The Global Billing scam
While this isn’t the time of day (3:45 am) that I’d planned on writing a post, Xion has had a rough night and I finally decided I would just get up. Of course, as soon as I get up he settles down and Ellie wakes up (lots of kicking and rolling). Such is life.
Health insurance sucks. Like seriously sucks. I can’t even begin to put into words how frustrated I am with our health insurance. I don’t know if we happened to have the absolute worst carrier or if this is indicative of all carriers.
I have been concerned because we have not been asked to pay a single copay or gotten a bill for any of the pre natal/obgyn appointments we’ve had with CHAS. I’ve asked a few times at different appointments and gotten no information. I’ve logged into the portal online to look for a bill and keep seeing no balance owed. I was starting to think maybe this is all covered by our insurance? At our last appointment I asked our provider who finally had a real answer for us. CHAS does this thing called “global billing” where they don’t actually bill the insurance for any pre-natal care until after the baby is born and then it’s just a flat fee. It’s not based on how many times you actually go in for visits as long as it’s pre-natal related. Weird. I asked how we would know what that one flat fee is so we can be prepared and she suggested calling the billing department which of course I did. To say they were zero help is probably giving them too much credit. After a LOT time on the phone what I found out is they don’t know how much they will bill (even though it’s supposed to be a flat fee) until after the baby is born. I asked a lot of questions and couldn’t get a straight answer about what they would bill the insurance. She finally said that if I was a self payor the bill would be around $5,000. I don’t understand the “around” part, a flat fee is a flat fee right? Apparently not. She recommended I call our insurance company and ask what services they cover for maternity. So I did. Once again, to say they were zero help gives too much credit.
I found out our insurance company has an “English” department that you only get sent to if you specifically ask to speak to someone in English (um…what????). I waited on hold for quite a while to speak to someone in English. I finally got through to Erica. Erica had a lot of words for me but none of those words made any sense when formed into sentences. Eventually what I think I pieced together is that they don’t know what they will cover until they receive the bill. They also say on their website that the cost for maternity care is a $50 copay however a specialist visit is $100 which means that to have the privilege of scheduling the appointment and having the MA take weight and BP you pay $50, but when the doctor comes in it tacks on an additional $100 because an OBGYN falls under specialist not maternity (what???). I said we haven’t seen an OB, we’ve seen nurse midwives and family practice doctors and so we shouldn’t be in that specialist category. She said those all count as specialists (again…um…what????). Is this making any sense? NOT TO ME!
I’ve done a little more digging this very early morning and found a few articles about the Global OB Fee Trap. One in particular was fascinating. Here is the link if you want to read it yourself
https://ohbabyrichards.com/2016/07/19/the-global-ob-fee-trap-how-to-find-and-fight-it/comment-page-1/?unapproved=2584&moderation-hash=5f44b64347b24bfcea5386149e9fbb5d#respond
Essentially the point of the article is that Global billing is actually illegal (typically) because it combines preventative care and diagnostic care into one billing code which most insurance companies don’t have software or policies in place to process so they bill it ALL as diagnostic care which typically means more of the cost gets passed onto the patient. The ACA made preventative care a covered cost that insurance should be paying fully. So while the pre-natal visits are definitely considered preventative, because they are wrapped into the Global billing fee (I also learned that typically covers labor and delivery and post partum care) you end up paying for them as a diagnostic service instead of preventative.
Some insurance companies have apparently put procedures in place to pay a percentage of a Global bill as diagnostic and a percentage as preventative care which is the legal way to do it, but most companies have just been getting away with this because people are too tired and frustrated with the system to fight it.
I now need to make a few more calls to our insurance company and learn a few more things. For example: how is the Global bill affected if we don’t give birth at Deaconess (the only place CHAS will deliver)?
After reading up on this a bit I feel very justified in my frustration and anger at insurance companies. I don’t know if all my research will end up saving us money but I can tell you it sure is educating me about the system.
