Giving Birth Has Hidden Costs. Here's How To Argue The Bills.

First comes baby, then come the charges.
Petri Oeschger via Getty Images

One of the more confounding moments of new parenthood ― amid a smorgasbord of WTF moments ― is when the bills for childbirth start to roll in.

There’s good reason for parents to be confused. For many women, pregnancy is the first time they’ve gone to a health care provider with any real frequency. Childbirth is the first time they’ve ever stayed in a hospital or had major surgery. So when the bills come, and they’re battling debilitating fatigue, it feels easiest to just pay whatever they’re billed for.

But it’s important to stop and take a really careful look, financial experts say. Estimates suggest anywhere between 7% and 49% of paid claims contain a billing error. And hospital bills comprise a huge chunk of what women end up paying for birth.

“Four out of five of all dollars paid on behalf of the woman and the baby across the whole episode from pregnancy through the postpartum and newborn period cover that relatively brief hospital phase,” said Carol Sakala, lead for maternal health and maternity care programming at the National Partnership for Women & Families, which has looked extensively into childbirth costs.

Here are a few basics to be aware of ahead of time, and how to push back after you’ve given birth ― yes, even with a screaming baby in your arms.

First things first: Know your benefits

Start with your deductible, which is the amount you pay for covered services before your insurance plan steps in and starts paying. Then make sure you’re clear on your plan’s out-of-pocket maximum, which is the most you have to pay for a covered service in any given year under your insurance plan. And get on the phone with your insurance provider and make them walk you through exactly what they cover under their maternity care (prenatal tests, treatments for any complications, etc.) and how much (often, insurance covers only a percentage of certain costs).

You likely won’t commit all of those policies to memory, but being relatively well-versed in the basics ahead of time will make it much easier for you to spot any red flags when the bills come in.

“If you have a $2,500 deductible with a $5,000 out-of-pocket max, but you end up getting bills totaling $8,000,” said Misty McCrackin, a medical billing specialist with Hudson Valley Medical Bill Advocates, “something is wrong.”

Oh, and check on your plan’s pre-authorization requirements, she said. Some insurers require you get pre-authorization for your baby to be covered, while others want you to call when you arrive at the hospital or when the baby is born.

Keep a list of your pre-birth costs as you go along

McCrackin recommended that all pregnant women (and/or their partners) keep a record of any costs going toward their deductible that they pay before they actually give birth. If you have an ultrasound or a non-stress test, write it down. Even if those things are covered and you’re never charged, it is a good idea to just track all the procedures you’ve had done.

“A lot of times, you have met your deductible prior to giving birth,” McCrackin said.

Make sure everyone you see is in your provider network...

Most women know to check if their OB-GYN or midwife is in-network (and of course many health care plans offer some level of coverage for out-of-network providers).

But women don’t necessarily think to check whether the hospital or birth center and everyone else involved in their care ― including any specialists ― are also in-network.

Including the anesthesiologist

“This is a really common one. Women will think, ‘I already did my homework and my OB is in-network, and the hospital is in-network,’ but they might use a contract anesthesiologist who is not,” said McCrackin. Check with your hospital ahead of time, even if you don’t intend to get an epidural or to have a C-section, because you never know what might happen.

“Unfortunately, you have no control over what anesthesiologist is on call that day,” said Sakala, but it’s still important to talk to your hospital about this ahead of time because you don’t want to be caught off guard, and if it’s a real concern, you still have time to look into switching providers or hospitals.

Unfortunately, stories abound of women and couples being hit with surprise bills after the fact.

Be prepared for multiple bills

Typically patients receive a hospital bill for both you and the baby, which includes (but is by no means limited to) the supplies used, room and board ― basically, everything that happened while you were there, McCrackin said. Sometimes, mom’s bills and the baby’s bills come together; other times they’re separate. So you could see multiple bills for the hospital alone.

Then there’s the bill from your primary provider (so your OB-GYN or midwife), as well as a possible bill from your anesthesiologist or any other specialists you or your baby may have seen. Read them all, McCrackin said. “It’s always good practice,” she urged. “There are errors made.”

Ask for things to be itemized

Typically hospital bills aren’t itemized when they come in—meaning you’ll just see one big charge. But if you have concerns at all about what you’ve been charged, you can request an itemized statement. FYI: Under a new federal rule, hospitals are now required to post their list prices for tests and procedures online, but the experts say that data is often hard to find or coded in a way that is more confusing than helpful.

“They’re also so out of proportion to what is actually negotiated that it’s not really helpful, and they tend to be in these arcane lists of billing codes that are not user-friendly at all,” Sakala said.

Don’t freak out if you get your itemized bill and you can’t really understand everything that is on it. Unfortunately, that’s kind of the norm. “I remember feeling confused when I got the bill after my first child was born, and I work in this field,” McCracken said. “It’s very common.”

Which leads to the last crucial point, which is...

Don’t be afraid to ask for help

Make someone from the hospital billing department spend time with you on the phone if you have concerns about charges you’re seeing, McCracken said ― or have a partner do it. If you don’t understand something, ask them to clarify. No, that’s not what new parents want to be doing, but it could save you significant money.

Alternatively, you can reach out to a medical bill advocate (which is what McCracken does professionally) who can take a look at what you’ve been charged and let you know if any of it was in error.

“When women chose their care provider, they kind of go with where that person has privileges, which kind of locks them into whatever is going on in that facility,” Sakala said. “That’s one really important way that the cost issues are kind of out of view, and out of control right now.”

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