Your Pregnancy Billing Questions, Answered

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The other month I arrived at my doctor’s office for my 20-week prenatal check up and was presented with a (whopping) bill. “These will be your expenses for the entire pregnancy,” the woman at the front desk informed me. “Not including delivery. And not including any ultrasounds.”

The already-exorbitant bill was enough to send anyone into a tailspin, let alone the fact that it didn’t even include any ultrasound or delivery charges.

To put it another way — having a baby is way expensive.

The first thing any expecting mom should do when she finds out she’s pregnant is call up her insurance company and figure out some of the specifics. (What exactly is covered for the pregnancy, what will my overall out-of-pocket cost be, how can I find doctors in my network, etc.?). Even after doing so, though, there are bound to be some questions. To help, we tapped Adria Goldman Gross, FIPC, president of MedWise Insurance Advocacy and MedWise Billing, Inc., a company that helps patients handle their health claims and medical billing. We asked Gross to answer some of the more pressing billing-related questions that a pregnant woman might have.

MM: What are some of the common reasons that pregnant women come to you for assistance with their billing?

Gross: The cases the come to me are issues that occurred while the client is pregnant, and there are many reasons. They include a change of health insurance carriers while the client is pregnant, relocation of residence, a new employer and therefore new insurance, the loss of a medical provider or dissatisfaction with a medical provider, for example.

MM: How often would you say it’s possible for patients to haggle over maternity bills and/or work out some sort of payment system?

Gross: In New York State, with the Surprise Bill Law, there can be more haggling or negotiations due to the new law. If the patient was not informed ahead of time, it is easier to negotiate. [Although this is a New York specific law, you’ll want to do a little research to determine if similar laws exist in your own state to help you out when it comes to negotiating medical bills.] Plus, sometimes the doctor is willing to decrease the bill by 15 to 25%, especially if they are out-of-network. The percentage discount can be offered anywhere in the U.S. It’s much more difficult to negotiate once you have signed an agreement. If you have an out-of-network provider and are willing to pay upfront, many providers will give you a discount with pre-payment.

MM: What would your main advice be to women who are pregnant and dealing with a slew of confusing healthcare bills?

Gross: To help you negotiate medical bills, there are many resources I would recommend investigating, but before you can begin the research, you must determine the procedure code for the billed service(s). There are many websites that list the procedure codes in the area where services are rendered. If you’re trying to determine the usual, reasonable and customary medical fees for the procedures, try the Fair Health Consumer Cost Lookup tool or the Healthcare Bluebook site.

MM: Are there any specific negotiating tactics you would recommend once you’ve done your research?

Gross: If possible, negotiate the fees prior to having the medical treatment. Very often, providers will accept what is considered to be the usual, reasonable and customary medical fees. Any agreements should be in writing prior to the provider performing the medical services. Many doctors also accept a payment plan and are happy to arrange it, but you need to discuss it once you first start seeing the medical provider. It will be much more difficult if you attempt to do it later.

MM: Is there anything else patients should know about this topic?

Gross: Try to find a doctor you feel you can trust. Discuss financial arrangements as soon as you begin to work with your doctor. If you ever feel you are being overcharged, denied or that you’re going nowhere with your claims, fight for what you deserve.

For more on pregnancy, check out this piece about what to do if you’re in debt and find yourself pregnant, and this one about five surprising financial things you’ll need to be ready for when you’re pregnant.

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