Global billing for maternity? Help! - Mothering Forums

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#1 of 8 Old 01-02-2008, 12:53 PM - Thread Starter
 
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I buy individual insurance from BCBSNC (employer doesn't offer insurance) and my very expensive maternity coverage just started yesterday. (I'm not preg yet but am hoping some of you ladies might be able to give me some info). My midwife mentioned at my last visit that they don't like to deal with BCBS because they do global billing, so they are now an out of network provider.

What I'm wondering is, how does global billing work exactly? Does that mean I will have to pay for every visit up front and then hope that BCBS won't fight giving me reimbursement after the birth? I am trying to figure out how we are going to have a prayer of affording all of this (we don't qualify for gov't aid). I have an appointment with my midwife's office next week to discuss billing and all but I am so antsy to get more info now. If we have to pay everything up front, we'll go broke.

Anyone have experience with this (not just with BCBSNC, but global billing in general)?
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#2 of 8 Old 01-02-2008, 01:50 PM
 
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I wish I had more info for you on the insurance side of things, but I don't. But I'm fairly certain that you won't have to pay for everything up front either. I guess everyone does things differently, but the midwives I interviewed here all had a system where you had to have things paid for by a certain time (usually 36 weeks) to get a very good discount. They help you figure out what you want to do based on your insurance, and help you pay as you go so that you are paid in full (if cash-paying) before delivery. And it was a different system if insurance would be billed.

I would just talk things over really well with the midwife. I bet a lot of your questions will be answered then.
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#3 of 8 Old 01-02-2008, 05:40 PM
 
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I have BCBSNC through the state employees system. I think that what global billing means is that they wait until the pregnancy is completed before paying on anything. So your midwife would submit all the bills to them as she gets them and they compile them. Then after they receive notification of delivery from the hospital they begin going through and paying what they will pay and your provider will bill for the remainder. So essentially,your midwife won't get paid until the end of your pregnancy. I can see where that would stink. Heck, we just finished working everything out from a delivery in July - it took 6 months to finalize everything.

Mama to Aeden, : my little NICU grad and Conner and Liam () my precious twins. is due mid April!
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#4 of 8 Old 01-02-2008, 05:53 PM - Thread Starter
 
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Thanks... I have another potentially dumb question

If I were to end up having a hospital birth - does the hospital require payment for their part of the care right there on the spot before discharge? Or would we be able to pay it afterward? Clearly as you can see, I have no experience/info about these things. I am nervous about the whole $$$ aspect of getting pregnant. We are one of those couples that falls through the cracks in the system since we make too much to qualify for pregnancy medicaid, but not enough to manage paying extremely high premiums & medical bills.
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#5 of 8 Old 01-02-2008, 06:04 PM
 
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Oh heck no! They have to submit the bill to BCBS just like the midwife would. The only part you'd be immediately responsible for is a co-pay. They would probably call it an "ER" visit if you were a transfer from a homebirth though. I paid nothing on discharge because my OB had almost all of that worked into my payments to them.

And FWIW, I don't think these are dumb questions. insurance is hard to figure out!

Mama to Aeden, : my little NICU grad and Conner and Liam () my precious twins. is due mid April!
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#6 of 8 Old 01-02-2008, 06:18 PM - Thread Starter
 
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Well, that is a relief. I guess part of what is confusing to me is that someone told me that with global billing, you have to pay everything yourself as you go along and then you get a check back from the insurance company reimbursing you for their part of it. For us, with an out of network midwife, that would be 60% and 70% for the hospital charges. I was thinking, how can anyone afford to pay like $6,000-$8,000 for an uncomplicated natural vaginal birth out of pocket (let alone high risk pregnancies/c-sections/NICU/etc)!

I called BCBS THREE TIMES in one day last week and spoke to three different people, none of whom had a clue what they were talking about. They couldn't find a way to explain these things to me. One guy just kept repeating, 'it's global billing.' I was like, yeah, thanks, but WHAT DOES THAT MEAN?

Apparently I am going to have to go see a local rep so they can explain it in person. Maybe that will be a bit more helpful.
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#7 of 8 Old 01-02-2008, 07:43 PM
 
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Quote:
Originally Posted by WoodlandFairytale View Post
Well, that is a relief. I guess part of what is confusing to me is that someone told me that with global billing, you have to pay everything yourself as you go along and then you get a check back from the insurance company reimbursing you for their part of it.
For regular doctors and hospitals, no. You'd just have to pay co-pays for each visit, then the doctor/hospital reconciles it all with BCBS after delivery. Anything that's left for you to pay (deductibles, etc) will be billed to you, usually months after delivery.

But with a midwife the story might be different. If she requires payment in-full at each appt or by a certain timeframe (36 weeks, for example), you'll have to pay her directly. Then after delivery, she can reconcile with BCBS and reimburse you for overpayment.

Mama to Boy (2) and Girl (5)
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#8 of 8 Old 01-02-2008, 08:36 PM
 
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we have bcbs, and the way I understood it to work is I have to pay my entire deductible while pregnant, and then after the baby is born my MW will submit a bill to the insurance company, who will then in turn (hopefully) pay her. the remainder of her fee that was not paid for by the insurance co and the deductible will be my responsibility.

does that sound right?

woodlandfairytale thanks for asking about what happens with a hospital transfer. I hadn't even thought about that (we're planing an out of hospital birth). I'm guessing that if my deductible is paid already then I'll only be responsible for the % the insurance co doesn't cover : ugh.

I hate insurance companies! they're so confusing
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