OB Global Fee = double deductible?

[Ms Independent]

Hi all,

I am pregnant with our first, and at second OB visit, the office presented us with a bill for $2028, due at our next visit. It was our portion of the "OB Global Fee" of $3650, which included prenatal appts, delivery and one post-partum visit. It excluded ultrasounds, labs & hospital stay. Ultrasounds & labs are covered at 100% by my insurance, but for the hospital stay I'll have to meet the deductible and then pay 20% until I hit the out-of-pocket max.

A few facts:

• My due date is 1/5/17. During most of my pregnancy, it will be 2016.
• My insurance deductible is $2000.
• While I haven't gotten the office to produce a list of line items included in the global fee along with associated costs, I estimate the delivery fee is ~$3000.
• The copay for each of my prenatal visits is $50 and I expect all the office visits are about $650 of the global fee.

So here's why I'm hung up: If we pay for the delivery fee in 2016 and for the hospital stay in 2017 (which I actually deliver), we'll end up meeting the deductible twice. If they billed for delivery and hospital stay at the same time (in whichever year I deliver), we'd likely meet the deductible only once, assuming everything else went smoothly throughout the pregnancy.

I have spent several hours on the phone with these people already trying to understand better -- so I can argue for them billing me after delivery. It's also possible they'd have me prepay an estimate and not actually bill insurance until I deliver ... but the person who gave me the bill told me they were billing the insurance for the delivery in 2016. No one has been a reliable narrator so far, so I have no idea if she's right or not.

I'll continue to pursue The Truth -- but in the meantime, does anyone have any experience with this? What a racket ... already.

[Beriberi]

I'm not an insurance expert. However, one thing to realize is that the OB is paid one lump of money for everything they do for you and the baby (the global fee).  The hospital "privileges" the OB, allowing them to use the facility, but neither charges nor collects from the OB. So, from the hospital's perspective, they can only bill you for services rendered (perhaps in 2017, perhaps in 2016). 

I doubt you can convince the hospital to "pre-bill" for the delivery - it seems like it would be impossible. The OB may be able to bill after the delivery, but they often collect up front, and refund later.  It is hard to collect from someone who has already taken their baby home, and they don't want to invest months of prenatal care in someone without assurance they will be paid. I would expect that the OBs office manager would be the appropriate person to authorize later billing, though they will likely still require a deposit.  The global fee should include the charge for delivery, if its vaginal and perhaps if it is an uncomplicated c/s (for the OB - remember, none of this is going to the hospital.)

Typically, one does not pay a copay with prenatal visits.   Also, there is another thread about "double billing" - you will likely have a deductible for your child due in 2017 as well (for the post-natal care). 

[seattlecyclone]

We used an OB with a "global fee" as well, but they billed on the delivery date. Keep in mind that this fee was only for the doctors' services, it did not include lab tests, ultrasounds, the or the hospital's own bill (for mom or baby, who each can get billed separately since they are two separate humans staying overnight in the facility receiving medical care).

I made a thread with more details about how our billing worked out here.

Do keep in mind that with a January 5th due date you're almost as likely to deliver in 2016 as in 2017. The due date is just an estimate. Variation within a couple of weeks in either direction is completely normal. Our due date was January 10th but our son decided to join us before Christmas.

[Cognitive Miser]

I've never heard of an OB Global Fee!  How crazy!  I'm with Kaiser and they do it the other way around - all my prenatal visits are free (except for visits to the perinatologist, for which I pay the Specialist co-pay).  Ultrasounds are billed at full price until I hit my deductible, at which point I pay 10% coinsurance up to my out of pocket max.  After reading your post I'm glad my entire pregnancy will occur in 2016, although I am getting bit by an increased max deductible as of June 1, which is when my insurance plan renews.  So I HAD already met my deductible, but now it is $500 higher.

You might be able to prepay at the hospital.  See http://www.frugalwoods.com/2015/11/02/pre-paid-discount-birth-and-other-october-2015-expenditures/

[sheturtle]

My OB with my 2nd child wanted to take payments towards their global fee while I was pregnant, but I was due in March and my insurance wouldn't let us use my HSA without a bill of services rendered. The doctor couldn't itemize the services until the delivery. So we refused payment until the delivery, your situation seems very similar. Our insurance is very basic: high deductible and doesn't have maternity coverage so it didn't affect the doctor or hospital costs (we negotiated my bill at the hospital as "uninsured", while little one was covered).