How much does childbirth cost? Our data reveal a wide range of prices

Filed Under: Costs, Patients, Providers

6323381975

Summary:  How much does childbirth cost? The price tag attached to labor and delivery in the U.S. has tripled since 1996, according to a recent report.  The annual amount spent in the U.S. on childbirth costs is over $50 billion. Even women who have insurance often pay some out-of-pocket costs. While all Affordable Care Act insurance plans must cover maternity and childbirth, non-A.C.A. plans or grandfathered plans may exclude such coverage. Even if your plan covers childbirth, it may cover only a portion, so you may find yourself paying a part of the bill. With estimated costs of maternal care cruising at tens of thousands of dollars, pregnant women need to be savvy consumers. Keep reading for advice….


About 4 million women give birth in the U.S. each year. The cumulative costs of childbirth, according to the New York Times, are well over $50 billion. That makes maternal and newborn care the single biggest category of hospital payouts for most commercial and Medicaid insurers.

At 1.3 million procedures each year, the Centers for Disease Control and Prevention (CDC) lists cesarean delivery as the most frequently performed inpatient surgery in the U.S.

Where does the money go?

According to the report by Truven Health Analytics, billing for labor and delivery breaks down as follows: On average, 59% to 66% goes towards facility fees, and 20% to 25% goes towards professional service fees, followed by anesthesiology, laboratory, radiology, and pharmacy service fees. The pre-ACA study was commissioned by three healthcare organizations, Childbirth Connection, Catalyst for Payment Reform, and Center for Healthcare Quality and Payment Reform.

Women with employer-provided commercial insurance are covered for the majority of hospital payments. For vaginal deliveries, the study reports, 86% was covered, and for cesarean births, 87%. Yet in 2010 these patients were still responsible for out-of-pocket costs averaging $1,686 for vaginal deliveries and $1,948 for cesarean births. This reflects an increase in out-of-pocket costs of nearly fourfold since 2004.

During the same period, payments made by private insurance companies for maternal care rose by 49% for vaginal deliveries, and 41% for c-sections.

What are they paying for?

Receiving a hospital bill – or, more accurately, a steady stream of bills – after delivery is daunting. Deciphering the various codes – typical bills tend to have anywhere from 10 to 50 line items – is just the beginning. What one might expect to be included in a general facility fee – such as the use of forceps or a fetal stress test – often ends up as an additional charge.

Instead of lumping maternity services together, billing has grown increasingly fragmented.  Rather than the all-inclusive buffet, it’s like ordering a la carte. And the price adds up.

How much does childbirth cost?

The study found that among women and newborns with employer-provided health insurance, the average charge nationwide for vaginal delivery care was $32,093; for c-sections that figure jumped to $51,125.

Insurance companies typically settle the bill for much less.  Average commercial insurer payments for all maternal and newborn care with vaginal and cesarean childbirths were $18,329 and $27,866, respectively.

But these 2010 averages hide wide disparities in cost that vary according to geographic location or facility.  For example, the difference between having a c-section in Louisiana or in California can be more than $7,000.

While insurance companies negotiate their own reimbursement rates with hospitals, self-pay patients lack that bargaining power. The rates charged to uninsured and self-pay patients for hospital services are often more than twice the sticker price that health insurers pay for the same services.

In response to increasing calls for transparency and the needs of the underinsured, some hospitals offer maternity packages.  These plans offer discounted rates for basic vaginal or cesarean section deliveries.  Depending on the facility, some of these packages are more bare-bones than others, with “extras” – such as epidurals – considered to be an additional cost. Florida’s Sarasota Memorial Hospital and the Maricopa Medical Center in Phoenix, Arizona are a few examples of hospitals that offer a maternity package.

Some hospital networks have begun to make hospital pricing information available on their websites. While transparency is a welcome trend for consumers, the pricing sources use different methodologies and can be confusing.

For example, some hospitals that list prices give the chargemaster prices, the official charged rate, which is confusing in health care: chargemasters are often wildly inflated, something like a “manufacturer’s suggested retail price” in electronics, or a rack rate at a hotel; the price paid by an insurance company is often half of the chargemaster rate, or even much less.

Other providers do not post chargemaster information, but instead aggregate the costs associated with a particular diagnostic code – such as appendectomy or vaginal delivery. As such, the estimates for care posted on the hospital website are not written in stone, and are hard to compare provider to provider because of methodology differences.

Our hospitals database lists childbirth and other prices

Some providers, though, list cash or self-pay prices. For example, the Hospital Corporation of America (HCA) has a pricing transparency initiative. This allows potential patients to get estimates – but only estimates – for medical procedures conducted in any of the network’s 165 hospitals in 20 states throughout the country. Vaginal delivery and cesarean section childbirth are two of more than 20 common medical procedures with listed estimated price ranges on the HCA websites.

We’ve collected these cash prices from various providers into a searchable database, which you can find at this link on our site. Here’s a blog post explaining where the data came from and how to use the search engine.

vaginal

 

Searching estimate cost ranges for vaginal deliveries and cesarean sections (sometimes listed as c-section, and sometimes cesarean) reveals broad cost variations from state to state, within states, and even within hospitals. At the low end of the HCA pay scale was Las Colinas Medical Center in Texas, where the average cost of a c-section ranged from $1,692 to $2,071, and a vaginal delivery cost between $1,304 and $1,594. HCA prices listed on the website are for hospital charges only, and are prospective estimates of what a person would pay; they exclude doctor and anesthesiologist charges. See this overall web page for details of the company’s policy.

At the high end of the scale, cesarean sections cost about seven times more. At two Florida hospitals, for example – St. Lucie Medical Center and Fort Walton Beach Medical Center – c-section estimates ranged from over $9,000 to more than $11,800. Notably, a vaginal delivery at St. Lucie was much lower – starting at $3,700 – while at Fort Walton Beach vaginal deliveries estimates were among the highest in the network, starting at $7,124.

At some hospitals, for example, there was not much difference between the estimated cost of c-section and vaginal deliveries. For example:

Typically, however, c-sections cost considerably more than vaginal deliveries, often more than double. For example:

 

 

Also, many people don’t know that the newborn baby begins incurring hospital bills instantly. For example, all of these hospitals also list a rate for the baby’s stay, which varies depending on whether it’s a vaginal birth – which is typically less expensive – or a c-section.

Where does the data come from?

The HCA site says the pricing data was pulled from the most recent calendar year from each network hospital to determine pricing on the most comment surgical procedures. These estimates, however, offer “no guarantees regarding the accuracy of the pricing information,” the hospital chain notes.

Other childbirth estimates are from Banner Health in Arizona, where a vaginal delivery without complicating diagnoses, for a cash or self-pay patient qualifying for means-tested financial aid, generates an estimate from $1,850 to $4,376. A c-section without complications: from $3,760 to $8,632.

Editor’s note: Because of the way the data came from providers, search terms are not parallel. You may have to search “c-section” and “cesarean,” “newborn” and “vaginal” delivery. We kept the terms used by the providers because changing their terms invited mistakes.

Yes, it’s confusing. So is our health care system.

 

The takeaway:  What can you do?

 

Price is often not the most important issue when choosing where to have a baby. But it may enter into the discussion.

We’re going to avoid some of the bigger questions – doula or no? Epidural or no? Can I go home immediately or must I stay overnight? Our main area of expertise is money, and the suggested questions below reflect that. Be sure to take names, take dates and take notes. Your records it may come in handy.

Maternity care is one of the “essential health benefits” that are supposed to be covered by all Affordable Care Act insurance plans. But deductibles, co-insurance and the like may apply; some things related to maternity care may not be covered (we hear a lot about hearing tests and genetic tests that are covered in some places and not covered elsewhere).

Questions to ask in advance:

  • How much will this cost? How much will this cost ME?
  • Is the baby’s stay included?
  • If the baby is staying in my room, why am I going to be charged extra?
  • How much does a night in the hospital cost?
  • Will I be charged extra for the doctor, for anesthesia, for anything else?
  • Are the providers all in network?
  • Is there a cash or self-pay rate? A prompt-pay discount?
  • Is there a financial aid policy with an income test?
  • Will I be billed by individual providers in a steady stream, or will I get one bill from the hospital?
  • Are all tests covered, both for me and my baby?

Questions to ask after the fact:

  • Why am I receiving so many bills from different providers?
  • Where is the bill itemizing every item and every procedure?
  • I don’t think this bill is right. (You should be able to identify everything that happened, when it happened and to whom.)
  • Why are certain listed procedures not covered?
  • Why is the bill so much higher than the estimated cost?