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Thursday
May062010

Billing Insurance for Hospital Birth

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By Jill

There are breakdowns of the cost of giving birth in U.S. hospitals all over the internet. This one is based on a small sample of maternity care patients in Maryland. Please read or skim the entire pdf if you want to put it in context. A short excerpt of the report is also pasted below.

Having given birth outside of the hospital system in a birth center where the medical billing and everything else was completely transparent, I still find myself doing a double-take at charts like this. The midwives billed insurance for about $5,500 total, which included everything. All prenatal visits, exams, blood draws, screenings, NSTs and AFIs, the birth, the 24 hour home visit, the three week postpartum visit, and the six week postpartum visit.

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The next step involved finding charges for each maternity care service. Fee schedules that insurers use to pay for services are proprietary and closely guarded. Instead, this analysis relies on a sample of claims for maternity care services for 106 women covered under one state high-risk pool, the Maryland Health Insurance Plan (MHIP). MHIP fee schedules for most providers are approximately 20 percent higher than those paid by Medicare. The MHIP payment level is thought to be generally consistent with that of other commercial insurers in Maryland. To estimate the cost of maternity care, median charges (those billed to and paid by MHIP) for each maternity care service were matched to each service and then summed. Researchers generated cost estimates for prenatal care, vaginal delivery, C-section delivery, and gestational diabetes care.

The most common model of health care financing is to reimburse providers for each service they perform, including diagnostic tests, office visits, and any other medically necessary care or service.

Obstetric care is an exception to this fee-for-service billing method. Most health insurance plans require costs of obstetric care after an initial consultation to be billed as part of one global fee encompassing prenatal care, delivery, and postpartum care.

 

 

 

 

 

 

 

 

 

 

 

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Reader Comments (12)

It IS amazing. I am currently losing my insurance due to treatment for an ectopic pregnancy in December. They want to investigate my gyne history and I am refusing to provide my medical records. What an invasion of privacy. I was really scared about dealing with the charges for my treatment on my own, but as it turns out doctors and hospitals have a lot of wiggle room in their fees. I have been assured of *at least* a 70% discount (!) Can you imagine the upcharge if they are able to give regular people a 70% discount?!?

When I was going through the ectopic, I had to see an OB/Gyn practice. It was amazing how I had to be on top of everything they did to prevent myself from paying for unnecessary tests and treatments. They wanted to do a standard blood panel, urine and blood pregnancy test and pap smear. They got the urine test on me ($45!) but I luckily refused the blood panel and pap smear. They aren't used to having people question costs and paying from their own pockets.

May 7, 2010 | Unregistered CommenterVanessa Manz

Wow, that's cheaper than I had to pay!! It was $30,000 for my first birth...b/c I not only c-sected but I labored for 16 hours there (15 at home) before the doctor told me a c-section *must* be performed. And the anestesia was paid seperately...to the tune of about $8k. I wish I still had those statements around.

My second was an attempted VBAC with a midwife group. Their TOTAL costs were $4,500. I ended up getting about $900 reimbursed (b/c I paid up front) b/c I had to transfer. In my state the midwives can't legally have me in their practice past 37 weeks if my baby is breech. My baby turned breech at 38 weeks...They hid my file until their office manager happened to be in on a day I was there...so my file was right on top of the pile of paperwork. Then when I was transfered I still had to pay the FULL $3,500 cost for JUST the doctor. In the area I was living doctors charged a "flat" rate no matter when you show up for care...Whether its 12 weeks or 38 weeks. They say its so that women will seek care early, b/c many women show up late to avoid the early costs of prenatal visits. Buuut...I had proof of care. And I wasn't looking to save a buck. I felt I should have been billed more fairly by the doctor. That was also the case in my first pregnancy, but I refused to pay the first doctor I saw anyway...

And then the hospital adds another $20k-$30k for THEIR services.

Disgusting!!

May 7, 2010 | Unregistered CommenterMaegan

Vanessa...I know what you mean, I refused a lot of things, and was really hassled about it. I know some tests have a false high positive...some tests (like the STD panel) are insulting. One girl was really trying to convince me my husband was cheating on me and had given me something JUST so I would submit to the damn test!!

And did you know if you refuse enough tests you can be kicked out of a practice? ;)

May 7, 2010 | Unregistered CommenterMaegan

I was going to saw the same as Maegan - my c/s was over $30k as well. I remember getting that in the mail and wanting to throw up.

May 7, 2010 | Unregistered Commenterterra

This is precisely why we need to get obstetric reform to health reform There is a lot of money that could be saved if more women had access to out of hospital birth centers and availability of using midwives for homebirth. Insurance companies should be forced to cover both. Vanessa..isn't it ridiculous that you could lose your insurance because you need to use it? Crazy!

May 7, 2010 | Unregistered CommenterLucinda

Man! If you want to talk about upcharge, with my first baby, had an epidural all day long, and then one more final shot just before my cesarean and the total came to about 2,500. With my insurance, we had to pay about $1000 of that. With my second baby in a different (non-VBAC) hospital, I got one shot of anesthesia from a spinal just before my surgery and the anesthesiologist charged $10,000! We ended up paying about the same as with my first, but HOLY COW! The anesthesiologist here sure thinks a lot of himself!

We're never going to a hospital for a normal birth again! Crappy prices AND crappy service!

May 7, 2010 | Unregistered CommenterHeather

I should clarify that the above costs are for anesthesia ONLY and don't include hospital or doctor fees.

May 7, 2010 | Unregistered CommenterHeather

Wow. Maybe I'm just ignorant (I had a homebirth and paid about $1700 total), but why would the baby's hospital charges be more after a cesarean???

May 7, 2010 | Unregistered CommenterA

I feel like I got off easy with my hospital birth, but I still think it was way too expensive. 2800$ for a LDR room that I was in labor in for 20 minutes and recovery for maybe an hour before I was transferred to the 870$ per night room...I almost got out of paying for anything else, but the stupid ob sent my placenta off for testing without asking me which cost another 500! grrrr....

Next time I will definitely do a home birth.

May 7, 2010 | Unregistered CommenterSara

@A, I think the reason the" hospital charges ( baby)" in the c-section part are higher is because these figures represent the median (similar to an average) amount billed in a data set of different births for which different amounts were billed. I would guess that it is more likely for a baby born via c-section to be admitted to a NICU or special care nursery (either because of complications that led to or resulted from the cesarean), and because charges for special baby care are higher, on *average*, c-section babies would have more expensive care. Hope this makes sense.

May 7, 2010 | Unregistered CommenterBirth Unplugged
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