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.

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

  1. Pingback: The Global OB Fee Trap: How to Find and Fight It | Oh Baby Richards

  2. 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!

    • 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!

  3. 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!

    • 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.

      • 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!

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