YOUR HEALTH INSURANCE

If you have health insurance, call your company right away. A representative may help you see what doctor and hospital charges are covered. You should learn if there are restrictions or caps. A cap is a time limit or dollar limit at which the insurance plan stops paying. See if the doctor and hospital you like are part of the plan’s network. If they aren’t, you may have to make a choice. You can switch doctors and hospitals and get the plan savings. Or you can pay more and stay with that doctor or hospital.

Your health plan may offer special maternity programs. These are programs that might include prenatal kits or educational materials. The plan may offer risk-appraisal screenings. In a screening, a nurse or expert who works for the plan may ask you questions about your health, habits and lifestyle. Then that person can offer advice on how to take better care of yourself. That means you’re taking better care of your developing baby too. These kinds of programs may cut your risk of going into labor early. These experts may also be able to guide you with advice about your medical care.

Doctors and hospitals send bills to you and your insurance plan using one of two billing methods. There may be a fixed fee. If you have what is called a managed care plan, doctors and hospitals in the network have already agreed to a charge. You may have a deductible and co-pay, but you should know exactly what that is. The other kind of billing is that you pay some percentage of the total charges. For example, if your insurance plan covers 80 percent after the deductible, you will have to pay 20 percent. Doctors’ offices and hospitals have staff who may be able to help you understand these charges. Your health insurance company does also.

Learn about your deductible and co-pay amounts. Find out what other rules apply to your pregnancy, the delivery and the baby’s care after birth. Make the call to your insurance plan early.

Your primary care doctor may charge you for care he or she gives you in the early days of your pregnancy. Then you may switch to an obstetrician (a doctor trained in taking care of pregnant women) or a certified nurse midwife. Either one can be part of your team for the pregnancy, vaginal childbirth and soon after the baby is born. An obstetrician can perform a cesarean section.

Some doctors charge a fee for every office visit or lab test every time you visit. Others may charge one fee that covers all of your visits usually up to about seven days after the baby is born.

The bills you get after your baby is born can be confusing. If you have health insurance, that company will pay parts of these bills. There are usually two sets of bills.

The doctor sends his or her bill.
The hospital has its own bill for caring for you and the baby while you were there. Some of the hospital charges may include doctor charges too.

How much you owe depends on the charges and whether you have met the requirements of your health insurance plan. Billing offices and the insurance company may be able to help answer your questions.

Previous | Next

Utilization Data
Now Available