Childbirth Hospital Costs With and Without Insurance: A Detailed Example.

The cost of raising a child does not come cheap.  That expense starts from day one where the  cost of delivering a baby in the hospital can be tens of thousands of dollars.     Our little Zachary was born April 21st, 2011 by vaginal delivery.  Forty-two days later we still had not received our explanation of benefits from Blue Cross Blue Shield for the midwife charge.  I had previously received a statement from them saying the charge was under review.  Perhaps they believed that delivering Zachary was not medically necessary.  I can't explain it.  When I called to ask them why this charge had not been approved,  they said they could not give me a reason why my explanation of benefits statement had not been finalized after 42 days.  I pressed for more information, but to no avail. I was given no reason other than to say that they had a lot of claims to review.   That's not an acceptable reason to delay a payment of a claim.  

At the end of my conversation, I indicated to the nice customer service lady that I would be filing a complaint with my state board of insurance for failure to process claims in a timely manner.  Then came silence. And a pause.  She indicated they would expediate the charge through the review process.  I got off the phone, went on line and filed a complaint with my state.  Three days later, I received a finalized explanation of benefits form from Blue Cross Blue Shield.  As part of a high deductible HSA, we prepaid our midwife for the global delivery fee and for me to get my money back from them, as we had now met our deductible for the year,  Blue Cross Blue Shield needed to stop stalling and pay the midwife.  And they did. And I got confirmation this week that my prepaid money would be coming back to me shortly.  With that mess settled,  I now have a complete list of all our Zachary's childbirth hospital costs.

Understand not all hospitals stays are the same.  Every delivery and their associated charges are dependent on individual circumstances.  Was it a vaginal delivery or a cesarean section.  Was their an epidural involved or was it natural?  Did complications play a role in the delivery? Was the baby premature?  Many issues will ultimately determine the cost of childbirth in the hospital setting.  Here's a little background on the services that were provided for our hospital stay.

How did the hospital admission day begin?  We had been having a wonderful day at the dog park with our two Italian greyhounds Marty and Cooper.  Things changed rapidly that afternoon after we left the dog park and headed to Lowe's.  Mrs Happy was admitted to the hospital on April 20th, 2011 at 7pm after her water broke at 37 weeks on the nose, at Lowe's, at 4:30 pm that afternoon while we shopped for a garden tiller. Because she  had not been tested for group B strep, a standard pre delivery test, she was initiated on Pen G every 4 hours prior to delivery.  She had pre delivery routine lab drawn, but I can't remember what it was. She also had an exam to check for amniotic fluid to confirm rupture of membranes.  It was confirmed.

After labor failed to progress over the next few hours and because her membranes had ruptured,  she was initiated on pitocin at 3 am on April 21st, 2011.  Zachary was delivered by a midwife at 1:01 pm on April 21st, 2011 in an uncomplicated vaginal delivery without an epidural, no anesthesiologist, no radiology charges and no opiate pain medicine. She spent just under 24 hours in the delivery room and 48 hours  in the post partum room prior to discharge before we headed home to start our life with Zach.  So, what did this uncomplicated hospital childbirth cost us and our insurance company?  Here's a table below detailing what all the childbirth hospital costs were with and without our insurance allowable charges.  These charges do not include other pre delivery office charges, lab work, ultrasounds and non global fee related midwife charges, which were billed separately and listed below the table.

HOSPITAL MOM

4/20-4/23
CHARGE (NO INSURANCE) ALLOWED CHARGE (WITH INSURANCE)
Private Room after delivery
(<48 hours)
$2,970 $1841.40
Ancillaries $1,371.53 $663.97
Laboratory $321 $199.02
Delivery Room (<24 hours) $3082 $1910.84
TOTAL $7,744.53 $4,615.23
HOSPITAL BABY

(4/21-4/23)
CHARGE (NO INSURANCE) ALLOWED CHARGE (WITH INSURANCE)
Nursery $1,240 $768.80
Ancillaries $164.43 $101.95
Laboratory $422.45 $261.92
TOTAL $1,826.88 $1,132.67
MIDWIFE CHARGE (NO INSURANCE ALLOWED CHARGE (WITH INSURANCE)
Global delivery charge $2,800 $2,221.41
PEDIATRIC CARE CHARGE (NO INSURANCE) ALLOWED CHARGE (WITH INSURANCE)
4/22 Newborn care $140.00 $89.93
4/22 Circumcision $653.00 $263.10

4/23 Hospital visit

$129.00

$105.69
TOTAL $922 $458.72
TOTAL HOSPITAL CHARGES

$9,571.41


$5,747.90
TOTAL PROFESSIONAL CHARGES $3,722 $2,680.13












GRAND TOTAL $13,293 $8,428.03

In addition to these childbirth hospital charges, we also incurred three days of home health care biliblanket therapy hospital charges of $1,069.20, with the allowable charges insurance discount reducing this cost to $555.  This was due to treatment for  jaundice of the newborn.

In addition, other pregnancy related charges incurred  included prolonged progesterone therapy, used in light of two prior miscarriages.  Some doctors believe in progesterone therapy during pregnancy and some don't.  Our pharmacy charge for this was $489.75.  Progesterone therapy was continued right up to the 34th week of pregnancy due to persistently low progesterone levels.  The cost of these frequent lab draws totaled $251.59 during pregnancy.  Add in five additional unbundled office visits with  four medically necessary  ultrasounds at  a post insurance allowable charge of $1,583.73 and the total cost to bring Zachary from pregnancy to birth (not including pregnancy tests,  a miscarriage blood panel and all the prior fertility treatments and therapies) was  $12,377.30.  Little Zachary cost $12,377.30  from conception through the  first few days of life.  I hate to be the one to tell him some day that it's coming out of his allowance.
  

Baby-Little-Peanut-Outfit-3-Months-Old



In addition, some hospitals are mandating therapeutic substitutions in an effort to reduce costs in the post Accountable Care Act (ACA) environment, as this medical humor ecard explains.

"In an effort to minimize disruptions to your birthing experience, we now mandate therapeutic substitution of birth plants for your birth plan.  Please accept this baby's breath as thanks."

Birth plants instead of birth plans ecard humor photo

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