NYC Dept. of Ed. GHI card holders

Hey girls...I know there are many of you out there....when reading posts, it seems like many of us work for the dept of ed and have GHI insurance. My question is....I am currently 15 weeks pregnant, but have to see my OB every other week and then a high risk Dr. every other week. I just received an assignment of Benifits from an appointment with my high risk dr. GHI covers basically nothing from the appointment. Now I am afraid that I am going to get hit with a bill from the Dr. Office. Have any of you ladies who have GHI and see both a regular OB and a Perintologist (high risk dr), get slammed with bills, bc GHI doesnt cover enough?! I tried calling GHI today, but they only have representatives Monday-Friday (I will be trying back on Monday).

I know that the Drs. always bill way above what they expect to get, and I have had GHI for the past 2 1/2 years and have never received a bill from a drs. office, I guess I am just nervous bc I have to go to the drs. so often. If you read this far thank you and thanks in advance for any feedback!!

Re: NYC Dept. of Ed. GHI card holders

GHI routinely denies my drs claims for prenatal visits as well. Is your dr an in network provider? If so, I believe it is their problem to take care of. I called GHI to confirm my dr was in network and they told me to have the drs office resubmit the bills. My drs office never said anything about the denied claims and they haven't passed on any of the bills to me. I've also had the same experience with my son's pediatrician. The office bills $200 and GHI pays $40, but I never see a bill.


It's frustrating and stressful, but I think as long as you are using network providers, you will not be held responsible for the portion that GHI will not cover.

Re: NYC Dept. of Ed. GHI card holders

I have GHI also and for a couple of months during my 2nd tri I also had to see a risk specialist and my own doc alternately (I was seeing a doc every week). I have never recieved a bill... in the end GHI always covered everything.

Hopefully this resolves itself.

Re: NYC Dept. of Ed. GHI card holders

i have GHI as well and although i have never had to go to a high risk doctor, for both pregnancies, i paid one co-pay in the beginning and then not another dime for any other visits with the OB the entire pregnancy. the same is true this time around and i am over half-way there with this pregnancy. the only thing extra i did have to pay for were sonogram co-pays ($15.00 each) and lab co-pays ($15.00 each).

however, my OB is in network. i would think they would cover the high-risk doc for you as well... are they in network?

also, perhaps if they are not in network, they would work with you? DD had to have ear surgery last year and the doctor we wanted was out of network. because we had met the deuctible on her earlier in the year because she was in the hospital for something else, they took her. GHI sent us the checks for what they would cover and we turned those over to the doctor. he did not ask us to pay the balance-he just took what GHI gave him.

also, do you carry the optional rider? it's only $15.00 a month... DH does. it covers extra things, perhaps it would help in your case?

Re: NYC Dept. of Ed. GHI card holders

thank you all for your responses. Both my OB and my high risk Dr. are both in Network. And I do pay the extra $15 for the optional rider (for better coverage). I was just nervous, because according to my assignment of Benefits, my high risk billed GHI about $600 for blood work and test, etc. and GHI only paid them $38. I through that was extremely low. I will let you girls know if I ever get a bill.


Thank you again sooo much for your responses!!!