Sierra is doing her best to budget for the cost of pregnancy and delivery. Much to her frustration, she hasn’t found a dependable source for estimating costs. According to Money, the cost of delivering a baby in the hospital ranged from $1,189 to $11,986. I’m thankful that she has health insurance from her employer. In addition, pregnancy and delivery remains an essential healthcare benefit under the current healthcare law. If she had to pay for this care out-of-pocket, she couldn’t afford to give birth. Unfortunately, she will probably still be paying co-pays and/or a deductible, though her employer’s health plan covers her.
The High Cost of Pregnancy and Delivery
Money notes that the cost of an uncomplicated vaginal delivery in the United States is $3,035. With that in mind, I checked the cost of pregnancy and delivery for our area at Fair Health. This website breaks down the cost of pregnancy and childbirth into these categories:
- Amniocentesis and chorionic villus sampling
- Cesarean childbirth
- Common lab tests (blood and urine)
- Hospital newborn care
- Routine obstetric visits
- Ultrasound and other imaging test for pregnancy
- Vaginal delivery
But how do you know which procedures you’re receiving?
CPT Codes for Pregnancy and Delivery
Healthcare providers use Current Procedural Terminology (CPT) codes as the universal language for medical procedure billing. So, under each of the categories, one or more CPT codes are used. CPT codes make for dull reading. However, understanding the common CPT codes used for billing pregnancy and delivery services can help expectant parents track costs.
First, what does a visit to the OB/GYN cost? Once you are an “established patient,” your healthcare provider will bill insurance $125 for a 15-minute office visit, which is CPT code 99213. Then, estimated insurance reimbursement is $87.50. The estimated out-of-pocket cost is $37.50. Next, what does a common lab test cost? A blood glucose level test is typically billed at $25, CPT code 82947. Insurance reimburses an estimated $17.50. Out-of-pocket pocket cost is $7.50. Finally, what does it cost to deliver your baby? A vaginal delivery, including pre- and postpartum care, is billed at $5,265. Insurance reimburses an estimated $3,685.50. The estimated out-of-pocket cost is $1579.50. Wait, will you get anesthesia for delivery? Expect a charge of $2,540 and an out-of-pocket cost of $762.
Tips for Sierra
Because I couldn’t find exact costs, I suggest theses tips:
- Establish a relationship with a representative from your healthcare insurance company. Similarly, contact the company that manages your employer’s healthcare insurance.
- Review all medical bills. Money (September 2017) estimates that 80% of medical bills contain errors like double billing, incorrect patient information, charges for healthcare professionals who did not provide services, and basic math mistakes.
- Don’t panic if you can’t pay the full payment. Certainly call the healthcare provider and set up a payment plan. Always ask: What are my options?
Above all, I’m proud of Sierra for doing her homework on this topic. But our complicated and expensive healthcare system appalls me.