Thursday, September 25, 2008

Small Victories

So this morning at the doctor my $417 for my doctor's fees was supposed to be due. But yesterday I looked at my insurance coverage more closely and discovered that I am only supposed to be responsible for 20% of my Labor/Delivery and hospital charges. My doctor's visits are supposed to be covered at 100% after a $20 copay. Well I questioned the receptionist about this and she just kept saying, "that's 20% of your visits" and completely did not understand my quibble. I was thinking that the 20% I was expected to pay was perhaps for my doctor's services delivering the baby, not the prenatal visits. But she kept saying it was for all of my visits. So they sent me to the business office after my visit.

At the business office, I expressed my concern to the billing person. She explained that all the fees for all the visits and the doctor's services in the hospital are billed under an "OB Global Fee". She said this is the way that the insurance wants it billed and the charges cannot be broken out separately. So in essence, even though my insurance SAYS they cover my visits at 100% after the copay, in PRACTICE, I pay 20% of those OB visits as well. She helpfully offered, "you'll have what, 13 or 14 visits and rather than paying a copay at each one you can pay it all at once!" Oh, that's so helpful. Because $20 at a time is always such a hardship. $400? I have that in my back pocket at all times! And I'm pretty sure that those visits are each more than $100. Because then my $20 copay would be 20% and they would be equal. I'm pretty sure I come out behind in the whole thing though. But I can't know because it's just impossible for them to break out the charges individually! I bet they'd do that if I was paying cash. So anyway, I asked if I could pay there and she said I could have a payment plan. I said, well, I have a Health Savings Account that starts over in January and I was hoping to pay for the baby charges with that, but didn't know I'd have to pay this to the doctor so far in advance. She asked when I was due, checked with someone and said the deposit was not actually due until my 7th month. Which is January! So if as long as I pay in the first two weeks of January, I'm fine. Which means that 1) rather than having to come up with the money now, I can use pre-tax money that is gathered over the course of a year, so essentially it's like a zero-interest loan. and 2) it will count towards my out-of-pocket maximum for next calendar year, so if I do wind up having to pay the whole $2,000 maximum, it will be $2,000, not $2,417. So small victories. Small victories. I'm not saying I'm completely done with this. I will make a call to the insurance company when I've worked up the energy just to confirm that this is the case. But I'm pretty sure I'll lose. Why do they advertise one thing when it's not the truth? And why does my doctor's office SAY you have to pay the deposit at your second visit, when you really don't have to pay it until your 7th month?

More interesting developments at my doctor's appointment: My tests from last week came back great and instead of having something like a 1 in 450 chance of Down's Syndrome because of my age, I have a 1 in 10,000 chance of it. Damn good odds, I must say myself. Unfortunately, my doctor already started harping on my weight. Not now, she said its fine, but she looked back at my previous pregnancy (damn computers, she brought it up instantly) and said again they'd really like to see me gain 30 pounds and that I really need to watch that, blah, blah, blah. I didn't say much other than that I eat much healthier now because I've been through Weight Watchers and I started out this pregnancy about 10 pounds lighter than the last one, but I am not going to get stressed out about this shit like I did last time. If she starts to harp on me, I'm going to be polite but firm that I am confident in my ability to stay healthy even if I gain a little extra weight and that I know I can lose it because I did once before. I hope that's enough to nip it in the bud. Blech, why do doctors care so much whether I gain 30 or 44 pounds. Is it really that big of a difference on my 5'10" frame? Stella was about as healthy as a baby can be. Who cares? That said, I don't plan to gain 44 pounds. I am hoping to keep it in the 35-40 range. But I think that 30 is a rather arbitrary number and I don't know why she chose that when I started out at the low end of the healthy BMI for my height. I've gained 5 pounds so far, which all the books say is perfectly fine for the 1st trimester. Even if my doctor said I'd only gained two (at the first visit the nurse recorded my weight wrong, and so they now think I lost 3 pounds between my first and second visits and so am now only 1 pound up rather than 4. Or something like that. I've mentioned it before but they don't seem to be eager to change it. Whatever. It'll give me some cushion.)

Man, this is a looong post. sorry. I have to go hang laundry before picking up no-nap Nelly at school!

1 comment:

Kate said...

First, I think that insurance thing is bull. I would call your insurance company first. It may be that the business office is just to lazy to separate out the charges. The insurance company has to provide the services they agree to, not some arrangement that is supposed to even out somehow.

Second, I want to punch that doctor. And I agree with you that the number means less when you're a taller person to begin with. Ah well. You look fabulous!