INSURANCE
Introduction: We understand that insurance billing can be a confusing and frustrating process. Below we have listed the most common questions asked by our patients. We encourage our patients to be proactive when it comes to their health care benefits. You can obtain benefit information from your employer, from the insurance company website, or by phone at the customer service phone number listed on the back of your insurance ID card. If your question was not addressed here, or if you require further assistance, please contact our OB Coordinator at (206)682-5800.
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 (see your ID card)
Cigna
DSHS
First Choice
Molina Healthy Options
One Health Plan
Premera Blue Cross
Regence Blue Shield
Uniform Medical Plan
United Health Care
Q: Do I need a referral to see a specialist at your clinic?
A: Generally, you do not need a referral to see a women's health care provider. If you are unsure, please contact your particular plan.
Q: I'm pregnant and have been coming to see the doctor for a few months, yet I have not paid a co-payment nor have I received a bill. Why?
A: Providing you have all your care with us and do not change your insurance company during your pregnancy, your maternity care is billed globally. That means that all of your regularly scheduled pre-natal appointments, your delivery and postpartum visit are billed as one charge. This is billed after you deliver. We do not collect co-payments for your prenatal visits. There are some charges that fall outside the "global" package: ultrasounds, lab tests, non-stress tests and visits not related to pregnancy are billed as they occur. After receiving the billing for any services, your insurance may assess co-payments, depending on the particular benefits of your plan.
Q: I am pregnant and my insurance has changed. What happens to the global billing?
A: If you have a change in insurance coverage, please notify the OB Coordinator as soon as possible. We will then bill out the antepartum care that you have had up until the termination date of the initial policy. Your insurance company will process this claim and may assess co-payments. Your remaining visits will be billed to the current (new) plan after 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. If your baby will be covered by Uniform Medical Plan or Medicaid, these plans do not cover circumcision. Pre-payment is required for these services when not covered by insurance. The OB Coordinator will be happy to assist you in making these payment arrangements.
Q: I came in for my "annual" gynecology exam but the claim was denied as "maximum benefit paid". What does that mean?
A: Insurance companies differ in how they cover preventive exams. Some companies have a "calendar year" benefit, allowing one preventive exam per year. Others have a 12 month or 366 day benefit (1 year + 1 day). Some insurance companies have a 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.
Q: I had a physical with my primary care physician, but had my preventive gynecology exam at your facility. Why wasn't this paid for?
A: Typically, insurance plans only allow one "preventive" or "well-woman" exam in their benefit period. (See previous question) Since both visits were preventive, both were billed with the same codes, and only one would be paid.
Q: Since your facility is "preferred" with my insurance plan, I assumed that the lab charges would also be covered. Why didn't you use XYZ 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. If we are not told in advance, we use Dynacare and Quest Labs.
Q: I saw one of the mid-level practitioners for my annual exam. Why did my insurance company deny my claim for a "not a covered provider"?
A: Some insurance companies will not allow visits with mid-level practitioners. There are variances in state v. national insurance plan benefits. Please check with your company to be sure.
Q: I received a statement but my visit should have been paid by my insurance company. Why?
A: There are a few reasons why you would receive a statement from us. You may not have provided us with your current insurance card at 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. Or, your insurance may have processed the claim as "coverage not in effect at time of service" or "coordination of benefits problem" or "information not received from insured". In those cases, we send you a statement, because the insurance company requires you to contact them to provide additional information before the claim will 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: We would be happy to bill your secondary insurance provided that we have all the information necessary, including the secondary insurance name and address, subscriber ID #, subscriber name, date of birth and group number.
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 for me?
A: Seattle OB/GYN bills claims based on the documentation of the visit and any services performed. If we have made a billing error, we will happily correct the claim and resubmit it, but we cannot change billing or coding for the sole purpose of having a claim paid. Any change of billing or coding must be accompanied by the chart notes for that date of service and must support any changes made. In most cases, the original denial stands.
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: Will my insurance company cover fertility services?
A: For specific benefits, it is always best to check with the company directly.
Q: Do you accept Medicaid or DSHS?
A: We accept DSHS "open" coupons and Molina Healthy Options for pregnancy only. Please be sure to bring your coupon to every visit. If your coupon says "Family Planning Only" at the bottom, you are only covered for family planning services. If you choose to come here for other services, you will be required to sign a waiver and pay for these services at the time you are seen.
Q: I have "Take Charge" coupons. Can I see one of your doctors?
A: No, if you have "Take Charge" coupons, you must see a Planned Parenthood provider.
Q: If I am scheduled for surgery, how is pre-authorization obtained?
A: When surgery is scheduled, our billing office is notified and they contact your insurance company for pre-authorization.
Q: If I am not covered by any insurance plan, can I still be seen at your facility?
A: Yes, we would be happy to see you. Payment will be expected at the time of your visit. We accept payment in the form of cash, check or credit card (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 are billing insurance and does not apply to medical supplies.
Q: Who do I contact if I have questions about bills for services Seattle OB/GYN group has recommended but were done elsewhere?
A: First call the facility that is sending you the bill. 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.
We will bill insurance companies if we are provided with the necessary information. Although we make every effort to help the patient with insurance questions and benefit information, it is the patient's responsibility to determine what their insurance company's requirements and benefits are 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.