A friend writes:
Here is my situation. I have a high deductible health plan with Cigna that doesn’t pick up until I meet the deductible. That deductible in any year is $3,000.
Right now none of my prenatal care is covered because I have not met my deductible. It’s all out of pocket but everything I’m paying is supposed to go towards the deductible. Once insurance picks up they will do global billing and I will get one bill at the very end for what I owe for anything prenatal and delivery-related up to my max out of pocket.
My out-of-pocket maximum in any year is $6,000.
My insurance premiums for this year will be $600 total ($50 a month, $25 a paycheck).
I am 20 weeks pregnant with a healthy pregnancy, my first – and the baby is due July 10.
‘I’m not sure what the deposit covers at all’
My OB/GYN has a policy where I have to pay a huge deposit to them up front – $1,000 – prior to the global billing at the beginning of my pregnancy right now. I’m not sure what the deposit does or covers at all. It does not cover lab or urinalysis because I’ve had those bills show up in the mail separately. I’ve not paid the deposit yet until I can discuss it with them further.
When I asked them if I could just continue to pay my out of pocket responsibility each time until I hit my deductible they told me that unfortunately I had to pay the deposit or they would not treat me. They said they can refuse me care if I refuse the deposit. I’m not sure that’s legal?
I have an appointment Thursday where I’m supposed to meet with the financial coordinator to go over all of this.
I called my insurance company for further insight and they said they do not do the global billing until they are covering which doesn’t happen until I meet the deductible. I have about $2800 out of pocket before they are even covering anything.
So far I have been only been billed for one visit, my confirmation of pregnancy appointment. That bill is $114 after an insurance negotiated “discount”. I have not been billed for my first ultrasound or my second visit yet. I paid out of pocket around $250 for genetic testing which did not go towards my deductible. I have also been billed around $80 for blood work, and the doctor is asking fir the $1000 deposit at my 3rd visit.
The doctor and insurer disagree
The doctor’s office is claiming they have to take the deposit due to global billing required by the insurance company but that’s contradictory to what insurance told me.
The office manager did admit to me that the policy was to make sure the office got paid and people did not run out on their bills since they all come at the end. But again my insurance is not paying anything right now because I haven’t met my deductible and the office honestly has no idea when I’ll meet my deductible for the global billing to start so I’m not sure what this deposit is for.
A huge concern is that the insurance company told me until I hit the deductible I should be continued to be billed each time – for each individual test and procedure — and then the global billing starts and I won’t see a bill until after delivery.
I asked the doctor’s office to provide me everything in writing , with line by line items of what each visit will be billed so I have record of how they intend to use this deposit. I am hoping this is provided to me at my next appointment. I also anticipate this deposit would have to be kept in escrow if they are intending to draw from it.
In the meantime , I made my 28 week appointment at a different provider where they also do “global billing” but there should not be a deposit required upfront. So if this OB/GYN will not agree to my terms and what my insurance company has advised then I will just go to a different provider.
We have several practices in town here that require this up front payment, and it seems this global billing is pretty standard with maternity. It seems like there is a great deal of room for error and overbilling to patients with these deposits.
So many women even co-workers are saying “just pay the deposit — you don’t have a choice.”
It’s horrible! Why do people refuse to fight for their medical rights?
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.