Pregnancy Billing and Insurance FAQ

You are responsible for providing all primary and secondary insurance information and establishing coordination of benefits at the time of registration.

UC San Diego Medical Center will send a bill, or claim, to your primary insurance company within a few days of your delivery. Your insurance company is expected to pay the claim within 30 days. You should receive an Explanation of Benefits (EOB) from your insurance company stating how much it paid and how much you owe. You are responsible for verifying that your insurance company pays in a timely manner; this may require you to contact your insurance company directly. We will submit your claim, but you must take ultimate responsibility for your account.

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How does my insurance company receive the claims for health care services?

We send the claim to your health insurance carrier. To ensure proper and prompt processing of your claim, please verify the insurance information we have at the time of your registration and at any outpatient visits, and notify us of any changes.

Why do I still owe a balance if my insurance company has paid?

Based on your insurance plan, you may be responsible for deductibles, co-pays and co-insurance for fees not covered by your insurance company.

What is the difference between an HMO and PPO?

HMO stands for health maintenance organization. If you are enrolled in an HMO insurance plan, you will select a primary care physician who is responsible for managing and coordinating your health care. When medically necessary, your primary care physician will refer you to medical specialists within your network for specialty care. Read more about HMO insurance.

PPO stands for preferred provider organization. If you have a PPO, you are free to see any physician contracted with the insurance plan’s network of providers. Typically, you do not need to select a primary care physician or get a referral before seeing a specialty care physician. Read more about PPO insurance.

What is a co-pay?

A co-pay is a set fee that you pay to health care providers at the time of service. Co-pays are applied to emergency department visits (labor and delivery triage visits are considered to be emergency visits), hospital admissions, office visits, etc. You should be aware of the co-pay amount prior to receiving services. You can call the 800 number on your insurance card to inquire about your specific co-pay responsibility, or it may be printed on the back of your insurance card.

What is a deductible?

Deductibles are provisions that require you to accumulate a specific amount of medical bills before benefits are provided. For example, if your policy contains a $500 deductible, you must accumulate and pay $500 out-of-pocket before the insurance carrier will pay benefits. Once you have met your deductible, the insurance company usually pays a percentage of the bill. You are responsible for the unpaid percentage. Deductibles are yearly, usually starting in January.

What is co-insurance?

Co-insurance is a form of cost sharing. After your deductible has been met, your insurance company will begin paying a percentage of your bills. The remaining amount, known as co-insurance, is the portion that you must pay.

Is my insurance “in network”?

We strongly encourage you to call your insurance company directly and provide them with tax ID numbers for UC San Diego Medical Group [tax ID 23-7064656] and UC San Diego Medical Center [tax ID 33-0599494] to verify their participation as in-network providers for your specific insurance plan. Questions? Call 800-926-8273 and we will do our best to answer your questions.

What is the difference between “in network” and “out-of-network” providers?

Many managed care plans (HMOs and PPOs) pay different amounts for health care services, depending on whether a health care provider is considered in network or out of network. These companies will pay a higher percentage of the costs for an in-network hospital or physician. If you choose to receive care from a provider that is out-of-network, your managed care insurer will pay a lower percentage of the costs and you may be responsible for a higher amount of out-of-pocket payment. We recommend checking with your insurer for the specific financial requirements of your plan.

What is the difference between a Hospital Billing Statement and a Professional Fee Business Billing Statement?

You may receive a separate bill for professional services rendered by physicians, as well as for any hospital charges related to the facility, patient room, supplies and nursing care. At UC San Diego Health System, the hospital services are billed separately from the professional services. The professional services are billed by the UC San Diego Medical Group, and the hospital/facility services are billed by the UC San Diego Medical Center.

For example, when you deliver a baby, you will receive a billing statement from UC San Diego Medical Center for the facility charges, and a separate billing statement from UC San Diego Medical Group for the physician who performed your delivery, the anesthesiologist (if used) and the pediatrician.

What are my payment options?

Most of your health care bill may be covered by private insurance, Medicare or Medi-Cal; however, you may still be responsible for a portion of the charges. If you are paying cash (ie, "self pay"), then you are responsible for paying the bill. UC San Diego Medical Center accepts payment by cash, personal check, debit card and major credit cards. Payment can be made by phone (858-827-3633) mail, online through MyUCSDChart, or in person at the hospital cashier. Customer service representatives from UC San Diego Medical Group and UC San Diego Medical Center are willing to work with you to establish a payment plan if you have a large outstanding balance.

How do I reach the billing office if I have questions?

Our customer services representatives are available to answer your billing questions. For UC San Diego Medical Center facility billing questions, call 855-827-3633 . For UC San Diego Medical Group professional fee billing questions, call 888-543-0999.