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.

Expand All | Collapse All

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

As a courtesy, we send the claim to your health insurance carrier. To insure 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?

A Health Maintenance Organization (HMO) is a group that contracts with medical facilities, physicians, employers and occasionally individual patients to provide medical care to a group of individuals. If you want your insurance company to pay for your care, you must see a provider within the HMO.

PPO stands for Preferred Provider Organization. You must select a primary care physician (PCP) who is under contract with the PPO. Like an HMO, you usually pay a small amount, or co-pay, each time you visit your PCP or healthcare facility. This will vary during pre-natal care visits depending on your individual benefit plan. Unlike an HMO, if you choose to see a doctor who is not contracted with the PPO, the plan might pay a percentage of the medical bills (out-of-network benefits). However, your cost will probably be higher than if you choose a provider that is in the plan’s network.

What is a co-pay?

A co-pay is a set fee that you will pay to providers at the time of service. Co-pays are applied to emergency department visits (labor & delivery triage visits are considered to be emergency visits), hospital admissions, office visits, etc. The cost is usually minimal. 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”?

Please contact your insurance carrier to verify your coverage and/or benefits. UC San Diego Medical Center is contracted with most insurance carriers.

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 Medical Center, 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 self-pay, then you are responsible for paying the bill and then filing the claim yourself, as we do not file insurance claims for self-pay patients. UC San Diego Medical Center accepts payment by cash, personal check, debit card and major credit cards (Visa, MasterCard, Discover and American Express). Payment can be made by mail 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 1-800-873-9057. For UC San Diego Medical Group professional fee billing questions, call 619-543-3000.