It cost HOW MUCH??

Most of the birth blogs I read have talked about one or both of the birth-related articles that recently appeared in the LA Times and Time magazine. But Knitted in the Womb talked about one I hadn’t seen — from the Wall Street Journal, which talked about the hospital bill a woman received for her uncomplicated vaginal birth: $36,625! Although the total cost was negotiated down by the insurance company (about half off), she still had to pay a percentage of the bill, and had the nasty surprise of finding out that in addition to her annual deductible, her newborn had his own deductible to meet! [If you haven’t read the other articles, Knitted in the Womb has the links on her blog page.]

Not having had a hospital birth, it was definitely a curiosity to me to see certain aspects of this as-yet-unseen type of bill. It was a rude shock, but important for everyone to know, because even if you believe you don’t pay out of pocket, you really do, because all costs the insurance company incurs are passed along to their customers in one form or another. You’re paying for your coworker’s C-section. Fun, huh? [Oh, and don’t expect nationalized health care to improve matters — it will have all the (in)efficiency of Medicare and Medicaid, but on steroids.]

Back to the article — she writes that she requested an itemized statement to make sure she wasn’t billed for services she did not actually receive, and found that the sterile epidural tray cost $530.29.  Then writes,

An “Anes-cat 1-basic Outlying Area” was billed at $2,152.55. (I was told this was the cost of the hospital’s resources related to the epidural.) These items were in addition to the separate anesthesiologist’s charge of $1,530 for giving the epidural. Even though the pain-killing epidural shot felt priceless during my 20 hours of labor, I was amazed that its total cost could run so high. [In case you haven’t added that up, it’s over $4,000 for an epidural. And people think that childbirth classes and a doula, which can help you avoid needing an epidural, are expensive! The woman had to pay 15% of charges, so if these charges were the final charges her insurance company agreed to, then that’s about $630, which could cover both childbirth classes and a doula in many areas of the country.]

… the hospital listed a price of $2,382.92 for my recovery, when I hadn’t had a Caesarean section. It turned out the charge was for the 90 minutes I spent in the birthing room after my delivery. I recalled lying exhausted there while a kind nurse checked my vitals and cleaned me up. Important help, for sure, but was it really worth that much money? [This cost of recovery is nearly as much as I paid for my whole birth “package” with my midwives each pregnancy. The prenatal visits were anywhere from 30-90 minutes long, plus they came to my house for the birth and stayed during labor and for a few hours afterwards checking on me and making sure everything was cleaned up. Oh, and it included a labor doula, too!]

Interesting, to be sure. To those of you who have had hospital births, did you know these charges (or anything like it) beforehand? If you have insurance, did you ever see these kinds of bills, or only your out-of-pocket costs (whether home or hospital birth)? If you work in a hospital, are you aware of how much people are billed for services in your hospital, or is that “just something people in billing deal with”?


10 Responses

  1. We used a birth center and student doula for our first birth. Our total out of pocket cost, after insurance, was a little over $400. This included all our prenatal visits/labs/one ultrasound, staying overnight at the center and a nurse coming to our home 48 hours later for a check up visit.

    We are expecting our second child around June 17th, with different insurance, but using the same birth center. We have already paid almost $1000 out of pocket (and I have seen the itemized invoices, argued them down, etc…). This pregnancy has been slightly more complicated with medication the entire time, three ultrasounds, and a hospital visit for pre term contractions. However, we expect to see less of a bill after the birth (assuming everything goes normally, as in our first experience) due to meeting all of our deductibles at this point.

  2. My first birth via C-section was around $25,000. We paid out of pocket $1000. This was for a 5 night hospital stay. The hospital were I work offers a “self-pay” package for people without insurance, but who do not qualify for public aid. For all prenatal visits, a normal delivery, and postnatal visits, it is $1500. If anything goes wrong, like the baby goes to the NICU, they must pay out of pocket. A NICU stay is $2000 a day. This does not include medicine, procedures, doctors fees etc.
    These hospital fees are over inflated to help pay for those who cannot. The system needs a lot of fixin.

  3. As I recall (this was almost 4 years ago, so I could be remembering wrong), the hospital I went to in California, the cost for my vaginal delivery (which included pit and nubain – no epidural) and two days stay afterwards came out to something over $3000. We had lousy insurance, so we paid for most of that, but we were able to make a deal with the hospital that if we paid it all at once, they knocked off quite a bit of the cost. The doctor had a flat rate package of $2000 for prenatal visits and vaginal delivery.

    The hospital here I thought was outrageous, until I saw the numbers in your post. I don’t know how we would afford anything here if we didn’t have such great insurance this time (and the nice thing is, my husband works for the biggest employer in town, so everyone automatically knows what things are going to be from our insurance). When I pre-registred, the lady at the hospital told me that if I paid in advance or on that day that we would get a discount (similar to what the other hospital did). She told me it would be about $10,000 before insurance, but with our insurance our cost is about $650. Then the OB will be another few thousand dollars, of which I don’t know how much we will have to pay.

    We’re also waiting for the other shoe to fall after the baby is born. I am not sure how the hospital knows how much everything will cost before the delivery. We won’t be surprised if there’s suddenly new charges they didn’t tell us about.

    Ultrasounds are also horendously expensive at this hospital. I think all my ultrasounds with the last baby (we moved in the middle of the pregnancy, so they were with two different doctors and hospitals in different states) were all $100-$200. The hospital here charges $600!

    I suspect one reason they are so expensive is because they can be. They are the only hospital around in a small city where most people do have pretty good insurance.

  4. $530 for a sterile epidural tray????? You’ve got to be kidding me. I got one off e-bay for only $12. Another CBE ordered a box of them, and we split the cost with a bunch of other CBEs. The company let us buy them for educational purposes=)

    I had an ultrasound when I wasn’t pregnant and the insurance was billed $1600 for it.

  5. I agree that the charges are horrendous. It is awful as a nurse, to get someone something simple, like a saline flush for an IV for example, and know that it will be costing them so much money.
    However, I do have somewhat of an explination on why some things are so expensive. Since hospitals cannot bill for nursing care directly, they must recoup the cost by adding it to other things. For example, when you get a foley catheter, you are charged not only for the catheter itself, but also for the nurse that was needed to insert it and care for it.
    This is a big problem with our healthcare system also. If hospitals were only allowed to charge for nursing care, costs of many other things could fall, because they wouldn’t have to recoup all their costs.
    It is rediculous though. I’ve heard it can be like $20 for a toothbrush!

  6. I can tell you some basic fees (I don’t know all of them, I’m curious to find out though). Just to walk in the door to my L&D unit is a basic “observation” charge (buys you up to 4 hrs on L&D) for around $900. Usually, you also need monitoring, so there is another charge for an NST of about $900. Almost everyone gets charged for an NST, because, we are monitoring the baby too. You must have a reactive NST to be discharged. So, just to walk in the door — $1800.

    If you’re admitted right off the bat, we don’t charge for the “observation” time or the NST. You get a daily “extended observation” charge, or if you deliver, you get a “vaginal delivery” or “c-section” charge. Those charges include your recovery time period on L&D.

    Epidurals are separate charges for L&D. I’m guessing they run around $1500 for the L&D charge portion. Plus you get a bill from the anesthesia department.

    Inductions cost around $1000 (Pitocin, no separate charges for IV supplies, but you do get charged for each and every medication, including that bag of pitocin, and the bags of IV fluids, etc)

    We also charge for:
    -breastpump use (daily charge)
    -oxytocin challenge test (OCT)
    -SCD set up charge (leg cuffs to prevent blood clots if you get a c-section)
    -charge for the actual SCD leg cuffs
    -different levels of intrauterine resuscitation
    -different levels of NICU attendance/interventions at birth (plus they bill you too for the physician charges)
    -complicated postpartum course (like, if you have a hemorrhage and need to have a higher level of care for a longer period of time on L&D)
    -induction with oral or vaginal agents (plus the cost of the medications)
    -multiple gestation births (twins, triplets, or higher)
    -IV hydration (first hour)
    -IV hydration (subsequent hours, charge is per hour)

    I think the hospital also bills a separate charge for the room set up and the basic hygiene supplies that come in every room. When I was a patient on a med-surg unit, that fee was around $1000. For a cheap plastic basin, a cheap toothbrush, some toothpaste, a small bar of soap, and a cheap black comb. Of which I only used the basin……because I brought my own supplies from home.

  7. […] regardless of what happens; but most people pay a percentage of all costs), and as I pointed out in this recent post, a percentage of all costs associated with an epidural and/or a C-section may easily be more than […]

  8. My first c-section in 2005 we paid $1700 out of pocket. I’m not sure of the entire bill, but it was somewhere between $23,000-$25,000.

    My second c-section (after unmedicated VBAC attempt) last July we paid $4000 out of pocket and the entire bill was around $27,000….maybe more.

    Looking back I wonder what would have happened if I went with the birth center that cost $4000 and then transferred to the hospital for a c-section….would I have ended up paying $8000 out of pocket?????? ugh

    Although there are things I would have done differently (in a Monday morning quarterback kind of way) I’m not sure that there was anything I could have done that would have gotten me out of the c-section for that birth…so in hindsight I’m glad that we didn’t have to come up with $8000.

    I do review my birth story every once in awhile and hope to finally figure out something that would have made a difference…it would give me more confidence for next time.

  9. i would like to know if there is a fund program to cover all my childbirth expenses (c section) for non american citizen with no insurance.

    • I don’t know of any such program, but it’s very likely that something like this exists — you can contact the hospital where you’re planning on giving birth as well as various charity organizations in your area to start. If you pre-pay your hospital, you will very likely get a discount from the standard fee. I have only heard of patients planning a vaginal birth doing this, but both women who have said they did this paid about $1200 (for the hospital; I think that the doctor’s fees would be an additional $3000 or so; and there may be other separate fees like an anesthesiologist), although for a C-section that might be more, since the hospital stay will likely be longer.

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