One of the biggest surprises I faced when I became a new mom five years ago were the bills that quickly rolled in after my delivery. “$500 for what?!” my husband and I asked each other, bleary eyed and trying not to freak out. It’s not that we hadn’t anticipated getting bills; it’s that we hadn’t anticipated just how high they’d be. I was lucky to have had a low-risk pregnancy and a very straightforward birth. I was luckier still to have health insurance via my employer. (Thank you, Mother HuffPost.)
But when my two-night hospital stay was over, my husband and I still owed nearly $5,000, which we scrambled to come up with — then just kind of forked over. I was wearing an adult diaper and running on four hours of sleep a day. I did not have it in me to get on the phone with my insurer to argue the opaque bills coming in. And new, eye-popping research about the rising cost of having a baby in this country suggests I’m not alone.
For women who have insurance through their employer, the average out-of-pocket costs for maternal care before and after delivery were roughly $4,500 in 2015, according to findings published in the January issue of Health Affairs. That’s up from around $3,000 in 2008. And it’s just an average ― other factors like in vitro fertilization can make things even more expensive.
“Ninety-eight percent of women [in the study] had some out-of-pocket costs for maternity care,” study co-author Dr. Michelle Moniz, an OB-GYN with Michigan Medicine’s Von Voigtlander Women’s Hospital and a researcher with the University of Michigan Institute of Healthcare Policy and Innovation, told HuffPost. “That was really surprising to me. I was not expecting that to be a universal phenomenon.”
The rise in out-of-pocket costs between 2008 and 2015 was also “striking,” Moniz said. And it wasn’t explained by any major changes in the standardized cost of maternity care during that time, which remained pretty stable.
It was simply the proportion of overall maternity costs shouldered by patients that seemed to jump — from about 12% in 2008 to roughly 20% in 2015, Moniz explained.
“It’s difficult even for me as a clinician and as somebody who does research in this space to understand and to be able to obtain health care costs.”
“Folks seem to think, ‘Well, the Affordable Care Act requires coverage for maternity care, so everything should be fine,’” she said. “But actually, large, employer-based health plans — which are the ones in this study — are required to cover maternity care. However, plans are allowed to impose cost-sharing: co-pays, co-insurance, and deductibles.”
That is different from preventive services, such as pap smears, mammograms or contraception. For most American women, under most plans, those are now free.
In general, health care costs can have a profound influence on people’s overall finances, and remain a leading cause of bankruptcy in America. Childbirth bills can be especially challenging for women (and their families) to manage, because they often come at a time when they have no source of income — given that the U.S. has the dubious distinction of being the only developed country without mandated paid leave for mothers.
It also happens to be the only developed country with a steadily rising maternal mortality rate, and Moniz says a study like this raises the distressing possibility that women might turn down necessary procedures and services during pregnancy and afterward because they’re worried about the bills.
She hopes the study gains traction both with lawmakers who can push for policies that limit out-of-pocket spending on maternity care, and with expectant women so they aren’t caught off guard by unexpected medical expenses.
I was certainly better prepared when I had my second baby and made my husband go through our bills line by line, because I was too wiped to make any sense of it. He was able to argue a couple of charges, which knocked off a few hundred bucks. It wasn’t much, however, and it was still way more than we could afford at the time.
That burden — paying thousands of dollars for care that is supposed to be covered by insurance, and then needing to carefully comb through complex medical bills when there is a helpless new human to take care of — is one parents shouldn’t have to face, Moniz believes.
“It’s difficult even for me as a clinician and as somebody who does research in this space to understand and to be able to obtain health care costs. It’s just very complex and often not transparent,” she said. “So I think that’s a very challenging ask for patients.”