It's important to find out as much as you can about your health insurance coverage for pregnancy care and delivery. Every insurance provider is different and what is included or paid for by one may not be covered by another. Along the way, you will have copays (payments for doctor visits, for example) and you may have a deductible or a certain amount you must pay out-of-pocket before your provider begins to pay. Your hospital stay may be covered partially or in full, but this also varies from provider to provider.
Getting these facts in advance will help ease your mind during pregnancy and help you better prepare for payments you may need to make after you've come home from the hospital.
What happens when my policy requires prior authorization?
If your insurance policy says it requires prior authorization, you need to ensure your physician has obtained this authorization before you are admitted to the hospital. If authorization is required but not obtained, you could be responsible for the total hospital charges.
How can I find out and prepare for my out-of-pocket liability?
Knowing before you deliver how you much you will be responsible for paying will help you plan for the costs. If you are not sure what your out-of-pocket liability is, you can request an estimate by calling customer service or by going online. Call 484.337.1970 or visit mainlinehealth.org/patientbilling.
How much time do I have to add my baby to the policy?
Most insurance companies require that a new child be added to the parent's policy within 30 days of birth. Failure to do so could result in your insurance company refusing to pay for the child's hospital and physician services. If this occurs, the patient or responsible party will be billed for the services. Call your insurance company ahead of time to determine when your new child should be added to the policy.
What happens if I do not have insurance coverage?
For patients who qualify, Main Line Health offers charity care/financial assistance. Main Line Health financial counselors can assist you with the application. Call 484.337.1970 or visit mainlinehealth.org/charitycare.
How will the hospital handle my insurance and billing?
The hospital will bill your insurance company or companies. A valid insurance card is required at the time of your admission. Your estimated out-of-pocket liability is due at the time of admission unless you show evidence of a secondary insurance.
Given Main Line Health's relationship with Children’s Hospital of Philadelphia (CHOP), will any bills come from them?
Many deliveries at Main Line Health are attended by neonatal providers (physicians, physician assistants or nurse practitioners) who are affiliated with CHOP. In the event you or your newborn requires care from a CHOP clinician during your hospital stay, you will receive a bill from CHOP.
Main Line Health requires a neonatal provider to attend cesarean section deliveries for the safety and well-being of the newborn. A neonatal provider may also be requested by the obstetrical care provider for certain deliveries, or may be required according to Main Line Health policy to attend vaginal deliveries where certain maternal conditions exist or there are concerns about the baby's health that may require immediate assessment. Ask your obstetrician if this is anticipated for your delivery.
If you do receive a bill from CHOP for questions. Call 1-800-283-3055.