Global Billing: Wait, You Want Me to Pay Before the Baby is Born?
by Sharon Tjaden-Glass
Let’s imagine that I need knee surgery.
Let’s say the total estimated expenses for my knee surgery are $20,000.
I have “fairly good” health insurance (at least these days…) so I will pay my $1000 deductible and then 20% of the total costs as co-insurance, which is $4000. And of course, we’ll be paying with our credit card which has a 10% APR (because who has $5200 in their savings account anymore?)
When will I pay for these costs? After I have the knee surgery, right?
Ah, but then the surgeon says, “Yeah, we’re going to need you to pay for the procedure in full, at least a month before your scheduled surgery.”
And this is becoming a standard practice for obstetricians now. Take a look at these discussion forums, in which mothers talk about the different variations of this wonderful billing protocol called “global billing.”
In some cases, you may have the added bonus of paying two deductibles if your baby was conceived in one calendar year, but born in the next. (Which, by the way, is anyone who conceives a baby from April-December.)
(And in case you’re wondering, it’s also terribly expensive to not have a baby. When I miscarried last year, our out-of-pocket expenses were $1500 for a D&C.)
Global billing can be useful. It simplifies all the billing involved in prenatal care by bundling all the prenatal visits and the obstetrician’s fees for delivery into one big package.
When I had my first child, that obstetrician also practiced global billing, but she didn’t send me a bill until all the services were performed. Then, we got a big, fat $3000 bill about a month after our daughter was born.
That was exciting.
With this pregnancy, our estimated out-of-pocket expenses begin at about $1400, just for prenatal visits and delivery.
And then there’s that lovely line in the letter explaining that they would like to start immediately collecting payment for all of these services… at my next appointment.
At 23 weeks.
“These fees are to be paid in full by the 35th week of your pregnancy.”
Their administrative assistant delicately told me that these expenses would not include the hospital costs or ultrasounds.
So let’s add those expenses here:
- One ultrasound at 20 weeks. (about $300)
- Any non-stress tests.
- My hospital bed for 2 days: $1720 (20% of $8600)
- My baby’s bed in the nursery for 2 days: $1120 (20% of $5600)
Even if I don’t use it. That’s right. Even if I room-in the whole time, I will be paying for the availability of the nursery bed. Ha!
- Anesthesiology fees, if I have that.
- That newborn hearing test machine that will roll into my room and seem like a good idea. ($400. Not covered by insurance).
I mean, really. What other medical procedures do physicians require to be paid for in full before you have them done?
And by the way, I really hate referring to birth as a medical procedure. I did all the work until the baby came out. I humbly acknowledge how many people were required to pick up the aftermath of the birth and take care of me during recovery, but I was the one doing the “medical procedure” for the first 34 hours.
Maybe I should be paid. Ha!
When I told my husband about all of this, his response was, “They aren’t getting a dime until after January 1st!”
You know, when next year’s FSA accounts go into effect.
You know, after the baby is born.
The good news is the hospital’s billing department is agreeing to let us start paying after January 1st. Nice of them, huh?
But really, isn’t it a bit strange that we have to request this?