The way many insurance companies reimburse hospitals for maternity services may be different than routine doctor’s visits. Instead of the hospital billing the insurance company for every procedure and visit, they agree with the insurance company to get reimbursed in one large payment after delivery of the baby. This is called global billing. You can Google your insurance name + “global billing” to see if they provide any documentation. Note that this doesn’t change your responsibility to pay the deductible and co-insurance.
The biggest way this impacts you is when you get billed and for what. When you attend your first prenatal doctor’s visit after you’ve confirmed your pregnancy, you won’t immediately get charged for this visit. In fact, many subsequent visits may not be individually billed. Items included in global billing may include:
- Routine prenatal and postpartum visits
- Admission to hospital for delivery
- Surgical repairs related to delivery.
For these services, the hospital will bill the insurance company after your delivery date in one lump sum, and at this point you be charged any remaining deductible and co-insurance for the year until you reach your out of pocket maximum. Note that if your pregnancy spans two calendar years, you are responsible for the deductible and co-insurance for both years.
But importantly, many common pregnancy services are not included in a global billing package, and these will be billed to you individually as you receive them. These can include:
- Ultrasounds
- Genetic tests
- Fetal non-stress tests
- Blood work
These will be billed on the date of service, and your usual benefits will apply. For instance, you may be liable for the entire cost of the ultrasound if you have not met your deductible for the year, and if your deductible applies to imaging procedures. In other words, such imaging procedures may not be covered under a global billing agreement.
