Does it sometimes feel like you need a degree in insurance to even understand your statement? Think of this as a crash course to help you understand how we bill for services and what questions to ask your insurance provider.
If you feel like the most complicated part of your health care is figuring out who is paying for what part, you are not alone. Fortunately, your WHA team includes financial coordinators. They can help you understand the potential WHA cost of your pregnancy, preventative care, test or procedure by giving you the information you need to follow up with your insurance company. Our billing specialists are also available by phone to answer any questions you have about your account or a statement you’ve received from WHA. We’re always here to help.
For our newly pregnant patients: Our financial coordinators will research your insurance benefits and prepare an estimate of your out-of-pocket expenses. They will share this with you around 12 weeks of pregnancy. In the meantime, here is a handy summary of billing and payments during pregnancy.
For pre-authorizations: We will contact your insurance company to obtain a pre-authorization if you are having a planned office or hospital surgery. Beyond this, it is important for you to know and understand your insurance contract and benefits. We are happy to explain general insurance terms and to help you know what questions to ask your insurance provider (including specific procedure codes, if you need them).
Refunds. We do everything we can to identify where you may have overpaid because of new insurance, a change of insurance or a difference in the amount your insurance company ended up paying for a particular service—and to refund that amount in reasonable time frame. If you believe you have made a payment in error or have any other issues or questions related to your payment history, please contact us.
COVID-19 testing. WHA offers COVID testing for our patients. We will bill insurance companies for this test. If you don’t have insurance, the cash price is $100.
A co-pay is a set fee your insurance company requires you to pay for medical visits, typically ranging from $10 to $50. WHA is considered a specialist practice, but some insurance plans charge only a primary care co-pay for visits like women’s wellness exams. If you pay a primary care co-pay when a specialist co-pay is required, you may receive a bill for the difference.
A co-pay is a set fee your insurance company requires you to pay for medical visits, typically ranging from $10 to $50. WHA is considered a specialist practice, but some insurance plans charge only a primary care co-pay for visits like women’s wellness exams. If you pay a primary care co-pay when a specialist co-pay is required, you may receive a bill for the difference.
Co-insurance is the percentage of a medical bill you pay after meeting your deductible. This continues until you reach your plan’s out-of-pocket maximum. The exact amount depends on your insurance plan. If you have questions about what your insurance covers and why, contact your insurer. If you have questions about your bill from us, WHA’s financial counselors are happy to help.
A deductible is the amount you must pay out-of-pocket before your insurance starts covering costs. Even after meeting your deductible, you may still owe a portion of your bill due to co-insurance or other cost-sharing rules. If you have questions about how your deductible applies to your care, your insurance company can provide a detailed explanation.
A wellness visit is a preventive health appointment with your midwife or OB-GYN focused on screening and early detection to help prevent illness. Most insurance plans cover one wellness visit per year at no cost to you, as long as it’s at least 365 days after your last one. These visits may include reviewing your health history, checking vital signs and discussing lifestyle and risk factors. If any tests or lab work are done, they may be billed separately depending on your insurance coverage.
This type of appointment is for gynecology care related to your annual exam or a specific concern—like a follow-up, symptom check or treatment discussion. It’s different from a wellness exam or OB (pregnancy) visit. Your cost depends on your insurance plan and the reason for the visit. If you’re not sure what’s covered, we’re here to help you understand.
An OB deposit is a payment made during pregnancy to cover part of the cost of your prenatal care and delivery. This deposit is based on your insurance plan and is applied toward your total out-of-pocket costs. If you have questions about your balance, our billing team is happy to help.
