The cost of giving birth in the US

[flyingiguana]

http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?hp&_r=1&

 

LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.

At a prenatal class in March, she was told about epidural anesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?â€

Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,†Ms. Martin said. “I was like, How could you not know this? You’re a hospital.â€

Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,†said Ms. Martin, a former art gallery manager who is starting graduate school in the fall. ......

[DawnM]

It seems like a range of $4,000 to $45,000 is correct. They do not know what sort of complications may arise or how much intervention will be needed. How could a hospital possibly give a concrete number for a service like child birth?

[xixstar]

I would think a business (hospital) should be able to state: for an uncomplicated, unmediated, birth it will be around $x-y, for a medicated, vaginal birth $x-y, and scheduled c-section $x-y. Then add the disclaimer about complications and special situations that could arise, along with additions if the child needs any special medical care.

 

That doesn't seem like an unreasonable expectations since I'm sure they have the data to calculate those numbers, especially if you're asking for a cash price versus insurance price.

[DawnM]

I just think there are too many variables.

 

If your labor lasts only 3 hours and you go home within 2 after birth, and have no medications and only one nurse, then it is X, if you have a 24 hour labor and stay 9 hours after birth it will be Y.....

 

It could go on and on for a very long time.

 

The other problem is, if there needs to be intervention, but the patient is so concerned about cost that she yells NO to all help because she knows all the costs involved, it could be harmful to her and the baby.

 

I may be in the minority, but I see the hospital's hesitancy to give concrete numbers.

 

I would think a business (hospital) should be able to state: for an uncomplicated, unmediated, birth it will be around $x-y, for a medicated, vaginal birth $x-y, and scheduled c-section $x-y. Then add the disclaimer about complications and special situations that could arise, along with additions if the child needs any special medical care.

 

That doesn't seem like an unreasonable expectations since I'm sure they have the data to calculate those numbers, especially if you're asking for a cash price versus insurance price.

 

[FaithManor]

_{I understand the hospital's reluctance, but it doesn't change the fact that we've hit a crisis in healthcare in America and more and more hospitals and health practitioners are going to have to come up with numbers and ballpark figures. There.is.no.other.way. People have to know.}

 

_{And yes, some will turn down vitally needed healthcare and even birth interventions because they can't pay for it. Happens every day all over the world in cash paying systems. Happens every day in America for the uninsured. Mindboggling that a nation with this many resources can't or won't take care of it's people, but that is our reality.}

 

_{I had to check myself out of the hospital post-birth twice AMA out of four pregnancies WITH medical insurance because the company was legally allowed to "disallow" so much of the bill, basically dictating to the docs what they could and could not do, and I knew I couldn't afford to stay any longer. One of those times was VERY dangerous - I could have easily died. Didn't matter. We didn't have the cash. On top of which the interesting thing about AMA is that once you announce to the nurse, or the doc, or the midwife that you can't afford to stay, that you won't have the money to pay the bill, the medical advice suddenly becomes "Oh, well then you in good enough shape to go home." Do I blame them? No. They are just trying to keep their jobs. I would imagine that if they could given their personal opinion, they would have said, "You need to stay. We are very worried about your health." But, personal medical opinion does not trump hospital policy these days. I also declined pain meds because they charge so much for them and the last blood transfusion that I really needed because the cost was astronomical and I knew my insurance company was fighting with the OB about ordering another one. Went home with a hemoglobin count of 6.5! Felt like something the cat barfed up and was too weak to take care of the baby.}

 

_{Insurance drives everything, not the people who went to med and nursing school!}

 

_Faith

[Mommyof4ks]

Under the new healthcare law they will have to come up with a number like it or not. It is the only part of the law I like. The prices will likely be inflated, but at least we will know and we can shop around for a better deal on services like unltrasounds and whatnot. One day we will probably be handed a sheet that lists every possible service and how much it costs like a lunch menu. That would be preferable to the current system which puts hosptials in charge to basically charge whatever they like and change those prices based on hiw much they need for the new building. Now I take my kids in for the same exact thing and get two different totals, no sense in it. That is with insurance, so without could be worse with no one in my corner to fix it.

[MolleenCarie]

When I was pregnant and without insurance, I figured I couldn't afford the hospital, so I found a lay midwife (I had never heard of pregnant Medicaid; I thought Medicaid was for old people). She charged a flat rate which covered pre-natal care, childbirth classes, the birth (at home or at the birthing suite), breastfeeding support and post-partum visits. She served tea during my check-ups. I ended up getting married and moved away before the baby came, but I'm sure we would have had a lovely birth. My point is that if a group of midwives can come up with a flat fee for eleven months of services, I don't see why highly educated HR, OB, and all the letters in the alphabet soup, choose to not do the same.

Here, even I can do it:

No intervention, no complications, two-night stay: $3K.

Epidural: $4K

Pitocin: $100 per bag

C-section: $10K

Stitches: complimentary

 

[elegantlion]

When ds was born we had no insurance. We sat down with the finance person at the office and discussed self-pay. We wanted total cost, everything, at least an estimate before we decided whether to go there or another clinic. Since we were pretty ignorant of the process - which we explained to her over and over- we asked TOTAL cost. When we went for our hospital visit when I was almost due, imagine my surprise when they asked how we were going to pay their part. The person at the office never mentioned in several conversations with her that the costs only covered the doctor, not the hospital, not other services. Never in our entire time in care was this brought up. I had a panic attack literally, ds had a not so nice conversation with the finance office, and I basically spent the last week of my pregnancy in tears. I ended going into labor 3 weeks early, complications caused by scar tissue from a previous surgery, was in "labor" for 3 days before they decided I needed a c-section and spent another week in the hospital. I'm sure the stress caused part of it. The bill was over 16k - that was the discounted price, it took several years to pay in full.

 

My dh has been a carpenter for years. He can't even move forward on a job until a price is negotiated and a contract signed. Yet, for health care we couldn't even get a straight answer about TOTAL cost. There was never a mention, one sentence that could have changed how we approached the situation, something as simple as "oh, that's our part, you'll need to contact the hospital to negotiate payment with them." Imagine if you had to do a house deal like that. Sorry, you have to negotiate a price with ALL of the subcontractors. I just do my part.

 

People want more details about how to pay for a paint job than they do about the cost to care for their own body.

[flyingiguana]

 

Stitches: complimentary

 

Actually, a further point of the article is that nothing is complimentary.

 

The whole article had a lot more info beyond the part I extracted.

 

Just went for a physical yesterday. This is supposed to be completely covered by our insurance. It's about the only thing that is. But I had to sign a form saying I now understood that only the "physical" was covered. ANYTHING else was not. So, if during the physical, my dr now decides I should have a hemoglobin test, or a thyroid test, or any other screening test, that's not covered. Used to be part of the physical. It no longer is.

 

Most anything you can think of that should be part of a well check up is no longer covered. I think maybe the only things that are covered are those that are mandated by law. When we get the bill, I will not be surprised if taking my blood pressure is charged for.

 

And while using a midwife will bring down the cost of a birth, the health provider industry will still nickel and dime your bank acct to death.

 

And yet, our health care is no better. And possibly worse.

 

The corporations (both insurance and health care companies) have way too much power. And greed.

[Murphy101]

It's ridiculous and our mortality rate is lower and, personally, I sure as heck have not been impressed by the care I've received. Call me jaded, cynical, disillusioned, but it's based on experience.

 

Personally, I don't think America will ever have quality healthcare as long as insurance is a mandated part of the equation bc insurance is a huge part of the problem.

[chiguirre]

I would think a business (hospital) should be able to state: for an uncomplicated, unmediated, birth it will be around $x-y, for a medicated, vaginal birth $x-y, and scheduled c-section $x-y. Then add the disclaimer about complications and special situations that could arise, along with additions if the child needs any special medical care.

 

That doesn't seem like an unreasonable expectations since I'm sure they have the data to calculate those numbers, especially if you're asking for a cash price versus insurance price.

 

 

Private clinics in Venezuela do this, although there are only two price tiers: vaginal birth (they assume anesthesia) and C-section. I think they average the price so they're not quoting a bare bones, unmedicated price, they're assuming that xx% of patients will need Pitocin, xx% anesthesia, xx% episiotomy, etc. You can buy a birth specific insurance plan that will cover a C-section and NICU if needed if you don't already have a private insurance plan. It's really not expensive and you can pay in installments over the 9 months before the birth. If this is standard practice in a country that's not at the cutting edge of technology or finance, there's no reason American hospitals couldn't do it. Of course, knowing how much it will be going in means they can't jack up the bill for insured patients--it would be one price for everybody. The other issue is that in Venezuela, if you can't afford a private clinic, you can use the public hospital where you won't be charged anything. It's not pretty, but it is safe.

[Laura Corin]

It cost 24,000 Hong Kong Dollars when I gave birth in Hong Kong (normal vaginal delivery, with gas and air then a painkilling injection) followed by a day at the hospital - I was booked in for three days, but I thought I would get more rest at home. That's about USD3,000. We had insurance that covered it at the time. That was the price for a shared recovery ward (five beds). It was a pretty nice place though - I'm sure it was possible to do it cheaper.

 

Calvin was born in the UK, so there were no fees.

 

L

[Mom2pandc]

I didn't have maternity insurance when I had my daughter. It was less expensive to pay out of pocket than to purchase a maternity rider. My doctor charged a flat fee of around $2,500, that included all the prenatal visits plus his delivery fee. Then I called the hospital as soon as I found out I was pregnant and asked about cash price. Without an epidural and a two day postpartum stay it was around $2800 with an epidural it was $3200 plus the anesthesiologist charge. The doctor required payment in full by a month prior to due date and the hospital asked for half before the delivery date and the balance 30 days post delivery, I chose the no epidural price since I didn't have one with my son. I actually paid the hospital in full prior to delivery. I however ended up needing an epidural but was only charged by the anesthesiologist for a couple hundred dollars. The hospital sent me a bill with a zero balance so either they missed that I had an epidural since I had already paid in full, or they just let it go since I left 24 hours post delivery.

Either way, it's easier to ask well in advance of the service. By asking months before hand, you don't feel pressured to hurry up and figure it out because you need something done right now.

And I didn't have any ultrasounds. I'm an X-ray tech and think that ultrasounds are way overused and not necessary but rather "fun" for most routine pregnancies.

[Dahliarw]

I just think there are too many variables.

 

If your labor lasts only 3 hours and you go home within 2 after birth, and have no medications and only one nurse, then it is X, if you have a 24 hour labor and stay 9 hours after birth it will be Y.....

 

It could go on and on for a very long time.

 

 

I had 2 midwife assisted births at home with 2 different midwives. Both charged a flat fee for all prenatal visits (not counting labs which were sent out, like blood draws, diabetes test, and ultrasound - all of which were optional if pregnancy was complication free), delivery, and 2 post-natal visits. I think it was 2500? I provided the birth supplies (under $100). It didn't matter if my labor was 1 hour for 48 hours, same price. The only "additional fee" was if I had to transfer to the hospital and I wanted my midwife to come with me. Basically, if I transferred, they could not collect the delivery fee, it went to the OB at the hospital, so that is why. But I could choose to have them not come (they would have only come as support, not medical staff). So the hospital could have a flat rate of any duration of labor + 24 hour post birth stay or something like that. Then a flat rate for 24 hour stay beyond that and a flat rate for basic supplies, rather than charging $10 for a diaper or Tylenol, whether you use it or not.

[HRAAB]

I was shocked at how much costs had increased since my last pregnancy. Guess I should have been since it's been 12 years. My oldest just had her first child. Midwife, epidural, no complications, overnight in the hospital = $17,000. That is a lot of money.

[PentecostalMom]

Our midwife has a flat fee as well.  It is $4500.  That is for a birth center birth with whatever they need to use there, including a birth assistant and all supplies.  Transfer to the hospital, of course, would be more expensive.  It is what we have done twice now, the others were all hospital births because we had no other options other than home birth with no medical professionals.  Something we are not quite comfortable with.

 

There is a movie, currently on Netflix and available at the library here titled, "The Business of Being Born."  The facts and statistics about c-section births and other unnecessary interventions are astounding.  I am not anti anything when it is necessary, but when it is done for the convenience of the hospital, doctor, or even parent, it's just not right.

[dakarimom5]

I had my yearly GYN visit a few months ago. In the exam room there was a sign saying that the pap would be free but anything else would require a copay. This upset me because if a woman just had a question she would be charged a copay.

[Audrey]

It cost 24,000 Hong Kong Dollars when I gave birth in Hong Kong (normal vaginal delivery, with gas and air then a painkilling injection) followed by a day at the hospital - I was booked in for three days, but I thought I would get more rest at home. That's about USD3,000. We had insurance that covered it at the time. That was the price for a shared recovery ward (five beds). It was a pretty nice place though - I'm sure it was possible to do it cheaper.

 

Calvin was born in the UK, so there were no fees.

 

L

 

 

When I had my son (here in Canada), I wasn't yet on provincial healthcare because I had to have an x-ray to finalize my PR (perm. resident) application and I couldn't because I was pregnant.  So, I had my letter that I could have my PR as soon as I got my x-ray which meant that my health care would get activated retroactive to the date of the letter, which was months before my due date. 

 

Well, I had 6 days in hospital in a semi-private (2 bed) room and a c-section and loads of drugs trying to induce labour, etc.  I did get a bill because when there, I still wasn't technically on PHC and didn't have a health # to give them.  The whole bill was just under $6K CDN.  I got my x-ray and my PR and my PHC retroactive within a few weeks of ds's birth, so I didn't actually pay anything at all.

 

The $6K billed to me was what they would have billed anyone not covered under PHC.  Knowing what it costs south of the border, neither dh nor I wonder why so many border jump around their due date.  It's a huge bargain.

[Elfknitter.#]

I get the huge span in cost. As others have said, there are a multitude of variables that will effect final cost. My first, turning 10 next month, was a hospital birth with epidural. We had an HMO insurance then (Kaiser) so everything was covered. Dh inquired what the cost of that birth would have been and he was told $29k. :-O

 

My next two were home births and both midwives had a flat fee that included prenatal checks, delivery, and transfers, if necessary. Neither of those were over $5000. With the second home birth, we were able to have the PPO cover part of the costs, which helped immensely.

[Ailaena]

I would think a business (hospital) should be able to state: for an uncomplicated, unmediated, birth it will be around $x-y, for a medicated, vaginal birth $x-y, and scheduled c-section $x-y. Then add the disclaimer about complications and special situations that could arise, along with additions if the child needs any special medical care.

 

That doesn't seem like an unreasonable expectations since I'm sure they have the data to calculate those numbers, especially if you're asking for a cash price versus insurance price.

 

 

 

Just a couple of months ago I was shopping for a place to give birth using cash.  I called every hospital in the Denver area and they ALL had plans for cash payments.  Most of them wanted payments to begin immediately and then you had a small grace period afterwards to finish payments.    I found the fees for a 24-hour hospital stay, vaginal birth, with no major complications to range from $1600-4500, and may or may not include a well check for the baby. The birthing center was @$4500.  Since the $1600 hospital was where I had my daughter a million years ago, I jumped at that chance.  A couple of hospitals had add-on packages for anesthesia that you were allowed to add right up to the birth of the baby.  And, of course, all fees are fully refundable in the event that you do not use their services (emergency, miscarriage, whatever).  Most of them did have further pricing quotes for longer stays.

 

Doctors fees also varied wildly from $1500-10000 (although the $10,000 doctor was a maternal-fetal physician), and of course you had to choose a physician that had privileges at the hospital you had chosen.  I chose an OB that charged $100 for the first visit, $50 for each additional visit, $1000 for a vaginal birth and $2000 for a C-section.  All ultrasounds and urinalyses were included, as were fees for blood draws (but not the actual lab fees).  And you could see the doctor as much or as little as you wanted provided you were not having any problems.  Other places charged extra for every, little thing.

 

In contrast, when I was facing the prospect of a D&C, the doctor had a $294 fee, but the hospital had a $2200 fee (which was 71% off of the normal price, yay!), was due up front, and did not include an anesthesiologist if one was needed.  I was like, um, can we just consider this a birth, maybe? 

 

On a somewhat related side note, my mother just spent 10 days in the hospital and the room fees alone were $230,000.  :ohmy:

[Night Elf]

There is a movie, currently on Netflix and available at the library here titled, "The Business of Being Born."  The facts and statistics about c-section births and other unnecessary interventions are astounding.  I am not anti anything when it is necessary, but when it is done for the convenience of the hospital, doctor, or even parent, it's just not right.

 

I watched that movie in one of my college Montessori classes. It was shocking and made me glad I wasn't have any more children. It was scary stuff. There is a 4-part sequel too. Netflix has both in streaming. Only the first one is also available as a DVD.

[VeritasMama]

My sister homebirths, her midwife charges $2,000 for everything, and she has insurance that covers most of it.

 

I have to have c-sections, wish it wasn't the case. My last c-section was over $30,000. Our share with the deductibles and copays was around $5,000, we are fortunate to have good insurance, and it is still a pretty big burden. I've never come across a hospital that wasn't willing to come up with a payment plan and negotiate the final bill, and I've given birth in 3 different states in 5 different hospitals, we've moved quite a bit.

[VeritasMama]

Dp

[AHASRADA]

OT a bit, but I am shocked at how many of you have had to pay out of pocket for prenatal care and delivery.

 

I was under the impression that most uninsured pregnant women were covered by Medicare. It covers all prenatal visits and tests, all hospital procedures, and 60 days postpartum for mom

and 1 year of pediatric visits for the baby. Everything is covered, no copays.

 

Did you not know about Medicare at the time, or not qualify due to high income? Just curious, since I believed pregnant women to be one protected class that is pretty much guaranteed coverage.

[NASDAQ]

OT a bit, but I am shocked at how many of you have had to pay out of pocket for prenatal care and delivery.

 

I was under the impression that most uninsured pregnant women were covered by Medicare. It covers all prenatal visits and tests, all hospital procedures, and 60 days postpartum for mom

and 1 year of pediatric visits for the baby. Everything is covered, no copays.

 

Did you not know about Medicare at the time, or not qualify due to high income? Just curious, since I believed pregnant women to be one protected class that is pretty much guaranteed coverage.

 

Medicaid covers people in need. Medicare is for old people. FWIW.

 

A woman in labour cannot be turned away, but AFAIK, Medicaid does have income restrictions. I think those are set by the state. But I don't know for sure.

[elegantlion]

Did you not know about Medicare at the time, or not qualify due to high income? Just curious, since I believed pregnant women to be one protected class that is pretty much guaranteed coverage.

 

Yes, our income at the time was too high for any coverage. 

[ktgrok]

I know lots of women that make too much for medicaid....several that were less than 100 dollars over the limit. So zero coverage.

[Unicorn.]

I know lots of women that make too much for medicaid....several that were less than 100 dollars over the limit. So zero coverage.

We didn't qualify with oldest by 50 or 75 cents. And yes, I said cents. And dh's insurance considered pregnancy a pre-existing condition, so I would have had to be covered by the insurance for a full year before becoming pregnant. Boy was paid off over several years, don't have the exact cost, but probably around 5-6000.

 

I had amazing insurance w/ the twins. Total cost of prenatal care, C-section, 5 days in hospital...$650. 150 for all the prenatal, including several ultrasounds, was 150. Total hospital...500.

[Shahrazad]

#1 was a complicated pregnancy and ended with a c/s and premature baby. Birth was $35,000 not including hospitalization and care for the premature baby which brought the cost up to 100,000 before insurance.

#2 was a natural homebirth with a midwife which was only $3,500, I believe. However, because of the complications I needed high-risk OB care during pregnancy so that bill was probably close to $20,000 before insurance.

[redsquirrel]

OT a bit, but I am shocked at how many of you have had to pay out of pocket for prenatal care and delivery.

 

I was under the impression that most uninsured pregnant women were covered by Medicare. It covers all prenatal visits and tests, all hospital procedures, and 60 days postpartum for mom

and 1 year of pediatric visits for the baby. Everything is covered, no copays.

 

Did you not know about Medicare at the time, or not qualify due to high income? Just curious, since I believed pregnant women to be one protected class that is pretty much guaranteed coverage.

There are lots and lots and lots of people in this country who make too much to qualify for Medicaid but can't afford private health insurance. That is why so many people don't have it. And just because you are pregnant without health insurance doesn't mean that you will qualify for Medicaid. There is nothing close to a 'guarantee' of coverage for anyone.

 

And even if you do qualify for medicaid it doesn't mean you can find a doctor who takes it. I live in a fairly rural and isolated county. Over half of the births in the county qualify for medicaid, however there is not one OB in the county who accepts medicaid. Zero. None. That means that pregnant women mostly go without or find a way to drive an hour to another county to an OB that accepts medicaid. It should be noted that if you are poor enough to qualify for medicaid you might not have a car, or a dependable car, or a job that allows you to take off a day for an ob appt in the next county, or be able to afford half a tank of gas to get to the appt if you can even get in. Getting to the next county is a 60 - 45 min drive on the high way. It isn't a reasonable distance for most people.

[MolleenCarie]

OT a bit, but I am shocked at how many of you have had to pay out of pocket for prenatal care and delivery.

 

I was under the impression that most uninsured pregnant women were covered by Medicare. It covers all prenatal visits and tests, all hospital procedures, and 60 days postpartum for mom

and 1 year of pediatric visits for the baby. Everything is covered, no copays.

 

Did you not know about Medicare at the time, or not qualify due to high income? Just curious, since I believed pregnant women to be one protected class that is pretty much guaranteed coverage.

Though I had not heard of Medicaid for pregnant women at the beginning of my first pregnancy, and would have qualified for it as I worked as a waitress, I would not have applied.

 

That is not how I was raised.

 

I did learn about it later, as well as the free housing, food stamps, and subsidized daycare, as several other girls I worked with were pregnant at the same time. They did not have supportive families, though, and the fathers were usually absent or irresponsible.

 

My mom was very helpful. After the initial shock of the pregnancy wore off, she was excited and supportive. My then-boyfriend was also a good one and would have sent money for the baby's needs if I'd asked. I didn't have to, though, because he asked me to marry him instead.

[MomtoCandJ]

Or the only ob/gyn in the area sucks, there for you have to drive 60 minutes a few counties away if you can. I am lucky that I am able to drive to the other ob/gyn.

[AHASRADA]

Thanks for the clarifications. I didn't imagine there were many women who didn't have insurance and also didn't qualify for Medicaid.

 

I also had no idea there were places that don't have doctors who accept Medicaid. How can that be legal?!

 

I gave birth all 3 times (with a variety of insurances) in an excellent teaching hospital, once with a physician's group, twice with a group of midwives, and received wonderful, respectful care. The doctors, midwives and hospital all accept insurance, including Medicaid, and treat patients equally. Protocols are in place so the treating professionals don't know the patient's funding source; that is discussed privately with billing.

 

I knew the healthcare system was a mess, but I thought pregnant women and kids were the exception (my home state covers uninsured kids in middle class families and below).

 

I am forever having my eyes opened by those with different experiences. It makes me grateful for the medical care I have been blessed to receive.

[redsquirrel]

As near as I can tell, accepting medicaid is the exception, not the rule.

 

I have insurance but our doctor doesn't take it. We pay out of pocket and hope some gets reimbursed. We have to pay 140$ for an office visit and get 30$ back. We don't go to the doctor unless it is very necessary.

[Punks in Ontario]

When I had my son (here in Canada), I wasn't yet on provincial healthcare because I had to have an x-ray to finalize my PR (perm. resident) application and I couldn't because I was pregnant.  So, I had my letter that I could have my PR as soon as I got my x-ray which meant that my health care would get activated retroactive to the date of the letter, which was months before my due date. 

 

Well, I had 6 days in hospital in a semi-private (2 bed) room and a c-section and loads of drugs trying to induce labour, etc.  I did get a bill because when there, I still wasn't technically on PHC and didn't have a health # to give them.  The whole bill was just under $6K CDN.  I got my x-ray and my PR and my PHC retroactive within a few weeks of ds's birth, so I didn't actually pay anything at all.

 

The $6K billed to me was what they would have billed anyone not covered under PHC.  Knowing what it costs south of the border, neither dh nor I wonder why so many border jump around their due date.  It's a huge bargain.

One of the things I love about Canada is the healthcare.  We may not have the super duper high end care but it's always available and has never let us down when we've needed it.

[TranquilMind]

No kidding!  I had a midwife, and it was pretty darn straightforward. 

Yes, they could do it. 

 

Ha ha at your "stitches complimentary". Oh, you pay and pay and pay.

When I was pregnant and without insurance, I figured I couldn't afford the hospital, so I found a lay midwife (I had never heard of pregnant Medicaid; I thought Medicaid was for old people). She charged a flat rate which covered pre-natal care, childbirth classes, the birth (at home or at the birthing suite), breastfeeding support and post-partum visits. She served tea during my check-ups. I ended up getting married and moved away before the baby came, but I'm sure we would have had a lovely birth. My point is that if a group of midwives can come up with a flat fee for eleven months of services, I don't see why highly educated HR, OB, and all the letters in the alphabet soup, choose to not do the same.
Here, even I can do it:
No intervention, no complications, two-night stay: $3K.
Epidural: $4K
Pitocin: $100 per bag
C-section: $10K
Stitches: complimentary

 

[Firefly]

This has been an interesting read-- like a PP I had no idea people were paying so much out of pocket for prenatal care and deliveries.  I had typical pre-natal care, including frequent visits, ultrasounds etc, wound up having two emergency C-Sections (spending almost a week in hospital both times), and never saw a single bill or copay.  This was in '97 and '99.  I don't remember exactly what we had for insurance at the time but I guess it must have been pretty good. 

[Erin]

I didn't imagine there were many women who didn't have insurance and also didn't qualify for Medicaid.

This is one of the big reasons the ACA was passed...

[kiwik]

if it costs so much to give birth over there how come so many people on these boards have so many kids?

 

Mine was essentially free - first 12 by my GP, 12 weeks to 12 days post partum. Check Ups by Plunket for a few years and immunisations by the GP. Free care until 6 but almost the adult rate after that (still usually less than $40).

 

Eta. If you work and pay taxes and still qualify for Medicaid and can't afford insurance it seems to me it is what a decent society should be giving you not something you should be ashamed of. No child should come to harm during birth because of its mothers financial state.

[EthiopianFood]

This is one of the big reasons the ACA was passed...

Yeah except, at least here, if you qualify for insurance through your work, and your employer pays 50% or more of the premium, you aren't eligible for state insurance anyway. Can't afford the premiums? Too bad.

[K&Rs Mom]

Thanks for the clarifications. I didn't imagine there were many women who didn't have insurance and also didn't qualify for Medicaid.

 

I also had no idea there were places that don't have doctors who accept Medicaid. How can that be legal?!

 

 

 

We have pretty good insurance, except that NOTHING related to pregnancy/maternity is covered, and I expect we wouldn't qualify for Medicaid.  My estimate for this baby from ob/gyn is about $1400 for all prenatal visits plus delivery & checkup afterward; this doesn't include anything from the hospital and would change if there are any complications.  We haven't yet called the hospital to get their estimate.

 

I know a family who used medicaid for the kids for a few years of lean employment, and they always had to call around to find someone who would take it.  When dh worked for an insurance company, he saw some of the inside of that system, and it doesn't work out well for the doctors, so no surprise some of them refuse or limit it - most medicaid visits end up a financial loss for them.

[ktgrok]

Yeah except, at least here, if you qualify for insurance through your work, and your employer pays 50% or more of the premium, you aren't eligible for state insurance anyway. Can't afford the premiums? Too bad.

It is my understanding that if your premiums would be more than 8% of your pay you would qualify.

[Paige]

I also had no idea there were places that don't have doctors who accept Medicaid. How can that be legal?!

We can't force people to work for whatever we feel like paying. Doctors refuse medicaid because it is a headache and doesn't cover their expenses. How could it be legal to force them to accept medicaid?

 

We have military insurance which doesn't pay the doctors much either. I had one OB tell me that he accepts the payment as a service and a way to give back to his country. He doesn't make money off of us. I see my explanation of benefits and what was billed vs. what was covered and I am shocked that the doctors are willing to accept it. They cannot bill me for the remaining amount. I know the original price is probably inflated, but there is a huge gap between what is billed and what is paid.

[4everHis]

Thanks for the clarifications. I didn't imagine there were many women who didn't have insurance and also didn't qualify for Medicaid.

 

I also had no idea there were places that don't have doctors who accept Medicaid. How can that be legal?!

 

I gave birth all 3 times (with a variety of insurances) in an excellent teaching hospital, once with a physician's group, twice with a group of midwives, and received wonderful, respectful care. The doctors, midwives and hospital all accept insurance, including Medicaid, and treat patients equally. Protocols are in place so the treating professionals don't know the patient's funding source; that is discussed privately with billing.

 

I knew the healthcare system was a mess, but I thought pregnant women and kids were the exception (my home state covers uninsured kids in middle class families and below).

 

I am forever having my eyes opened by those with different experiences. It makes me grateful for the medical care I have been blessed to receive.

Just found out a friend who's dh makes about $25,000 and they have over 6 kids have lost their state insurance because they make to much. I think the amounts ($$$) must be changing for state aid because there would have been 0 question 5 years ago that they qualified.

[FaithManor]

There are lots and lots and lots of people in this country who make too much to qualify for Medicaid but can't afford private health insurance. That is why so many people don't have it. And just because you are pregnant without health insurance doesn't mean that you will qualify for Medicaid. There is nothing close to a 'guarantee' of coverage for anyone.

 

And even if you do qualify for medicaid it doesn't mean you can find a doctor who takes it. I live in a fairly rural and isolated county. Over half of the births in the county qualify for medicaid, however there is not one OB in the county who accepts medicaid. Zero. None. That means that pregnant women mostly go without or find a way to drive an hour to another county to an OB that accepts medicaid. It should be noted that if you are poor enough to qualify for medicaid you might not have a car, or a dependable car, or a job that allows you to take off a day for an ob appt in the next county, or be able to afford half a tank of gas to get to the appt if you can even get in. Getting to the next county is a 60 - 45 min drive on the high way. It isn't a reasonable distance for most people.

Yep, in our county, this is very true. Many Medicaid recipients can't make it the 50 min. drive one way to the only OB office accepting new Medicaid patients, so they get a little prenatal care at the health department...an OB nurse records weight, does a urine analysis, blood pressure, and hands out prenatal vitamins. Many will never see a doc the entire pregnancy. Then when they go into labor, they call the ambulance which Medicaid does have to pay for so they have a ride to the hospital and someone to deliver the little one if labor progresses too rapidly. The county hospital is terrified of women delivering in the ER, and routinely wave the ambulances on in the hopes they'll make it in time. Some don't, and the medics catch...works out well, medics are calm and outside of starting and IV and tributerol drip for pre-term labor, don't have a lot of options for interventions, so hey...they just pull over, catch, APGAR score the babe, make sure mom is doing okay, wrap the little person up and hand to mom, almost never cut the cord unless the afterbirth comes before reaching the ER, look over the afterbirth and bag it up for OB staff, and off they go again. Seriously, there is a medic in our county that has delivered 30 babies in the last ten years, and local women report that if you need to deliver, he's the man you want! Apparently, he is very sweet and supportive during labor and his EMT partner is a doll!

 

So, that's America for you! But, it's not as though this is new. Many, many rural areas of the US have always been underserved, badly underserved and so dealing with the medical mess of not having practitioners who deal with medical condition X anywhere within a reasonable commuting distance is normal, unfortunately.

 

By the way, your delivery by medic, runs around $600-800.00. It's a real bargain! :D  DD says she would be more than happy to attend your birth! (Stinker medic that she is!)

 

 

Faith

[FaithManor]

It is my understanding that if your premiums would be more than 8% of your pay you would qualify.

 

That varies by state. The thresholds can be surprisingly high in some areas due to serious state budget cuts.

 

Faith

[Mom2pandc]

I had health insurance at the time, just not a maternity rider. I spoke with the insurance company and was informed that as an expectant parent, they would not cover any maternity, but they would cover and complications during pregnancy and they cover the baby automatically including any complications post delivery. Therefore, I only had to pay for the prenatal and delivery, but could rest easy if there were complications and an increased cost as a result.

I think we probably made over the Medicaid limit to qualify, but as a previous poster said, I wouldn't have used it even if I qualified. We planned our pregnancy and planned for the costs of the pregnancy and baby. We knew when we signed up for regular insurance what that did and did not include.

[goldberry]

This is one of the big reasons the ACA was passed...

 

 

We are self-employed with a 10K deductible bare bones policy for $300/month.

 

Under ACA, our insurance will be going up estimated to $1000-$1200 (for a family of 3).  We are supposed to be able to afford this without any assistance.  I don't see how it's going to be possible.  We just don't have that money in the budget.

 

I am in favor of universal coverage.  I think the problem was them trying this half-way fix without addressing all the problems.  It's going to get ugly really fast.  I just hope it goes forward and not backward.

[MomtoCandJ]

Just found out a friend who's dh makes about $25,000 and they have over 6 kids have lost their state insurance because they make to much. I think the amounts ($$$) must be changing for state aid because there would have been 0 question 5 years ago that they qualified.

Oh wow dh makes $30,000 a year, there are three of us (soon to be four). Dd and I both have Medicaid (Michigan Healthy Kids). Is there a program available that has a low monthly fee for uninsured children? In MI there a variation of healthy kids (MiCHILD) where you pay $10.00 a month for all the children. This is what we had originally signed dd up for, but was told we qualified for the free one.

[BlueTaelon]

It's ridiculous and our mortality rate is lower and, personally, I sure as heck have not been impressed by the care I've received. Call me jaded, cynical, disillusioned, but it's based on experience.

 

Personally, I don't think America will ever have quality healthcare as long as insurance is a mandated part of the equation bc insurance is a huge part of the problem.

Keep in mind America doesn't have health care, we have sick care. We've gone though a lot of Dr's over the years, our medical costs were easily over $100,00 year paid though Medicaid and not ONCE did a Dr find out what the frag was wrong with us. I DID! I went online and searched until I found answers and now were doing pretty well, I'm actually able to work for the first time in years and none of it thanks to American Medicine. The system here is designed to keep you sick from high priced "healthy unprocessed food" (I'm not even talking organic!) to medications that require other medications to deal with the side effects of the medication thats supposed to make us better! You can't really get decent healthcare in the US with health insurance, the really good Dr's don't seem to take insurance which once again means healthcare is only for the rich which is frustrating. It means the quality of healthcare you get depends on your brainpower and ability to learn for yourself and afford the cost of what ever you need to get better because IME you sure as heck aren't going to get better using the Dr's your insurance pays for. Really ticks me off when family I KNOW has the same metabolic disorder we have is having their lives turned upside down and they say "I'll talk to my Dr about it". Your Dr will never have heard about it most likely and will blow you off and will hand you powerful drugs that will make you worse.