Billing and Insurance
There will be a meeting with you to discuss your financial responsibility for the pregnancy. Despite the personal nature of the doctor-patient relationship, the practice of medicine is a business. We agree to be responsible for taking care of you and your unborn baby to the best of our ability. In return, you agree to be responsible for paying your share of all fees and charges incurred.
Many patients now have high deductible health plans or Health savings Accounts. If you have this type of plan or you do not have health insurance, then we request that 50% of the expected obstetrical fee be paid by your 2nd doctor visit and the remaining balance paid in full by the 7th month.
The overhead in running a medical practice is very high, and we depend on prompt payment to be able to meet all of our financial obligations. We may also ask to keep a credit card number on file so that 30 days after the delivery we can charge any remaining balance due.
Contact Your Insurance Company After Delivery
It is a good idea to contact your insurance company as soon as you learn that you are pregnant, and again about one month before your due date to be sure that your maternity coverage is valid. Also, you will need insurance for the newborn, which can be provided by either parent’s policy. If you are billing your own insurance, you can use our superbill form, which we can provide you after the delivery. Enter the baby’s birthday on the form and send it to your insurance company.
Sometimes the pregnant patient has HMO insurance (her insurance is called the Primary) and her spouse has PPO (his is called the Secondary) . In these cases, it is easy to assume that we can just bill the spouse's insurance. Unfortunately, this is not the case. The Insurance companies battle each other over who should pay. The Secondary will NOT pay unless the Primary has been billed and and a Denial of Coverage is issued.
Since we are not on any HMO plans, we still have to bill the Primary HMO Health Plan, wait for a denial, and then bill the Secondary Health Plan. Sometimes the HMO refuses to issue a denial. They will tell us that we are "not a covered provider." This is not a denial. The result is a billing MESS. Unless we get that denial, the Secondary will refuse to pay. Please do not get upset with us when it is your Health Plan that is causing all of these problems.
If the patient and her spouse both have private insurance (PPO), and if she is also covered on his Plan, this is good coverage. We bill the patient's plan first (the Primary) and wait for them to settle the claim. After that, the Secondary can be billed for any unpaid balance leftover from the first claim and they will normally cover it.