The XX Factor

Having a Baby in the U.S. Costs Way Too Much, Especially If You Actually Pay Your Bills

American Way of Birth, Costliest in the World,” declares the New York Times on Monday, and man everyone is outraged. But the piece, which details the ridiculous costs associated with pregnancy and delivery in this country, could only get a nod out of me. Because there in my purse, sitting on my lap as I read the story on the subway this morning, was my pile of bills, many of them still unopened, from the birth of my third son in March.

Times reporter Elizabeth Rosenthal:

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

Women with insurance pay out of pocket an average of $3,400, according to a survey by Childbirth Connection, one of the groups behind the maternity costs report. Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.

Not just two decades ago! Five years ago, when I had my first child, the only thing my husband and I paid for was the television in my semiprivate room. (The baby arrived the night of the third Obama-McCain debate. Don’t judge.) With the second child, I managed to go without television for a full 48 hours, so the whole thing was free (otherwise known as “covered”). No. 3, however, was a different story. Part of this is because I switched jobs and also switched insurance plans—I can’t say what my third labor would have cost had I stayed on my old insurance. But what the hospital would have charged insurers would presumably be roughly the same.

So, lucky No. 3. All of my labors were induced, but the third time around, before the nurse could even hook me up to the Pitocin drip, we were hit with a $2,500 charge. And it only got worse from there. The delivery went fine—textbook vaginal—but the baby had some respiratory issues that required a week stay at the NICU. Here, a brief synopsis of how things go in the NICU: Your baby is hooked up to a bunch of tubes and IVs and a mask (and even more tubes and IVs if your baby is in worse shape than our baby was—and our baby was not in such bad shape). Everything beeps. They run tests. Various doctors from various departments come in to check on who knows what all day and all night. They see something “a little off” on one test result, so they order another. Not to worry. Night and day are all the same in the NICU, so it’s not unusual for a doctor to decide that your baby needs an EKG at 2 a.m., when you are not actually at the hospital because you have two other kids at home to take care of and also need some sleep. That EKG is expensive. Not that you ever had the opportunity to turn it down, because, again, 2 a.m. But even if it had been 2 p.m. and you had been caffeinated and Purell’d and on the ball, your tiny newborn baby is still hooked up to tubes and can’t breathe on his own, so you’re not about to say no to anything. Nor should you, I guess. Thankfully, this hospital you’ve chosen is “in-network,” so whew for that.

Or not whew. What we later found out is that although the hospital we chose was in-network, some of the physicians that work in the hospital we chose that is in-network are not in-network. They are out-of-network. Did you know that you pay the physicians separately from the actual tests and procedures and diapers? Well, I didn’t know, which is why after having paid off a bunch of incomprehensible hospital bills that came in succession nearly every day for a good chunk of my maternity leave, I was quite surprised to get a whole new round of bills from the “physician services” department. (That’s one of them, above.) When I called to say, “Hey, wtf, I already paid for this stuff,” the hospital representative very nicely informed me that, no, I had paid for the tests but not for the doctors who administered (or ordered?) the tests. And then she very nicely explained to me that, while my plan covers 90 percent of costs (and I’m on the hook for the other 10 percent), if any of the doctors who cared for my son were out-of-network, I would have to pay more. I’m paraphrasing here, but I believe I said something like, “Wait, was I supposed to stop the doctor who worked in an in-network hospital and wanted to run a test on my newborn son’s heart three days after he was born and ask him if he took my insurance?!” “Of course you wouldn’t have,” she very nicely replied. Have I mentioned how nice she was?

Much of Rosenthal’s piece focuses on a couple whose insurance does not cover maternity care. That all insurance plans don’t cover one of the most common “conditions” in life (a condition that is not only part of life but necessary for life) is enraging. (And it actually won’t be allowed starting next year, when the Affordable Care Act will require insurers to include maternity coverage, though, as Rosenthal writes, “the law is not explicit about what services must be included in that coverage.”) But even for someone like me, someone with a “good” insurance plan, costs are exorbitant.

For a while I had convinced myself that I wouldn’t actually have to pay these bills. That some insurance fairy was going to magic wand this all away, because, hey, I’M COVERED. But I’ve been commuting to and from work for over a month with these bills in my purse, and they keep being there, in my purse, not going away. After reading the Times story this morning, the takeaway for my personal situation is that there’s no getting around this. I better pay up. 

Rosenthal writes: “In most other developed countries, comprehensive maternity care is free or cheap for all, considered vital to ensuring the health of future generations.” My husband and I are done having kids—remember Eight Is Enough? Well, three is enough. But even if we wanted to have more, we really couldn’t afford it.