Medical Bills 101: From Pregnancy to Delivery

Preparing for a Baby? Tackle These 15 Financial Tasks

Pregnancy and childbirth are costly, and medical bills aren’t simply explained. With price and insurance coverage differences spanning tens of thousands of dollars, deciphering the expenses will take some work, but you can do it with our help. Read this guide to:

• Understand your coverage.
• Know what costs to expect when.
• Set your mind at ease about the anticipated expenses.

Having a baby is expensive — sometimes alarmingly so. Navigating through the costs of nine months of pregnancy and then the cost of raising a child can seem overwhelming, but knowing what to expect can help.

Major differences in cost and coverage

Any guide to medical bills and your share of the cost should come with several disclaimers.

• Prices vary considerably from city to city, and even local hospital to local hospital. Researchers at the University of California, San Francisco, found in 2014 that in the Golden State alone, the cost of an uncomplicated vaginal birth varied widely — from $3,296 to $37,227 depending on the hospital. Cesarean sections ranged from $8,312 to almost $71,000.
• If you have health insurance, coverage differences are similarly dramatic. Also, because the ACA doesn’t define precisely what must be covered under these umbrellas, insurance companies have interpreted and applied the stipulation differently.
• Price and out-of-pocket cost estimates are handy but are only estimates. The only way to know for certain what you’ll pay is to contact your medical providers and health insurance company. The more work you’re willing to do on the front end, the less likely you’ll get surprise bills in the mail.

Get a handle on your insurance

If you’re unsure how your health insurance works, now’s the time to research your benefits. You could take an entire course in understanding your policy, and still likely have questions. Consider this a cram session. Your top two study areas include:

• Out-of-pocket costs: Copays, coinsurance, and deductibles
• Making sure your doctors are all in your provider network

Contact your health insurance company, with policy number in hand, and ask these key questions, making sure to write down whom you talked to and the date:

• Are prenatal care, labor and delivery covered benefits under my policy?
• Do I need a referral from my primary care doctor to see an OB-GYN or other specialists?
• Will I need pre-authorization for any prenatal care?
• What prenatal tests are covered (ultrasounds, amniocentesis, genetic testing, etc.)?
• What common prenatal, labor and delivery needs are not covered by my policy?
• Which hospitals in my area are in my insurance policy’s network?
• What do I need to do to ensure that my newborn is covered from the moment of delivery?
• How long of a hospital stay is covered after delivery?
• Does my policy cover a private room or suite, or will I have to share a room?
• If you’re interested in nontraditional deliveries, like a home birth with a midwife, for instance, ask about coverage for these.

Throughout your pregnancy and into your baby’s well-child visits, err on the side of caution. If at any time you are unsure about your coverage and want to be doubly safe, call your insurance company to get confirmation in advance.

Watch out: Depending on your medical providers’ billing practices and your due date, you could be caught having to pay two deductibles if your prenatal care happens in one calendar year and your baby is delivered in the next. Some providers package their charges to insurance companies in what’s called “global billing,” which can include all prenatal and delivery charges. Ask your OB-GYN whether he or she plans to use global billing so you’ll know where you stand ahead of time.

Uninsured? Seek help

If you don’t have health insurance, you’re looking at tens of thousands of dollars in care over the next nine months. Despite requiring health insurance companies to offer well-woman and maternity care, the Affordable Care Act has a notable shortcoming in that it doesn’t consider pregnancy a “qualifying event.” This means you have to wait until your child is born to sign up for a new plan under the ACA.

But ACA insurance plans aren’t your only option. If you meet income requirements, you could be eligible for Medicaid. If you’re forced to pay cash for your maternity care, be a smart health care consumer:

• Comparison and price shop for prenatal visits, tests and your labor and delivery.
• Explain to your doctor and all medical providers that you are a cash-paying customer. They often offer discounts for uninsured patients.
• Negotiate lower balances and payment plans on your medical bills.
• Ask the hospital about any “charity care” programs that may be available.
• Consider a maternity package, increasingly offered by hospitals as a way for new parents to get all of their maternity and childbirth expenses covered under one price.

Cost breakdowns

During a routine pregnancy, you’ll have several standard appointments and tests. Any special concerns about your or your baby’s health could mean more doctor visits and interventions, all potentially coming at an additional cost.

Medicaid Eligibility, Costs and Benefits

A NOTE ON ULTRASOUNDS

Who wouldn’t want to see their little bundle of joy grow from week to week? Unfortunately, that can get pretty expensive; ultrasounds cost hundreds of dollars each. If you’re uncertain about coverage, call your insurer when you know your doctor has one planned.

Expected expenses

First trimester

If you have an uncomplicated pregnancy, you’ll see your doctor for monthly checkups during the first trimester. Typically, these are subject to a copay, ranging from $15 to $35 on average. These visits will involve checking your weight, blood pressure, fundal height measurement and fetal heart rate as soon as it’s audible. Additional lab work and tests will come throughout and could carry an extra cost.

• Prenatal vitamins: Your doctor may prescribe these, or you can find them over the counter at most drugstores. Under a prescription, they’ll be subject to your copay. Purchased over the counter, a bottle containing a one-month supply will cost about $10 to $20.
• Lab work: Blood will be drawn for a series of lab tests including screening for common birth defects, your blood type, Rh status, hemoglobin measurements, and immunity and exposure to certain kinds of infections. If you have insurance, it’s likely that much of this will be covered, though it could be subject to your deductible. Costs vary widely.
• Early ultrasound: If everything appears healthy, your doctor may not recommend an ultrasound this soon. However, a first-trimester transvaginal ultrasound may be necessary to establish the location of the fetus, how far along you are, viability of the pregnancy and number of fetuses. Cost information site Amino estimates the average national price of a transvaginal ultrasound to be $686.
• Cell-free fetal DNA testing: After 10 weeks of pregnancy, your baby’s blood can be screened for genetic conditions. This is typically performed only for at-risk pregnancies, and costs can run upward of $2,000. Because some insurance companies consider this method “investigational,” it may not be covered.
• Chorionic villus sampling (CVS): This test looks for many of the same genetic abnormalities as a cell-free fetal DNA test does but analyzes the tissue surrounding the baby, similar to an amniocentesis. It looks for things such as Down syndrome, cystic fibrosis, sickle cell anemia and other genetic abnormalities. Most insurance plans will cover CVS in high-risk pregnancies, though you could be responsible for out-of-pocket costs if it’s subject to your deductible.

SECOND TRIMESTER

Through the end of your second trimester (week 28), you’ll continue with monthly prenatal visits. In addition, you’ll likely need:

• Glucose screening: Used to test for gestational diabetes, this blood work is typically done around week 24 to 28. If it’s not covered by your policy or if you haven’t met your deductible yet, you could pay up to $100, according to Healthcare Bluebook.
• Maternal blood screening: This blood test looks for four substances that could be evidence of possible birth defects. Costs vary widely by location and coverage.
• Amniocentesis: An amniocentesis is the analysis of amniotic fluid surrounding your baby. It looks for genetic conditions like Down syndrome and is usually covered by insurance when medically necessary. Full price for this procedure can cost more than $7,000.
• Ultrasound: The main ultrasound during a pregnancy occurs around 16 to 20 weeks, according to the American Congress of Obstetricians and Gynecologists. Here, your doctor will be looking for things such as the overall health and position of your baby and placenta, and your ovaries and cervix. It’s at this ultrasound that your doctor will be able to determine your baby’s sex — if the little one is willing to reveal that. This ultrasound is usually covered by insurance.

THIRD TRIMESTER

By your third trimester, basically every lab test that needs to be done has been done. Your monthly checkups will be every two weeks from weeks 28 to 36, and then weekly until the baby’s birth.

• Birthing classes: It’s time to get ready for baby’s arrival. Birthing classes help you prepare for labor and delivery and are often covered by health insurance. Without insurance coverage, these classes can cost $50 to $200.

The largest expense you can expect during this last phase of pregnancy is the cost of labor and delivery.

Labor and delivery

Your itemized bill for labor and delivery will be immense, in ink and paper if not cost. That’s because hospitals in the U.S. often bill per service, and each hospitalization represents a series of small services and related fees.

It’s common to be billed not only for each doctor who attends you, but for each pill and IV fluid pouch and the use of your room, among many other things. Because these prices vary from hospital to hospital, the total cost of childbirth can be difficult to estimate. In 2014, the most recent year for which data are available, the combined median charges for mother and newborn care for a normal, vaginal delivery were $17,184.

If you have to be induced, need an unexpected cesarean section, receive an epidural or get a snack, the charges climb further. Things such as doulas, midwives and birthing tubs are typically considered optional and thus additional, too.

If you’re insured, determining how much you’ll pay will include knowing what’s covered and how much your share of the bill will be, including deductibles and coinsurance.

To try to lower childbirth charges:

• Call the hospital’s billing office to get an estimate of total charges, and apply that to what you know about your policy specifics.
• If possible, set aside enough money to cover any remaining deductible for the year, plus your coinsurance share of the expected charges and some cushion for any unexpected denials and charges.
• If you have access to a health savings account or flexible spending account through your employer, you can set aside these anticipated expenses using pretax dollars.
• Consider a maternity package: These offer all of the normally itemized features of a delivery for a flat fee. Many of them come with payment options and discounts for cash-paying patients, with some costing about $2,500 to $8,000.

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