Insurance question following a homebirth transfer to hospital

[allisonrose]

I planned to have a homebirth but after three days in labor including being at 9 cm for a good part of a day, we transferred for pain relief and pit to get me to 10 cm. My insurance's website is showing a claim from the OB on call where there is a $300 charge for "medical visit" and is not being covered because "This Procedure Or Supply Is Part Of The Global Service. These Charges Are Not Eligible For Separate Reimbursement." I'm thinking about contacting the hospital about this charge because my insurance is claiming that we are solely responsible and that that amount isn't even going to be applied to our deductible. I'm hoping they can bill it in such a way that the insurance will cover it. But how/what do I ask? Anyone out there with experience in this?

We still need to see what our insurance company will cover in terms of the midwife's fee and I'm so worried that the transfer is going to screw us financially and I already feel lousy enough about having to transfer!

[HariB]

 Maybe the place to start would be to call the hospital and simply say you are confused about some charges and need to talk to someone about the details of the billing.  Once you are talking to the right person, ask why that charge is present, what service it was for, why it's not on the global fee, etc.  You may be able to clear up what was just a mistake on their part--or, if they feel it's a righteous charge under their billing system, you may be able to talk them into ditching it since it will be such a financial hardship for you to pay your deductible, even without that addition.

Also, not sure if you know this--you don't have to let med bills ruin you.  They pretty much have to accept whatever payment you can make on your budget, as long as you are faithful in making pmts.

good luck!  I think it's such a shame that medical care has become so extremely expensive!

And by the way...you didn't say, but I assume your baby did get born after some pit with epidural, and you are both well?  Congrats!

[allisonrose]

I think part of the problem is that no one gets to bill global. My midwife can't since the OB "delivered" my son (she actually caught him since the OB didn't know what to do when I refused to get into bed). The OB didn't provide prenatal care so he can't bill global. I talked with my hubby and we figure the place to start is the hospital. I've heard that there ends up being moms delivering there that had prenatal care under a doctor that doesn't deliver at the local hospital so it can't be too uncommon of a situation. If that gets us nowhere, then I'll call the insurance company and the last resort will be appealing.

Yes, my son and I are both healthy after some IV pain relief and some pit. It's also not that we don't have the money to pay medical bills but that my husband is concerned about his job security and worries excessively about our finances.

[AlexisT]

is the OB a hospital employee, or private practice? If this is an OB charge and he's billing you on his own, hospital billing won't be able to help. You need to speak to someone at the OB's office who deals with billing. Often, resubmission with correct codes can get a payment. Your insurance may be able to help as well.

[allisonrose]

I am assuming that the hospital billed the insurance under the OB's name because they contacted me on Friday to let me know I owe them my deductible. There are two claims with the OB's name on them: the one that has been processed that includes this charge and another that is still being processed.

[allisonrose]

I talked to both the hospital billing department and the OB's billing lady. Neither had any information although I think the charge is probably from the OB. Both said don't worry we don't collect that type of thing. While I am glad to hear that, I do think it's a tad silly if they decide not to attempt rebilling.

[IntoTheRoseGarden]

As a medical biller, here is my take on it. It sounds like that particular charge was billed by the OB. Any hospital visit related to the delivery is included with the delivery fee, regardless of whether it is billed as a global OB package or as delivery alone. The OB will not (or should not) hold you accountable for the charge because it is not billable service. They are not letting anyone off the hook for the bill here, don't worry.

I would be inclined to scrutinized the other charges very carefully if I were you.

[allisonrose]

Quote:

Originally Posted by IntoTheRoseGarden 

As a medical biller, here is my take on it. It sounds like that particular charge was billed by the OB. Any hospital visit related to the delivery is included with the delivery fee, regardless of whether it is billed as a global OB package or as delivery alone. The OB will not (or should not) hold you accountable for the charge because it is not billable service. They are not letting anyone off the hook for the bill here, don't worry.

I would be inclined to scrutinized the other charges very carefully if I were you.

I think you're right that it is from the OB's office. The charges listed are a "medical visit" the day of the birth (this is the one that was declined), "surgery" and a "medical visit" for the day after birth. I had kind of assumed that the first medical visit was the delivery, the surgery was stitching up my tear and the second medical visit was the when the doctor came in to tell me to get my stitches checked in two weeks.

There is a pending claim that I'm sure is for the hospital. (Something like $9,000.)

I'd love any advice you can give about looking over the charges. Feel free to PM me if you prefer.
 

[IntoTheRoseGarden]

A charge of $300.00 is probably not for the delivery. That charge would probably be along the lines of  $1000.00 - $2000.00.

I am thinking the first "Medical Visit" is your hospital admission, and the second is your discharge. The "surgery" is probably the delivery, even though was not actually a surgery. Of course that is just for the professional services of the OB. You are probably right that the $9000.00 bill  is for the hospital.

The OB should not bill for repair of a tear unless it was at least 3rd degree: http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=4645

Now that I have my books in front of me, if they billed delivery only (59409) and not delivery+postpartum (59410), they are eligible to bill any hospital visits after the delivery. So, as far as I can tell, the only shady charge was the initial hospital visit, which your insurance processed as a no-go anyway. You're probably good.

[allisonrose]

Okay it looks like my insurance company processed the hospital's bill. They are writing off most of the fees with the note "We Have Applied The Contracted Fee." "Room and board" is the only charge that is being subjected to our 20% coinsurance. The hospital billed $1,802. The insurance has the network discount as -$865 and is claiming they are going to pay $2,133.60 and $533.40 is our responsibility. So the insurance decided the hospital should get $2,667 even though they only billed $1,802?! Gosh, this is so confusing!