Managing hospital bills after childbirth isn’t all that different from delivering a baby all over again. If that sounds far-fetched, consider the parallels: Despite careful planning, you can’t possibly predict how things turn out. You will be confused by jargon. You will encounter deeply troubling aspects of our medical system. You will be overwhelmed. You will hear about how they “do it better in Europe.” And you will wonder how the hell the majority of American women somehow muddle through it.
I don’t know any mom (myself included) who fully understood the flurry of bills that arrived in the mail after they gave birth. Plenty of new parents don’t bother trying to parse the line items — they’ve got their hands full, after all. But the charges are worth checking. A friend of mine saw a $5,000 “room and board” charge for the day after she left the hospital and, once she flagged it, was told it was an “error” — oops! Another friend encountered an $11,000 “nursery fee,” which her health insurance wouldn’t cover because they deemed it an “optional” expense. She had no idea what it was for until she realized that one of the nurses had whisked her newborn son out of the room for about 20 minutes to check his hearing, which was done in the aforementioned “nursery” and definitely not presented as an “option.” She contested the charge and, after months of back-and-forth, the hospital dropped it.
Most pregnancies are considered low-risk and result in “uncomplicated” childbirths. Even still, the average out-of-pocket health care cost for pregnancy, childbirth, and postpartum care is $2,854 — that’s after insurance — according to a recent analysis by KFF, an organization that researches health policy. That’s probably why one in five postpartum women carries medical debt, including those with private health insurance (which accounts for more than half of all births in the U.S.; Medicaid finances about 40 percent).
Also, don’t forget that your baby will have their own hospital bill, too. It’s for standard newborn screenings (they’ll check hearing, heartbeat, lung function, and test for genetic disorders, etc.), and the average out-of-pocket costs are usually between $400 and $1,000.
Here’s how these bills work: Hospitals have a list of fixed prices for their services called the “chargemaster.” The numbers on that list are almost arbitrary, and sometimes marked up to more than three times the procedure’s actual cost (to maximize hospital revenue, of course). No matter; they’re intended for your insurance company (or Medicaid) to pay, not you directly. But the total will scare your pants off when you see your initial bill.
Then your health insurance steps in, works its black magic, and conjures up the “allowed cost” — an adjusted number negotiated for its plan-holders. Your insurance provider will then cover a large chunk, leaving you with out-of-pocket costs that are a fraction of the original — but usually still nothing to sniff at.
The point is, don’t freak out over the five-digit bills that show up at first. “Those commercial charges are basically a ruse,” says Carol Sakala, the director of Childbirth Connection programs at the National Partnership for Women & Families. “Our research found that hospitals charged over $32,000 for a vaginal birth, on average, but the actual amount paid by the insurance company, the mother, and any other third parties added up to about $18,000. Meanwhile, the out-of-pocket cost is much, much less.”
So, how can you anticipate what your bill might actually look like? It’s tough to gauge in advance. One major factor is, of course, what kind of birth you have and where you live. A C-section, being a serious operation and all, costs about 50 percent more than a typical vaginal delivery. However, a vaginal birth with complications can quickly surpass the cost of a routine cesarean. If your baby has to go to the NICU, that could also add thousands to your bottom line. In short, a lot of expensive things can happen during labor, delivery, and its aftermath. And just like everything else, costs will be higher in certain cities and states.
One way to prepare is to talk to your doctor beforehand, says John Hargraves, a senior researcher at the Health Care Cost Institute. “Women often feel embarrassed to bring up the cost of care, but that’s an important discussion,” he explains. “When choosing a hospital, ask your doctor if any of their other patients have had issues with expenses, or if he or she can recommend someone for you to talk to about it.”
Also, don’t be shy about consulting your insurance provider, as annoying as that sounds. Most insurance companies now offer relatively user-friendly(ish) portals that allow you to research the approximate prices of services in your area without having to get on the phone and wait on hold for half the day. “A lot of people don’t know about the transparency tools offered by their insurance, and as a result, they’re underutilized,” says Hargraves. “They’re a good resource when you’re dealing with procedures with a lot of price variation, and childbirth definitely falls under that category.” Some health insurance companies even have apps you can use to find local providers and see what out-of-pocket costs to expect.
If you’re medically low-risk, it’s worth considering a birth center, a non-hospital health care facility staffed by midwives. “We strongly encourage healthy women to consider a birth center instead of a hospital ward because the costs are much lower, they’re less procedure-intensive, and there’s a high degree of patient satisfaction,” says Sakala. Under the Affordable Care Act, insurance companies are required to cover birth centers that are licensed by the state; some birth centers are even affiliated or located within hospitals, so you can be transferred easily if the need arises. That said, they are still quite rare and can be tough to access. And if you’re thinking a home birth might be cheaper, guess again; most insurance doesn’t cover it, so you’ll have to pay for midwifery services and other associated costs — which adds up to an average of $4,650 — out of pocket.
In the end, over 98 percent of American parents deliver their babies the most expensive way: in an American hospital. If you plan to be one of them, here’s a run-down of information, advice, and resources. (Please note that these figures were taken from a 2022 KFF analysis and based on health care claims submitted between 2018-2020; they apply to parents with commercial health insurance, not Medicaid.)
Vaginal delivery
Average total cost for prenatal, intrapartum, and postpartum care: $14,768
Average out-of-pocket cost: $2,655
What you’re paying for: With vaginal births, you may still pay hefty fees for anesthesiology and professional services, but your facility fees will be much lower because you won’t be in an operating room.
What to watch out for: Interventions to speed up the delivery, like labor induction that isn’t medically necessary. One way to lower your chances of getting a C-section is to hire a doula, a licensed professional who functions as your advocate during labor. Research has found that women who hire doulas have significantly lower C-section rates — between 28 percent and 56 percent. Depending on where you live and what services you want, doulas can cost between $500 and $3,500. Some insurance plans will reimburse you; if yours doesn’t, hiring a doula might not actually save you money, but it will likely make the birth process go more smoothly.
Caesarean section
Average total cost for prenatal, intrapartum, and postpartum care: $26,280
Average out-of-pocket cost: $3,214
What you’re paying for: Higher facility fees (hospital equipment, operating space, etc.) and anesthesiology.
What to watch out for: The anesthesiologist. Sometimes different doctors, even ones in the same hospital, will take different types of insurance, and the anesthesiologist on duty might be out of your network. “That will trigger an additional charge that you may not know about until you get a surprise on your bill,” says Sakala. “Be sure to ask.” The best time to do so is before you’re admitted — your health care provider should be able to tell you, or at least point you in the right direction. That said, you can also ask the anesthesiologist in person when they arrive — which I did, in the delivery room!
What to do when you get your bills
All your bills should be itemized. The chore of going through them, line by line, is a great thing to outsource to a partner or close friend. (I personally texted photos of all my hospital bills to a nurse friend to make sure they looked right.) If you see something suspicious, call the number on the bill or deputize someone else to do so. Medical bills have a shockingly high rate of error — up to 80 percent, by some estimates.
If you can’t afford to pay your bill, welcome to a very large club. Most hospitals are open to “discussing” your payment options, which can mean everything from reducing your bill outright to putting you on a zero-interest installment plan. So pipe up if you need help — you aren’t the only one.
