Pre-Natal Insurance Coverage Question
I just moved to the USA (Tennessee) with my husband last month so I am very lost when it comes to navigating American health insurance. We have coverage through his work with United Health. Any guidance is appreciated. This is our first time dealing with this system.
The situation: I am currently pregnant, and was receiving pre-natal care in Canada prior to our move to US. Since my pregnancy is fairly textbook and low-risk, I decided to continue the pre-natal care in USA with a midwife clinic instead of an OBGYN. I had my first routine pre-natal checkup at the midwife last week. This is an in-network provider, who’s information I found through United Health Care.
What I am trying to understand is, will I be getting a bill for the pre-natal checkups? Or is it considered “Preventative” and not counted towards the $3k deductible (as per my plan outline)?
I have called United multiple times, and the answer I keep getting is “Well it depends. If your provider bills it as preventative, then it doesn’t count towards deductible. If they bill it as something else, then you will have to pay 100% until the deductible it met.” They seem to get tripped up on the fact that the provider is Certified Nurse Midwife and not an actual doctor, so they told me my cost could be $0-$200 per visit, depending on the billing codes they receive.
The issue is the clinic says they don’t typically bill insurance until after the delivery which will be approximately January 8th. Which is annoying because United says my deductible will re-set on Dec 31st.
I want to know if essentially I will be billed $1000+ for prenatal care (and ultrasound) on my deductible for 2023. And then have it re-set for the hospital delivery in 2024. We are trying to make a budget and not getting a clear answer on wether we will have to pay or not is very annoying.
I already tried calling the clinic and asking for billing codes, but the receptionist didn’t seem to know what I was talking about. She said all it says on my chart is “authorization not required” which typically means they will not bill me. Insurance says the clinic hasn’t submitted a claim to them yet so they cant say how much they will cover, if anything.
Thank you for reading. Any insight/advice is much appreciated!!