is understandably upset and confused at the prospect of owing another $1,500. Doesn’t the insurer know that she already paid that $1,500 deductible to Dr. Robert? Here is what happened:
Dr. Robert’s office is not allowed to file a claim for delivering the baby until the baby has been delivered. As a result, the payment Julie made when she was 20 weeks pregnant was not initially reported to the insurer. Only after the baby is born does Dr. Robert submit his claim. The hospital will often submit its claim before Dr. Robert does, however, resulting in the insurer telling the hospital to collect the deductible from Julie while paying Dr. Robert in full.
At that point, Dr. Robert’s billing office should issue Julie a refund of $1,500, which Julie can use to pay the hospital. Whether Julie gets the refund in a timely manner or not, she needs to pay the hospital or will be at risk of the hospital turning her over to collections. Even if Dr. Robert is associated with the hospital, his practice generally will not forward the $1,500 over to the hospital — it is up to Julie to make sure the hospital bill gets paid.
Not all OB/GYN groups take exactly the same approach. We spoke to four popular groups in the Nashville area to ask how they handle prenatal care. Representatives from the groups pointed out that every patient is unique, and atypical situations often arise. Even groups that normally ask for payment upfront will often work with patients who aren’t able to do so.
With those caveats in mind, what follows outlines the general approach explained to us by each practice.
Heritage Medical Associates OB/GYN
Representatives from Heritage Medical Associates said they estimate the patient’s remaining deductible and ask for payment by the 26th week or through a payment plan. The money is held in the case of overpayment, and if it turns out after delivery that the patient is owed a refund, they issue it to the patient.
Baby + Co
Baby + Co is a fairly new boutique birthing center in Nashville. This facility takes a similar approach, estimating the full out-of-pocket costs early in the pregnancy and developing a payment plan to be paid in full by the 37th week of pregnancy. They also issue refunds after the baby is born.
Saint Thomas Medical Partners Obstetrics
Saint Thomas Medical Partners representatives acknowledged that this process is fluid, noting that they currently bill for all care after the baby is born, but they are familiar with requiring patients to pay by the 16th or 17th week. Representatives said they may return to that practice in the future.
Vanderbilt Women’s Health
Vanderbilt Women’s Health said they do not ask for payment upfront. At Vanderbilt, services are sent to insurance before asking for payment from the patient. Representatives acknowledged that asking for deductibles upfront is a practice with which they are familiar and have considered.
Again, representatives at all the practices said they work with patients on a case-by-case basis. It is worthwhile to take some time to understand how billing works on the front end rather than to be surprised afterwards.
Reader Q+A I just had a baby boy and in between trying to figure out how to be a mom, I...
More options for Tennesseans Do you need individual or family health insurance coverage...
More options for Tennesseans Open enrollment is almost here, and after years of...