Good OB

[Anonymous]

Dr. Malcom DeSouza in Spring Valley. I had an absolutely lovely delivery with him.

[Anonymous]

Anonymous wrote:what does it mean when you say a physician doesn't "participate" with insurance?
Does that mean I have to pay upfront, submit my own insurance paperwork and THEN the visit will be reimbursed to me directly or does it mean that NO part of the visit is covered?

Thanks for any help figuring this system out...we're leaving Kaiser this month so I've never had to worry about finding my own doctor!

I'm not the PP but have had to deal with out-of-network providers in the past (but not OB). You should call your insurance and find out how much they reimburse, and what your deductible and annual out-of-pocket max are. Be aware though, that the percentage they say they reimburse usually applies to "customary charge" (or whatever the language is) and not the actual fee charged by the doctor (if it's higher). So for example if your insurance pays 70% but their customary charge for prenatal care is say 4,000 and your doctor charges 6,000, then they'll pay the 2,800 (70% 0f 4,000) not 4,200 (70% of 6,000). A few times I've dealt with out-of-network providers, I had to pay them directly and then submit a claim for reimbursement to my insurance. My OB practice requires all money above what insurance pays for prenatal/L&D to be paid to them by 7th month of pregnancy (I don't know the details since mine was completely covered, but I think they estimate the amount assuming you will have a vaginal delivery and I guess then afterwards would bill you more if you end up with a c-section).

I would guess that most large practices in the area participate with insurance though, so unless you have a specific reason to go out-of-network then you should be able to find an OB that accepts your insurance.

[Anonymous]

I second Dr. Malcolm DeSouza in Spring Valley. He does a sonogram every visit (yay!) and was really supportive of my choice for a natural birth. He delivers all his babies except one weekend a month, when Dr. Footer covers. I've been seeing him for years as my GYN and couldn't have picked a better OB.