Pre-paying for a hospital birth but then not using hospital... get a refund?

[Harmony96]

Originally Posted by jaelynsmommy61607 Are you continuing ob visits until the end?

I had planned on it. I'm also seeing my midwife this last month as well.

[jaxxy]

Providers can't bill for services that weren't rendered so if the delivery is truly a separate charge and they don't provide delivery services they cannot (legally) charge you. Call your insurance company.

[twinpossible]

I wouldn't pay it, never ever count on getting your money back from a doctor or insurance company. Like it was said earlier, if you show up to the hospital they have to help you. If you are planning a homebirth I would stop paying now. This must be a state thing because in my state OBs are not allowed to bill anything until after the birth. You only pay your copay until then, this is SO weird to me!

[jaxxy]

okay, so I had to do some research on this subject. I have more to do but wanted to report back what I found so far.

The CPT code that your provider is probably charging you for is 59400. The description reads: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and /or forceps) and postpartum care. It includes:
biweekly visits to 36 weeks gestation
fetal heart tones
hospital/office visits folling cesarean section or vaginal dleivery
initial/subsequent history
monthly visits up to 28 weeks gestations
physical exams
recording of weight / blood pressures
routine chemical analysis
weekly visit until delivery.


So basically this is an all-inclusive code and looks like it pays around $5000 dollars.

I don't think a provider can bill this way if they don't do the delivery.

There is a code for antepartum care 4-6 visits 59425 (pays at around $1000) and includes
biweekly visits to 36 weeks gestation
fetal heart tones
initial/subsequent history
monthly visits up to 28 weeks gestations
physical exams
recording of weight / blood pressures
routine chemical analysis
weekly visit until delivery.

or 7 or more visits which includes the same thing as above and the code is 59426 (pays around $1500)

Then for pospartum care only the cpt code is 59430 (pays around $350) and includes office / other outpatient visits following c section or vag delivery.

It seems that if you go for pre natal and post partum care but actually deliver with another provider, they'd have to use the codes for antepartum care and postpartum care only.

I am going to check with a coder tomorrow and also going to call my insurance to make sure these codes are covered. I'd like to have a HB but was planning on doing co care so I also want to make sure I understand how the billing works.

[Harmony96]

Originally Posted by cheri_pira okay, so I had to do some research on this subject. I have more to do but wanted to report back what I found so far. The CPT code that your provider is probably charging you for is 59400. The description reads: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and /or forceps) and postpartum care. It includes: biweekly visits to 36 weeks gestation fetal heart tones hospital/office visits folling cesarean section or vaginal dleivery initial/subsequent history monthly visits up to 28 weeks gestations physical exams recording of weight / blood pressures routine chemical analysis weekly visit until delivery. So basically this is an all-inclusive code and looks like it pays around $5000 dollars. I don't think a provider can bill this way if they don't do the delivery. There is a code for antepartum care 4-6 visits 59425 (pays at around $1000) and includes biweekly visits to 36 weeks gestation fetal heart tones initial/subsequent history monthly visits up to 28 weeks gestations physical exams recording of weight / blood pressures routine chemical analysis weekly visit until delivery. or 7 or more visits which includes the same thing as above and the code is 59426 (pays around $1500) Then for pospartum care only the cpt code is 59430 (pays around $350) and includes office / other outpatient visits following c section or vag delivery. It seems that if you go for pre natal and post partum care but actually deliver with another provider, they'd have to use the codes for antepartum care and postpartum care only. I am going to check with a coder tomorrow and also going to call my insurance to make sure these codes are covered. I'd like to have a HB but was planning on doing co care so I also want to make sure I understand how the billing works.

This is helpful. I'm going to print out those codes and take them to the office, and also email a friend of mine who works in insurance and see what she says.

I grabbed my paper and they are billing at a 59400, and I'm only going to have 5 antenatal visits in total (I had one month ago, one last week, and I have three more scheduled), MAYBE a sixth one depending on if I go overdue, so that 59425 code is something to look into. My midwife's agreement includes the postpartum care, so I won't need to go back to the OB office after the delivery.

But while reading EVERYTHING on my paper today, there was a tiny line that said "Payment plans upon request - 3 months max" and that is a timeframe I can handle a lot better than the four weeks I'm left with right now, so if push comes to shove and I do end up with a hospital birth, I can just make arrangements to pay some in Jan-March and then be done with it.

[Harmony96]

Okay, I just called my insurance customer service and told them the deal, and she told me that even if the OB's office bills globally, they separate it all out on their end, and she confirmed that all my prenatals are covered at 100%. She also said that if they collect money from me for a service that they don't bill for (i.e. if I'm able to have a homebirth, they wouldn't be able to collect for a hospital delivery), then they absolutely will need to reimburse me for anything I paid them towards that service. It could take a while, but it will be done.

I feel so much better now.