Medical care can be expensive, even with insurance. In addition, The New York Times reported: “Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs.”
If you have had a baby in the last few years, you might have some idea of healthcare costs associated with pregnancy, childbirth and postpartum care. There is also a good chance you still don’t really know the overall cost of having a baby.
I have found that I don’t have many personal sources for information and tips about paying for maternity care. Since charges for delivery have tripled since 1996, according to analysis by Truven Health Analytics for The New York Times, my parents were looking at very different costs when they had children.
I recently returned from maternity leave after having my second child and I have learned a few tips for saving money on medical bills and navigating insurance. This was our second baby, we have the same insurance as we did for the delivery of our first and we are pretty good at keeping savings in a health savings account, so I felt I had a good idea of what we would pay going into this pregnancy. However, medical costs for having a baby vary widely.
Maternity care is more expensive in the U.S. than it is in any other developed country, according to the International Federation of Health Plans, so a few unexpected complications increased the cost for my second child by a lot.
Here are some things I learned:
Ask for a discount. Sometimes, all it takes to get a discount is to ask, “Can you offer me any discounts on paying my bill today?” You might be glad you asked.
Pay in full. Even if you can’t pay all of your medical bills in full right away, you might consider paying the full amount on one or some of your bills instead of spreading out payments. After a couple of the healthcare providers offered a discount for cash payment (which didn’t always mean paper money—sometimes they meant paying it all on a debit or credit card instead of setting up a payment plan), I made sure to ask each time I paid a bill if they offered a “paid in full” discount. For most of my bills, the provider of the service offered me a discount for paying in full after I asked. I did encounter a problem when I paid in full before services were rendered and the bill was due, so read on for more about that.
Use an HSA. If you have a high-deductible insurance plan, you can use an HSA for approved spending, which will likely include all of your pre-natal, childbirth and post-natal care. My husband and I saved money paying for medical care this way because we made the decision to have his employer deposit part of his paycheck into his HSA pre-tax. When we use that money on qualified medical expenses, we aren’t paying taxes on that money. Whether you’re using an HSA or another type of account to save money, this article about automatic savings might help.
Think ahead. The OBGYN practice I go to prints a statement of estimated cost of their services (this doesn’t include hospital costs, lab costs or other costs by any other healthcare provider) at the beginning of pregnancy and breaks down the cost into an average payment to make at each visit. They took my insurance into account based on estimates from previous patients. The office requests payment in full by delivery. I think this estimated statement can be really helpful. Breaking up the overall cost into monthly or weekly payments can help patients to pay for their healthcare costs instead of spending that money on something less necessary. You can ask your doctor’s office for an estimate of your costs—it won’t be exact because insurance can’t always tell you ahead of time what they’ll pay—and find out if you can pay in installments ahead of time.
However, make sure you’re thinking ahead to figure out what will be the best for you. I paid the estimated amount in full with money we had saved in our HSA in preparation for having a baby. What I didn’t take into account was that I would meet my insurance deductible before delivery, since my baby was born in December. That meant that the OBGYN owed me money—even though I paid the amount earlier than I paid other bills, the office actually bills one global charge for most of the services through my doctor at the time of the delivery. It took three months after delivery to get the money back. First, the office received payment from my insurance company that exceeded the amount I owed when added to the amount I paid. Then, they cut a check, which had to be signed by authorized physicians in the practice. They sent me the check. Once I received it, I had to fill out paperwork from HealthEquity, my HSA provider. I mailed the check and paperwork and after their processing and approval system, the money was back in my HSA.
In hindsight, I wish I had not paid the full estimated amount ahead of time. It would have been easier for me to keep the money in my HSA and wait to pay my OBGYN until after more of my healthcare costs for the year were sent as claims to my insurance provider.
While I received all of my money back, waiting for the money made paying my other bills in a timely manner a bit of a pain, which is how I learned the next tip…
If you can’t pay your bill, ask about a payment plan. The hospital where I delivered offers payment plans that can keep a bill from going to collections. I called and spoke to someone in the billing department, whom I told I wanted to pay the bill in full, but I wouldn’t be able to until I had enough money in my HSA one month out. She set up a “payment plan” on my account with the date I would pay my bill, and this kept my bill from going to collections until after that date. I didn’t have to pay any fees or interest to set up the payment plan.
I didn’t want to pay the bill in installments or out of another checking account. For taxes and other reasons, it’s easiest for us to put money in our HSA directly out of a paycheck, instead of paying the bills with another account and filing claims afterwards. I wanted to wait for my husband’s next payday, when he arranged to have all of his check deposited into our HSA. We had to wait for that refund check from my OBGYN, which meant some of the money that we saved for healthcare costs was tied up in red tape. I could have also set the payment date out a little further if I wanted to just wait for the refund check money to be available in my HSA to use.
Many healthcare providers can also help you set up a payment plan if you don’t have the money to pay your bills, and you need to be able to make monthly payments to pay off the bills. If you set up a payment plan, be sure to ask if you’ll be paying fees or interest to help you weigh the cost of the plan.
You should consider not charging medical costs on a credit card you can’t pay off right away, as the interest you’ll likely pay will be higher than what you would be charged by the provider.
Ask about the cash cost for services. I had to get a bilirubin test for my baby when I was out of state. On a weekend. On Christmas. In a lab that offers pediatric testing. You can imagine how difficult it was to figure out which lab to go to when many businesses use an automated telephone system that don’t address holiday hours. As I was making phone calls in the airport and feeling increasingly frustrated, I decided to just call a hospital in the city I was traveling to. I found out they had a lab in the hospital that would be open on Christmas Sunday and that the cash fee for the test was only $30. For me, for that test, it was worth paying the fee without hassling with in-network or out-of-network costs for my insurance. In addition, the scientist who administered the tests offered to try and file a claim through my insurance and if they rejected it, she’d call me and I could still pay the cash fee.
Find a provider that understands your financial and medical situation. When my baby had some oral problems, we determined that it would cost us less to pay for it out of pocket than it would to pay for any extra insurance coverage. Knowing we planned to pay out-of-pocket, the specialist charged us once for his procedure, despite needing to have the procedure re-done through no fault of the doctor. We chose the doctor in part because of his reassurance that additional visits would be covered by the first charge, which helped me to feel that I didn’t have to choose whether or not a visit was worth the cost when I wasn’t sure if everything healed properly.
Find out how much extra services or procedures will cost. It can be helpful to know the cost of certain services or procedures so you and your doctor can make informed decisions about what you really need and you can plan for the bill. This study provides separate cost analyses that might be useful to you. I found on receiving a bill that the test to diagnose my rare, aggressive autoimmune disease cost $3,000. While I needed the test and there wasn’t a cheaper option, knowing the cost may have helped me to plan.
Learn everything you can about your insurance. Sure, you learned about your insurance plan when you selected it, but sometimes it can feel complex and intimidating when you’re dealing with multiple types of payments to different providers.
Talk to your insurance provider about what you could pay in deductibles, premiums, co-payments, co-insurance, out-of-pocket costs and out-of-network costs. Knowing the maximum amounts you’ll pay for these might give you a number to set as a goal for saving or applying toward your HSA.
With insurance, you might have to look outside of the box to get answers. When I had my first child, I had a lot of questions. I knew I was going to have to change insurance, on the day of my daughter’s birth. It seemed complicated: I couldn’t change insurance before delivery because I had to wait for a qualifying life event. I couldn’t put her on my current insurance. One insurance only covered delivery and care at Hospital A and the other insurance only covered delivery and care at Hospital B. When I needed care prior to delivery I had to go to hospital A, but what if I ended up needing to deliver while I was there? Would I have to pay the out-of-network cost for delivering at Hospital A because the new insurance would become my primary plan beginning the date of delivery and only Hospital B was in-network for that insurance? I spoke to five different people at the two insurance companies, who claimed my problem was very unique and they didn’t have any answers.
Finally, someone in the billing department of one of the hospitals was able to help me. He had gone through the same thing when he had his first baby the year before, and mentioned that it happens all the time (this was very validating). He gave me the answers I needed, including that my new insurance wouldn’t charge me the out-of-network cost if I ended up delivering in Hospital B. This gave me some much-needed relief. I wouldn’t have figured this out if I hadn’t talked to everyone in the healthcare system—the insurance customer service couldn’t really give me answers because of the liability of quoting me a cost that might be different than actual payment.
While you should talk to a qualified representative for your insurance provider to find answers you can definitely count on, it may be worth finding out how it goes for others in your situation to give you some idea of what you might be able to expect.
Not all of these tips will apply to you and your medical situation. Make sure that you talk to your doctor and insurance company when you make decisions that will affect your care or your bills—at the end of the day, what matters the most is keeping yourself and your baby healthy. Despite feeling like figuring out medical care was a full-time job, the cost and time feel so worth it to have answers and a healthy family.
Plus, with everything I learned, I finished paying off my brand-new baby.