How to Fight Your Global OB Fee Bill

**This post is an addendum to The Global OB Fee Trap: How to Find and Fight It. It probably won’t make any sense unless you read that first!**


Fighting your insurance company is a pain the ass. There’s no way around it. But persistence pays off and if you fight hard enough you will usually win – whether you’re actually right or not.

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In this case, you’re actually right so it should be a little bit simpler. Here’s what to do:

  1. Have your insurance card, your doctor’s bill (that shows what the insurance company paid and what you still owe) on hand. If the bill from your doctor doesn’t have this information on it, you can obtain it from your insurance company by requesting (or printing out from their website if you’ve set up an account) a claims summary statement. Shoot me a message if you need help locating this information.
  2. Call the Member Services Center and tell them you have questions about a medical bill.
  3. When you get someone on the line, save your breath. Give them your member ID number and confirm your birthdate – yada yada yada – before launching into your story.
  4. When they ask what’s wrong, tell them which claim you are disputing so they can bring it up in their system. Then proceed by confirming facts with them one step at a time – so that they walk themselves into a little trap. Start by confirming that your plan covers all preventative care with “first dollar” coverage as required under the affordable care act.
  5. Then, confirm with them that routine prenatal visits are considered preventative care. (They should say yes – but if they don’t, remind them that all well-women visits, including well-women prenatal visits, are considered an essential preventative health benefit under the ACA. My insurance rep initially fought me on this one, and then after I insisted, she put me on a brief hold to check with her supervisor. When she came back she apologized for being misinformed.)
  6. Next let them know that your received a Global OB bill that included the cost of the delivery, as well as the cost of your prenatal visits – and ask them why your prenatal visits aren’t being paid for in full AS REQUIRED BY LAW. When they tell you it’s because of the way your doctor billed them, remind them that according to their own provider handbook (this is true for Harvard Pilgrim, and I bet most other insurance companies, but check with Google) doctors are NOT ALLOWED to bill OB visits separately and MUST use the Global OB code instead. Then piece the puzzle together for them and tell them that if they can’t pay the preventative portion of your bill in full, and they won’t let your doctor bill them differently, then they are breaking the law. Tell them that you would prefer not to get your lawyer involved, but that you will if you have to.
  7.  When the rep gets exasperated (and likely confused – they probably don’t understand the system) they will probably tell you they’re sorry but there is nothing they can do. Be sympathetic, but firm. Remember – there really is nothing a front line member services rep can do. Their hands are tied and you don’t need to shoot the messenger. Tell them that you understand they can’t do anything personally, but that you feel strongly about this and would like to speak to a supervisor. They’ll resist this is long as they can. Just keep repeating yourself. If they really resist, use phrases like: “If I can’t speak with someone who can handle this directly, I’ll have my lawyer contact you via certified mail” and/or “I really would like to resolve this on my own, but if I need to file a claim with the state insurance commission, I will.”
  8. You will probably end up either being transferred to a supervisor (in which case repeat steps 3-7 until you get someone on the phone that can actually reprocess your bill) OR they will tell you they’re going to “look into it” and call you back. If that’s the case, ask for the representative’s name, direct phone number and when you should expect to hear back.
  9. If you don’t hear back in the specified time frame (you won’t), call back and ask for the status of your claim. Call every day until you get a response. Remind them each time that you intend to fight this claim in court if you have to. Use the word lawyer, use the word insurance commission. DON’T BE INTIMIDATED. Insurance companies win these battles because they wear people down. Be a bee mean-ass wasp in their bonnet. Pester them incessantly until they eventually throw their hands up and reprocess your bill. It took me almost 3 weeks, but they did eventually give in.
  10. Remember, the goal is to have your bill reprocessed so that the preventative portion is paid in full, and the diagnostic portion applied to cost sharing. If they ask “what do you want/expect us to do about it” tell them that. You can also share with them that other insurance companies (United Healthcare) are using a percentage basis to pay out Global OB claims, with 44% being considered preventative and 56% considered diagnostic. This can help them to realize that this is an actual issue other companies are having to deal with and not just some nut job on the phone making shit up.
  11. All in all, try to keep your tone polite but firm. Don’t freak out and yell because then they’ll write you off. And if after weeks of persistence you still aren’t seeing results – file a complaint with your state insurance commission. Here is the link to the Maine Insurance Commission – but if you live in another state you can Google it or ask me and I’ll find it for you 🙂

I know this seems like a LOT of work (it is). But it’s worth it. Because if enough people do it, eventually they’ll have to change the system. And if they change the system that’s a lot of dollars we will have collectively kept in our pockets. And those dollars pay for diapers, ok? They prevent shit from getting all over your house.

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So if you don’t like shit, then just do it. Basically.

12 thoughts on “How to Fight Your Global OB Fee Bill

  1. Hello!

    I had some issues with billing for a women’s wellness appointment last year, so when I got pregnant recently, I started doing a lot of research before choosing a doctor. I’ve been reading all your articles about the Global OB fee, and would really like to talk to you more about it if possible. Your advice for fighting a global maternity bill is great, but how can you avoid it before the fact?

    Every doctor that I’ve called in the area says they have Global Maternity packages and will be accordingly with the average being about $6000, for normal vaginal delivery (59400). Your $2950 bill didn’t seem so bad once I started hearing that!

    Hope to talk soon!

    1. Hi Maria,
      Thanks for getting in touch! Unfortunately there isn’t too much you can do about it before hand because I doubt you will be able to find a doctor that bills without a global OB code, since that is standard now and most insurance companies require it. It isn’t the global code in and of itself that is the problem, rather, how your insurance company processes it. What you could do is call your insurance company ahead of time and ask how they process global OB bills in terms of separating the prenatal preventative portion and the delivery (diagnostic) portion. If they tell you they bill it as one service and do not separate the preventative portion then you can let them know they are in violation of the ACA. It may help to do this ahead of time, although I suspect it will be harder to fight them when you don’t have an actual bill to actually refer to yet – but you may be able to make some headway. I’d be happy to talk to you more about it if you’d like – I’ll drop you an email!

  2. Hi Hannah, thanks so much for the info. My insurance contract says that prenatal care is subject to copayment and coinsurance. When I called to ask about the prenatal appointments they said that deductible applies to those and then it is my coinsurance amount. When I brought up ACA and the question of shouldn’t those be preventative, they said that what my contract says is what correct info is. If this is the law, then is my insurance plan in violation of the law? I know your post is from 2016, so I’m wondering if there were any changes in 2017 that allowed insurance companies to make it non-preventative. Your help would be huge! Thank you so much!

    1. Hi Elena,
      This will be a bit tougher of a battle to fight, only because the issue isn’t global billing, it’s that your insurance company isn’t covering prenatal care as preventative, period. This IS in violation of the ACA, but as usual, it comes down to semantics within the law so the insurance company will certainly have some kind of justification for interpreting the law to not include prenatal visits as preventative.

      There is precedence to fight it but you will likely want to involve you state insurance commission to help you – I promise, it’s not as hard as it sounds!

      This piece (the IOM report used to update the ACA in 2016) will likely be helpful to you when fighting your insurance company. The fact that they told you nothing in pregnancy is considered preventative care (and wrote that in their handbook) is in direct violation of the ACA. The link below quotes the exact text from the IOM report and states that all prenatal well-woman visits MUST be covered without cost sharing beginning December of 2016. If your plan year started before that date, it may be grandfathered until your new plan year starts, but if they change(d) the plan or price AT ALL in 2017 they will be required to adopt the new rules.

      http://www.healthlaw.org/issues/reproductive-health/well-women-visits-prenatal-care-under-the-acas-womens-health-amendment#.WilmnhNSxTY

      Also, be prepared that your average customer service agent is NOT going to be able to fix this for you, since it requires actually changing their policy. You will likely need to either get (or threaten to get) a lawyer, or get your state insurance commission involved to help you pressure them. I know it sounds like a lot of work, but if you do it you will create wonderful change for so many other women! This is what I did in my state and my insurance company did end up having to change their policy and reimburse hundreds of thousands of dollars to women across Maine. So it does work!

      When you initially speak with the insurance company, insist on being escalated to the “higher ups” in the company – they are the only people with power to change this for you. Lastly, if your insurance is through your employer, they likely have a company that is managing the policy for them. If that is the case, ask for that company’s contact information, explain the situation, and they may be able to help you fight this. Good luck, and let me know how it works out.

      1. Wow! Thank you so much for such a detailed and quick response, Hannah! It’s much appreciated. I think going through the state insurance commission might be a good call. In my case, it’s a bit tricky since the plan that I have is the plan of Oregon, and I reside in California. I think going through the state insurance commission of Oregon would be a place to start since this is where the insurance company is and they operate under their governing laws. I’ll let you know if we get anywhere with it. Thanks much!

  3. Hi

    This is really a useful post. I am in the same boat as you were. I have not delivered yet but struggling to get this straightened with my OB and insurance. My OB wants me to pay 600 dollars up front before delivery which is 20% of all the charges. Please provide suggestions on how to handle this.

    Thanks in advance.

    1. Hi Harini,
      Unfortunately, if your OB requires you to pay upfront you will either need to make the payment, or find a new OB. They aren’t doing anything wrong by charging for their services – and in all likelihood you will owe at least 20% of the global OB bill (depending on your deductible and cost sharing). SO they are basically just covering themselves by getting that money up front. Once you deliver, you’ll want to make sure your insurance company pays at least 40% of the global bill in full (not subject to cost sharing or deductible) as that is the preventative portion of the fee. The remaining (delivery) portion of the global fee would be subject to your deductible/cost sharing. So, unfortunately there isn’t much you can do ahead of time except call your insurance company and confirm with them what portion of the global OB fee they plan to cover. If they aren’t planning to pay at least the preventative portion of the bill then you should fight them on that (see some of my responses below for tips on how to fight them). Best of luck!

  4. Thanks for these great articles and for sharing. I am presently pregnant and have had these questions but could not find answers. How do you find the billing handbook for your insurance provider? I have googled to no avail. Any help is appreciated! thanks

    1. Hi Elizabeth, are you looking for the benefits booklet (the one that tells you what services are covered and to what extent), or the billing handbook (which is given to providers/doctors to instruct them on how to send in claims)? If you’re looking for the benefits booklet, just call your insurance company or plan sponsor (employer) and request a copy be mailed or emailed to you. If the latter, you may need to ask your doctor to share it with you since that is technically for the doctors, not the members. I would think if you called your insurance company and requested a copy of the billing handbook they are likely (I don’t know for sure) legally obligated to show it to you but I’m guessing they will give you some resistance. Be confident and persistent and I think you would be able to get them to send it to you, especially if you are threatening legal action.

  5. Question for you: my OB pre-billed memfor the delivery before it even happened. Is that normal? Would I be allowed to decline that and make them bill through my insurance first? The OB made it seem like that was just how it was done (pre-paying $3,000) but now I’m really questioning that!

    1. Unfortunately, yes, your OB is allowed to pre-bill you. What they likely did is run the cost through your insurance model to determine what you are likely to owe after insurance – then after your delivery they will bill your insurance and if the insurance pays more than expected, they will reimburse you, if they pay less, they will bill you the remainder. Basically, they are just covering themselves financially by billing you for your portion in advance. Once you do deliver and you get the explanation of benefits from your insurance company, make sure they are paying the preventative portion (at least 40%) of the global OB fee. If you do end up having to pay the full 3k, I would say the insurance did NOT properly process the claim and I would look into it further. Good luck, let me know how it works out!

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