Frequently Asked Questions

About Onsite Neonatal, newborn health and insurance and billing

About Onsite Neonatal

What does Onsite Neonatal do?

Our doctors are specialists in caring for newborn babies. This specialty is called “neonatology.”

We are experts in taking care of babies who are sick, or babies who are born too early, which is called “premature.” These premature babies can have serious problems at birth. Their lungs and eyes and other organs are not always ready for life outside of their mother’s womb. Onsite doctors help them survive and grow healthy until they are strong enough to go home.

What is a neonatologist?

A neonatologist is a specialist in newborn care. Our doctors are pediatricians who have extra years of specialized training to care for early (premature) or sick newborns.

How much training do neonatologists have?

Typically, neonatologists go through 4 years of medical school. Then they work as a “resident” pediatrician in a hospital for 3 years. Then they do 3 more years as a fellow in neonatology. It is a very intense specialty.

What kinds of help do newborns commonly need?

Babies who are born early may need lots of help. They are meant to be inside the mother’s womb. Her body would do things like keep them warm and provide oxygen and nutrients. When babies arrive too early, they aren’t really ready to breathe air or nurse yet. Their bodies aren’t good at staying warm. Their eyes aren’t ready to handle light.

The more prematurely infants are born, the more help they are likely to need. But even babies who are just a few weeks early can often use some help.

About insurance and billing

I don’t remember seeing a neonatologist. Why do I have a bill?

In the hospital, you see lots of people wearing scrubs or lab coats. It can be hard to tell the neonatologist from another pediatrician, or even from a nurse. However, Onsite doctors only care for a baby if your obstetrician or your pediatrician asks us to. If you have a bill, our doctor did care for your baby.

If you want to find out more about your baby’s specific care, please contact our Patient Advocates. They can look up your file and talk with you about it.

My pediatrician says there’s nothing wrong with my baby. Why was a neonatologist called?

It’s great that your baby is healthy now. That’s what we all want. However, at some point while you were at the hospital, one of your doctors had a concern. Your obstetrician or pediatrician called the Onsite doctor to help care for your baby.

If you want to find out more about your baby’s specific care, please contact our Patient Advocates. They can look up your file and talk with you about it.

I gave birth at a participating hospital. Isn’t everything supposed to be covered?

Hospitals are an unusual business. If you go to a store or restaurant, everyone who serves you is an employee of that business. But at hospitals, many doctors are independent. Onsite doctors are not “participating providers” with all insurance companies, even though we work in many hospitals that are.

That’s ok. We can still bill your insurance for the care we gave your baby. With your help, we can get the insurance to pay your bill.

What is an “Explanation of Benefits” (EOB)?

It’s a page that your insurance sends you. It shows what services Onsite gave your baby, how much we billed, and how much your insurance paid. If they did not pay anything, it will say why.

It’s important for you to send the EOB to Onsite when you get it. The EOB is the only way we know the insurance company’s response to our bill. We can’t close your account until we get the EOB from you.

Why did the insurance company send me a check instead of sending it to you?

We wish we knew! Insurance companies do things we don’t understand either.

Here’s what we do know: when you get the check to pay for the care Onsite doctors gave your baby, endorse it (sign the back) and send it to us. Send the Explanation of Benefits (EOB) too. That way, we can close your account.

The insurance company didn’t pay the whole bill. Now what?

If you have insurance, the insurance should pay for your baby’s care—not you. Contact our Patient Advocates, and we can work together to close your account.

About newborn (neonatal) care

Jaundice

Sometimes newborn babies develop a yellow tint to their skin and eyes. This is called jaundice. It is caused by high levels of a yellow pigment in the blood, called bilirubin.

Before the baby is born, the placenta removes bilirubin from the baby’s blood. The mother’s liver processes the bilirubin, and it is removed in her stools. Right after the baby is born, the baby’s liver takes over this process. But it can take a few days or even a few weeks for the baby’s liver to get up to speed.

Treatment is not always needed. Sometimes, the doctor will put the baby under special lights that help break down the bilirubin. In extreme cases, a baby may need a transfusion—the baby’s blood is replaced with fresh blood.

Newborn jaundice is not usually harmful. Most babies get over it in 1 to 2 weeks. But very high levels of jaundice can damage the brain. For babies who do need treatment, the treatment usually works well.

Infection

Respiratory Distress Syndrome

Babies who are born too early (premature) often have trouble breathing. That’s because if they were still in the womb, they would be getting oxygen from the mother, through the umbilical cord, not their own lungs. When they’re born prematurely, the lungs are still developing and aren’t ready to handle air.

Premature babies’ lungs may not produce enough of something called “surfactant.” Surfactant helps the lungs to expand when the infant breathes in air and stay open when the baby breathes out. Right after birth, the neonatologist can give the baby replacement surfactant. The baby may also need to be on a breathing machine (ventilator) for a while.

Patent Ductus Arteriosis(PDA)

Patent ductus arteriosus (PDA) is a heart problem that occurs soon after birth in some babies. Before birth, the two major arteries—the aorta and the pulmonary artery—are normally connected by a blood vessel called the ductus arteriosis. After birth, the blood vessel is supposed to close within a few days. In some babies, however, the blood vessel remains open, or “patent.” This allows blood to flow directly from the aorta into the pulmonary artery. This can strain the heart and increase blood pressure in the lung arteries.

About 3,000 infants are diagnosed with PDA each year. It is more common in premature babies but can also occur in full-term infants. Sometimes, PDA may shrink and go away by itself. Sometimes, it may need to be treated with medication or surgery.

Necrotizing Enterocolitis(NEC)

NEC is a condition that affects the bowel. Between about 1 and 5% of babies in neonatal intensive care units get NEC.

NEC typically occurs within the first 2 weeks of life, usually after milk feeding has begun. The exact cause of NEC is unknown. It is thought that because the intestines of premature babies are weakened by too little blood flow, when feeding starts, the added stress of food in the intestine allows bacteria to invade and damage the intestinal walls.

NEC can cause serious problems. The infant may not be able to feed. The bacteria can spread to the bloodstream. The baby may develop imbalances in the minerals in the blood. In severe cases, a hole can develop in the intestine, allowing bacteria to leak into the abdomen.

Treatment may include stopping feeding for a few days, or giving antibiotics. Most babies with NEC don’t need surgery, although some do. Most babies who develop NEC recover fully. In some cases, however, there may be ongoing problems with blockage or poor absorption of nutrients.

Retinopathy of Prematurity(ROP)

ROP is a problem that affects premature babies, especially babies less than 31 weeks at birth. In ROP, abnormal blood vessels grow and spread through the retina, at the back of the eye. The blood vessels can leak, scarring the retina and pulling it out of position.

It is one of the most common causes of vision loss in childhood.

Most babies who develop ROP after birth do not need treatment and have no lasting vision loss. About 1,100-1,500 babies a year develop ROP that needs treatment.

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