Having your first baby is a tremendous joy. Preparing for the newborn’s birth is very exciting – from receiving all those adorable shower gifts to seeing your unborn baby for the first time. No one prepares new parents for the cost of having that little bundle of joy however. Understanding and calculating copays, coinsurance, deductibles, out of pocket maximums and what the sum of these will mean to your paycheck is complicated.
My daughter and son-in-law recently welcomed their son into the world, my first grandson. The new parents truly embraced parenthood and all the ups and downs that come with a newborn. The baby was born with a heart murmur, as many newborns are including both my granddaughters. He was referred to a pediatric cardiologist and had a heart scan. Fortunately, it was determined the murmur was not life threatening and he will outgrow it.
Soon after, the bills began to arrive, one bill for each type of service. My daughter was so overwhelmed I told her I would help organize them. Billing in healthcare is confusing. The way physicians and other licensed professionals and clinics bill is different from the way hospitals bill. Many healthcare systems send a summary bill initially for each service billed, and then combine the multiple services per system onto one statement. Multiple providers mean multiple statements.
Making matters even more confusing, medical professionals and facilities talk to insurance companies in “code.” As a result, it can be very difficult to understand your insurance company’s explanation of benefits which is an interpretation of the claims the provider is billing the insurance company. In my daughters case, her bills included all of the following charges:
- Hospital Mom $16,121
- Physician Delivery $6,765
- Anesthesiologist Epidural $1,282
- Hospital Baby $3,116
- Pediatrician Hospital $1,148
- Pediatrician Follow-up $235
- Lab $120
- Pediatric Cardiologist $569
- Hospital Heart Ultrasound $2,371
- Physician $1,983
When you consider how deductibles and out of pocket maximums might apply to these charges, which are different between in-network and out-of-network care, it can be very confusing. To make matters worse, many providers have policies that require full payment of bills within six months, just when new parents are starting to come of out of the no-sleep fog!
My advice to new parents is to contact your hospitals and clinics prior to the arrival of the baby, find out their payment policies and ask for an estimate of the anticipated charges you will incur. Calculate what you think you may owe based on the deductibles, copays, coinsurance, etc. Talk this through with your insurance company to ensure all prior authorizations are received and you understand what is covered. Then, set up a savings plan accordingly. The stress you will avoid during one of the happiest times in your life will be well worth it!
Member to Member is a feature in our blog and newsletter where real members talk about lessons learned while navigating the healthcare system. If you have a story you’d like to share with other CGHC members, please reach out to us at: MemberStories@cgcares.org