Insurance & Billing
Due to the vast array of plans and coverage options, your insurance coverage may vary widely. We want to help make the payment process as simple as possible.
Will my care be covered by insurance?Coverage depends on your insurance provider and policy. It is best to check with your insurance company regarding coverage of your condition before making an appointment. Austin Perinatal will also call your insurance company to confirm coverage and deductible during each visit.
Some policies of small businesses will specifically exclude any healthcare expenses resulting from a pregnancy. Many of these policies will cover “complications of pregnancy.” However, your insurance company and you may or may not agree on what a “complication” entails.
Many insurance policies have recently excluded all “obstetrical complications” which would include:
• preterm labor
• twins and triplets
• gestational diabetes
• breech babies requiring Cesarean sections
These policies likely will not cover any prenatal care, labs, ultrasounds, consultations, delivery or postpartum care, which will all be “out of pocket” expenses. However, they will cover your broken leg, car wreck or appendicitis while you are pregnant.
What should I know about deductibles and co-payments?Deductible and co-pay expenses are highly individualized by your insurance company. If, for example, you have a high deductible and have met none of your deductible for the plan year, you could pay several hundred dollars out of pocket for an ultrasound and a consultation.
We will frequently see patients for a radiologic procedure (ultrasound) and a consultation. Your insurance will dictate what is covered without a deductible or co-pay or a specific amount or percentage that applies to both radiology procedures and office visits/consultations. You will be responsible for paying these fees at the time of your visit.
We will contact your insurance company during every visit to find out the amount of your deductible already met. These are plan year posts already made for previous medical expenses. The insurance companies may or may not have posted other expenses, especially from your obstetrician’s office if that office has not yet filed a claim. Some policies only allow your Ob to make one claim for your entire prenatal care and delivery AFTER delivery (global billing). This process may lead to you “double-paying” your deductible, only to receive a refund from your obstetrician after delivery.
How are service costs determined?Just as a dermatologist may have multiple complexities of office visits and biopsy fees, consultation and ultrasound charges at Austin Perinatal depend upon the type and complexity of the services that we perform.
Not all ultrasound procedures are billed the same. For example, although each is a type of obstetrical ultrasound, a quick check for a baby heart rate at 6 weeks would be different from a comprehensive anatomic survey at 18 – 20 weeks which would be different from a “biophysical profile” which looks for fetal well-being near term. You may even have multiple ultrasound procedures done at the same time (growth scan plus a biophysical profile, or an early fetal scan plus a nuchal translucency). Also, abdominal ultrasound examinations are charged differently than vaginal ultrasounds.
Does APA offer payment assistance?Austin Perinatal Associates does not offer in-house payment plan options, but we do offer Care Credit, a quick line of credit designed to help you with these expenses should the need arise. Our insurance specialists and office manager are always happy to help you start the process.
If, at any time, you do not understand our billing, insurance, or collection procedures, please ask anyone in our office and you will be directed to the right member of our staff.