INSURANCE
Introduction: Below, we have listed the most common questions asked by our patients about billing. We encourage our patients to be proactive when it comes to their health care benefits. You can obtain benefit information from your employer, from your insurance company’s website, or by phone at the customer service phone number listed on the back of your insurance ID card. If your question is not addressed here, or if you require further assistance, please contact our Billing Office at (206) 682-5843.
Frequently Asked Questions:
Q: Are your doctors contracted with my insurance plan?
A: We are contracted with the following insurance networks:
Aetna
Blue Cross/Blue Shield plans
Cigna/Great West
First Choice
Premera Blue Cross
Regence Blue Shield
United Health Care
If you are covered by a plan that is not listed here, you may still be seen at the Seattle OB/GYN Group. We advise that you contact your insurance carrier and inquire about the benefits available to you when you see an “out of network” provider.
Q: Do I need a referral to see a specialist at your clinic?
A: Most insurance plans do not require a referral to see a women’s healthcare provider, but there are a few plans that do require referrals. If you are unsure of your plan’s requirements, please contact your insurance company’s Customer Service Department prior to your visit.
Q: What is included in “global” pregnancy care?
A: If you have all of your obstetric care with us and your insurance coverage does not change during your pregnancy, your maternity care will be billed globally. That means that all of your routine prenatal appointments, your delivery and postpartum visit are billed as one charge on your delivery date. There are some charges that fall outside the global package: ultrasounds, lab tests, non-stress tests, procedures and non-routine visits to evaluate a problem are billed as they occur. Your insurance may assess co-payments on these services, depending on the benefits provided by your plan. If you have a Cesarean delivery, there will be an assistant surgeon’s fee in addition to the global obstetric care package.
Q: What happens to the global billing if my insurance coverage changes during pregnancy?
A: If you have a change in insurance coverage, please notify the Billing Office as soon as possible. We will then bill out the antepartum care that you have had up to the termination date of the initial policy. Your insurance company will process this claim and may assess co-payments. Your remaining visits and a separate delivery fee will be billed to the current (new) plan when you deliver.
Q: I am expecting a baby boy and would like to have him circumcised. What billing information do I need to provide?
A: If your baby boy will be covered by a plan other than your own, please provide the billing office with that information before you deliver. Most insurance companies cover routine circumcision but policies vary. Please contact your insurance carrier. Pre-payment is required for these services when not covered by insurance. The Billing Office can assist you in making these payment arrangements.
Q: I came in for my routine gynecology/ well woman exam but the claim was denied as “maximum benefit paid.” What does that mean?
A: Insurance companies differ in how they cover preventive care. Some insurance companies have a set dollar limit for preventive care. It is a good idea to check your benefit booklet or contact your insurance company to determine how this benefit is allowed before you are seen.
Q: I had a physical with my primary care physician, but had my preventive gynecology exam at your facility. Why wasn’t this paid by my insurance?
A: Typically, insurance plans only allow one “preventive” or “well woman” exam during their benefit period. Since both visits were preventive, both would fall under the same benefit, and your insurance company may choose to cover only one of them. Keep in mind, some insurance plans charge a separate premium for preventive visits and therefore, this may not be a covered benefit on your plan.
Q: Since your group is “preferred” with my insurance plan, I assumed that the lab charges would also be covered. Do you use my preferred lab?
A: If your insurance plan limits you to certain labs, you need to inform our Medical Assistants or Doctors prior to your exam so that arrangements can be made to get the specimens and orders to the correct lab facility. If we are not told in advance, we use Dynacare and Quest labs.
Q: I have an appointment with a Nurse Practitioner (ARNP) or Physician Assistant (PA-C). Will my insurance cover this visit?
A: Some insurance companies that are based outside of Washington State will not allow visits with mid-level practitioners. There are variances in national insurance plan benefits. Please check with your insurance company before your visit to be sure.
Q: I received a billing statement, but my visit should have been paid by my insurance company. Why am I being billed?
A: There are a few reasons why you would receive a statement from us. We may not have had your current insurance card at the time of your visit. Or, perhaps we are not contracted with your particular plan. In that case, the insurance is billed, but you would get a statement as well. Your insurance may have processed the claim stating “coverage not in effect at time of service” or “coordination of benefits problem” or “information not received from insured.” In those cases, we send a statement to you because the insurance company requires you to contact them to provide additional information before the claim can be reprocessed. Your insurance company determines how your claim is processed and paid. You should be receiving an explanation of benefits from them showing how this was done. If you have any questions, contact the insurance company at the customer service number located on your insurance card.
Q: I have primary and secondary insurance. Will you bill both?
A: Yes, we would be happy to bill your secondary insurance plan as long as we have all of the information necessary, including the secondary insurance name and address, subscriber ID#, subscriber name, date of birth, and group number. Please bring both insurance cards to your visits so that we may scan them into your account.
Q: My insurance company denied my claim, but said that if you billed it differently or changed the codes, it would be covered. Would you do that?
A: Seattle OB/GYN Group bills based on the documentation of the services performed. If we have made a billing error, we will correct the claim and resubmit it, but we cannot change billing or coding for the sole purpose of getting a claim paid by insurance. Any change in coding must be accompanied by the chart notes for that date of service, which must support any changes made. In most cases, the insurance upholds the original denial.
Q: Will my insurance company cover fertility services?
A: For specific benefit information, it is always best to check with your insurance company directly.
Q: How is pre-authorization obtained?
A: After a procedure is scheduled, our billing office is notified and they contact your insurance company to inquire re: benefits and pre-authorization requirements for your plan. If your insurance policy pays less than 100%, we will provide an estimate of your out of pocket expenses, and we will collect this amount on the date of service. If your procedure will take place at the Hospital, we will collect your copay/ co-insurance amount at the time of your pre-operative visit. For maternity care, we collect your co-insurance estimate between 26-32 weeks gestation, since the actual delivery date can be difficult to predict. The estimate we provide will be for our provider’s bill only. The hospital, anesthesiologist, lab, and other providers involved in your care will bill you separately for services they provide.
Q: If I have no insurance coverage, can I still be seen at your office?
A: Yes, we would be happy to see you. Payment would be expected at the time of your visit. We accept payment in the form of cash, check, Visa, or Mastercard. Returned checks are assessed a $25.00 processing fee. If you pay with cash or a check at the time of your visit, we will extend a 10% discount. This discount is not offered if we will be billing your insurance, and does not apply to medical supplies.
Q: Who do I contact if I have questions about bills for services that Seattle OB/GYN Group has recommended, but the services were done elsewhere?
A: First, call the facility that is sending you the bill to find out what they need. If there is a question about diagnosis coding, you will need to speak with your doctor’s assistant to have this resolved. The Seattle OB/GYN billing office does not have access to billing records at other facilities.
Q: Can I make payments if I cannot afford to pay my entire bill at once?
A: Yes. Please contact our Billing Office as soon as possible to establish a payment plan. Once you have established a payment plan, we ask that you make your payments once per month. If you are unable to make your scheduled payment, we ask that you contact our Billing Office. If we do not receive any payment, and we do not hear from you, your account may be forwarded to a third party collector.
We will bill directly to your insurance company if we are provided with the necessary information. Please bring your insurance card(s) to your visit so that we may scan them into your records. Although we make every effort to help patients with insurance questions and benefit information, it is the patient’s responsibility to determine their insurance policy’s benefits and requirements and obtain prior approval, a primary care physician’s referral or second opinion if necessary.
Insurance co-payments are due at the time of each visit. Patients are financially responsible for all charges for services rendered regardless of insurance reimbursement.
If you have any billing or insurance questions, please do not hesitate to contact our business office. If you have financial problems, please communicate them as soon as possible so that we may work out a mutually beneficial payment plan, and not jeopardize your credit.