# Cost of a hospital birth?



## barose (Dec 6, 2006)

How do I find out the cost of a hospital birth in a specific given area? I tried Google and some information I found was outdated (2003).

I'm just curious (not pregnant yet) because my insurance covers 90% in-network and 70% out-of-network and would like to know what my potential costs would be if I _had_ to birth in a hospital.

For my stillbirth, I had an entirely different type of insurance and never received an itemized bill (which is strange) but I didn't have to pay even though my insurance originally stated that they wouldn't cover pregnancy _at all_.


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## nccrunchymama (Dec 9, 2007)

Call the hospital. The billing dept will have a list. You can also call drs. They bill separately.


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## Mamabeakley (Jul 9, 2004)

Or call your insurance company, since what the hospital bills is likely not what the ins. co. will pay or base your copay on. The tricky part may be getting the ins. co. to give you actual information - I have often been told they need procedure codes, etc., to tell me anything - which is bull - they surely know what they pay out on average for an average birth.

So you also could ask around among other people who have your same ins. policy and have had a baby and find out what they actually had to pay.


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## barose (Dec 6, 2006)

Thanks for the tips! Ill try the hospital first---then call insurance...


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## zoeyzoo (Jul 6, 2007)

Sounds like you have a PPO. You should have something called an out of pocket maximum. This is the max they can charge you out of pocket per person (and the baby counts as a second person). If the hospital bill goes over this amount, it doesn't matter how much the bill is, your portion (provided you have the coverage for the services billed) will not exceed that amount per calendar year.

For example if you out of pocket maximum us $1,000 per person then your hospital birth will cost $2,000 ($1,000 for you and $1,000 for the baby); assuming the hospital will bill the insurance company more than $1,000 per person.

There are usually seperate maximums for in and out of network hospitals. If you have a preference, check whether that hospital is in-network too.


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## barose (Dec 6, 2006)

Yes, its a PPO.

I just check out my "out of pocket maxium" and its $2000 for in-network and $6,000 for out-of-network care. Family coverage (which this is not) is $6,000 and $18,000.

Dumb question: (probably something I should ask my insurance when the time comes) does the baby - regardless if I have a MWHB or hospital birth have to be added to my insurnce in order for the services (for the baby) to be covered?


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## notwonamesalike (Nov 13, 2007)

Not before the birth. With our PPO we had 30 days after the birth of our son to add him to our insurance. Check with yours just to be sure.


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## JamSamMom (Apr 17, 2007)

My hosptial charges 5k for an uncomplicated vaginal delivery and then 15k for a c-section and 3day hospital stay. The more interventions you need like pitocin, epidural, internal monitoring, etc. is all charged extra. and then ususlly a 1-2 day hospital stay after the vaginal delivery about 3k a day. If the baby needs a billiruben light or extra tests equipment then the hospital charges extra for this. OH most insurance companies give you 30-45 days to register your baby after dilivery and get their legal name and information. So the baby is covered as part of your coverage and grandfathered in during the grace period after birth. I would call to check how long the grace period after birth to sign the baby up. My friend missed this and had to pay for tests and post checkups out of pocket.


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## barose (Dec 6, 2006)

(wondering out loud)

Would I HAVE to put the baby on the plan in order to have a birth at a hospital paid for?

I wonder because I _may_ not continue to work at my job after baby. We dont have maternity leave so I may have to quit after SDI runs out. No job = no insurance.

Yikes! And they (on MDC) say babies are cheap.


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## 1006baby (Aug 22, 2006)

Sorry - a little rambling to address questions from a few posts...

Call your insurance company and tell them you need to know how much "usual and customary" charges are for a normal uncomplicated vaginal birth and a "normal uncomplicated" [their words not mine!] c-section. They will be able to give you this info for in-network.

For in-network, obstetric cases are paid out on a "case rate" which means your insurer has a contract with the provider (both the doctor and hospital) which tells the provider how much they can bill in total. If you go out-of-network, the provider may send you a bill for anything above "usual and customary" that your insurance does not pay (in addition to the fact that you also have a higher % contribution anyway)

When you call, you may have to demand, maybe even scream and shout. Don't listen to the customer service rep you get when you first call, as he/she will tell you they don't have access to that info. They may not, but their supervisor does.

If you have insurance on the day the baby is born, the baby's care is paid for so long as you add the baby to your insurance plan. Your monthly contribution will most likely go up, but only after the baby is added to your insurance plan. I know it is so expensive - but compare the increase in you monthly health care contribution to the hospital bill for newborn care and it does make sense to add the baby to your insurance plan. Even if you only have that insurance for three more weeks after the baby is born, it is probably more cost effective to add the baby to your plan than to leave the baby uninsured.

By the way - just fyi - unless you ask for it, almost no hospital will provide you with an itemized bill anymore.


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## barose (Dec 6, 2006)

Quote:


Originally Posted by *1006baby* 

By the way - just fyi - unless you ask for it, almost no hospital will provide you with an itemized bill anymore.

Thats strange because I have had hospital services since then and always receive a statement from the hospital/medical group.

Thanks for all of the answers. Now I know its a bit more complicated than I thought.


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## westcoastma (Jan 10, 2008)

OMG!! 15K for c-sec? Holy... I live in Canada and until now had no idea what US citizens pay for these kind of things. I never paid a dime for my hospital stay/emergency c-sec. Thank goodness. I could never afford that AND the baby!!


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## crazydiamond (May 31, 2005)

Quote:


Originally Posted by *barose* 
(wondering out loud)

Would I HAVE to put the baby on the plan in order to have a birth at a hospital paid for?

I wonder because I _may_ not continue to work at my job after baby. We dont have maternity leave so I may have to quit after SDI runs out. No job = no insurance.

I don't know how much this differs between insurance companies and plans, but here's how my PPO plan works.

All of baby's treatment is covered under your plan until you two are discharged. After which, baby's treatment is billed separately. You have 30 days to add baby to your health plan, after which the bills in the previous month (excluding the hospital stay) are payed for retroactively.

What this means is that if you leave your job after your hospital stay and never add baby to the health plan, all the hospital bills will be paid for but any other services afterwards will not be. For example, if the pedi sees your baby in the hospital, that will be covered but if you take the baby to the office for a 2 wk check up that won't be covered.


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## cchrissyy (Apr 22, 2003)

I have a PPO with those same rates.
here are the numbers pulled off my blog from my 06' medicated and midwife-attended hospital birth, and my husband's '07 apendectomy at the same place. And yes, we have itemized bills from both.

in-network vag birth:
billed $16,000
Cigna's negotiated/contracted price was $2600
our 10%- $260

appendix
The hospital billed $44000
Cigna got that adjusted down to $2930
our share was 0

(because we'd hit our family deductible and out of pocket maximum for the year with our special needs boy)

my insurance website lets you look up usual costs of procedures and hospital ratings for care quality and costs.


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## dlm194 (Mar 23, 2005)

Quote:


Originally Posted by *westcoastma* 
OMG!! 15K for c-sec? Holy... I live in Canada and until now had no idea what US citizens pay for these kind of things. I never paid a dime for my hospital stay/emergency c-sec. Thank goodness. I could never afford that AND the baby!!


My c-section cost $27,000 (uncomplicated, no NICU admission) but I didn't actually *pay* $27,000. Based on my insurance coverage, I paid $1000 out of pocket and insurance paid the rest. There is a BIG difference between what we pay and what insurance will pay (I can't remember what the hospital actually charge - I just remember that my insurance covered about 26,000 and I paid $1000). The hospital will charge crazy amounts of money for birth but insurance companies negiotiate much lower rates.

The (different) hospital still charged over $8000 for my completely drug free vbac. I was pretty surprised about that since I literally just needed a bed. I had no pit, no labor inducing drugs, no narcotics and no epidural. I received 2 motrin after the birth and I only stayed 24 hours. My baby needed nothing and never left my side. That did not include my midwives' fee nor the pediatricians fee. Insurance (also different from 1st birth) only paid about a quarter of that (based on their negotiated rates) and I wound up paying $25 out of pocket.









I had private health insurance the first time and military health insurance the second time. Used network hospital both times.


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## zoeyzoo (Jul 6, 2007)

For a hospital birth mom and baby are billed seperately. The insurance will cover it but you have officially add it within 30 days. The insurance covers it starting at birth.

If you quit, I would consider signing up for Cobra until you deliver so that it would be covered fro both of you. It has to be less than paying out of pocket. Based on your income, you may be elgible for medicare once you quit to pay for things.

Midwives in home births and many birth centers bill a flat fee for mom and baby. It is usally a lot less for a HB than a hospital birth.

With your insurance you wouldn't be billed more than 4,000 in network and 12,000 out of network (the single rate x 2). Next I would check on the usual and customary charges. I'm sure they will be more than 2,000 per person (assuming you go in network). The insurance company will pay what ever your in network percentage is after you pay your deductible (on both mom and baby). Usually this amount goes over the out of pocket maximums so that is why I asked what those were. For example if they bill 8,000 for you, you have a $500 deductible and the insruance pays 80% then you pay ((8,000 - 500) x .80) = 6,000 paid by the insurance company. This leaves ((8,000 -500) x .20) + 500 = 2,500 for you to pay. Since your out of pocket maximum is $2,000 this is what you would be billed and the insurance company will pay the extra $500.


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## barose (Dec 6, 2006)

Quote:


Originally Posted by *ZoeyZoo* 
For a hospital birth mom and baby are billed seperately. The insurance will cover it but you have officially add it within 30 days. The insurance covers it starting at birth.

If you quit, I would consider signing up for Cobra until you deliver so that it would be covered fro both of you. It has to be less than paying out of pocket. Based on your income, you may be elgible for medicare once you quit to pay for things.

Midwives in home births and many birth centers bill a flat fee for mom and baby. It is usally a lot less for a HB than a hospital birth.

With your insurance you wouldn't be billed more than 4,000 in network and 12,000 out of network (the single rate x 2). Next I would check on the usual and customary charges. I'm sure they will be more than 2,000 per person (assuming you go in network). The insurance company will pay what ever your in network percentage is after you pay your deductible (on both mom and baby). Usually this amount goes over the out of pocket maximums so that is why I asked what those were. For example if they bill 8,000 for you, you have a $500 deductible and the insruance pays 80% then you pay ((8,000 - 500) x .80) = 6,000 paid by the insurance company. This leaves ((8,000 -500) x .20) + 500 = 2,500 for you to pay. Since your out of pocket maximum is $2,000 this is what you would be billed and the insurance company will pay the extra $500.

Thanks for that info. Insurance have alwasy been confusing to me.

I'm better off not quitting right away. COBRA for me + a dependent would be about $1200/mo. (If I keep working, it would still cost me about $600 a month to add someone on).

Its very hard to qualify for Medicare here unless you are really poor. We make too much. Insurance will always continue to be an issue for us (DP is self-employed and doesnt have benefits).


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## crazydiamond (May 31, 2005)

For insurance after the baby, you might want to look into several individual plans. For my family (fairly young, non-smokers), insurance would only cost, for example, $200-$300/month for a PPO plan through Blue Cross Blue Shield. The higher the deductable, of course, the lower the premiums. The only downside to these plans is that they do not cover maternity benefits, so it's something you wouldn't want to switch if you're planning on having more children right away.


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## barose (Dec 6, 2006)

Quote:


Originally Posted by *crazydiamond* 
For insurance after the baby, you might want to look into several individual plans. For my family (fairly young, non-smokers), insurance would only cost, for example, $200-$300/month for a PPO plan through Blue Cross Blue Shield. The higher the deductable, of course, the lower the premiums. The only downside to these plans is that they do not cover maternity benefits, so it's something you wouldn't want to switch if you're planning on having more children right away.

In 2007, I could not get an individual plan when I was contracting. I was denied due to pre-existing conditions. Hopefully, I will be able to get that cleared up in the next year or two.

*cchrissyy* - Thank you for posting those numbers.


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## Mama Poot (Jun 12, 2006)

When I had DS1 in 2005 the bill was $12,000 for a vaginal delivery/48hr hospital stay. I live in NE Ohio.


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## cchrissyy (Apr 22, 2003)

Oh! I hadn't noticed you are in my area too. That should make the numbers even more relevent.


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