Giving Birth And Covered By Health Insurance? $22,000, Please
The individual health insurance market can be a scary place for Americans who turn to it for health coverage. If they're accepted to a plan at all, patients often find that their coverage isn't quite what they were promised, and limits and restrictions lead to high medical bills for covered services that aren't really covered.
That's how Sarah Wildman ended up with a $22,000 bill from the hospital where her daughter was born, despite having what she thought was good health insurance with a maternity rider.
She wrote an excellent article about her experience and the larger context of the individual health insurance market, especially how it affects pregnant women.
Birthing our daughter was so expensive precisely because we were insured, on the individual market. Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy-riddled with holes and exceptions-that the health care reform bills in Congress should try to do away with. The "maternity" coverage we purchased didn't cover my labor, delivery, or hospital stay. It was a sham. And so we spent the first months of her life getting the kind of hospital bills and increasingly aggressive calls from hospital administrators that I once believed were only possible without insurance.
About 63 percent of Americans receive medical care through their employer and nearly 20 percent are uninsured. 16 percent receive some insurance through a federal program like Medicaid or Medicare. The rest of us-between 5 and 7 percent-pay for insurance out of pocket. That's a small share of the total at any one time, yes. But it amounts to at least ten million people (the American Medical Association says it's more like 27 million; that number would be even higher if premiums weren't out of reach for many.) Over the course of our lives, roughly one in four Americans will buy their own health insurance. We're the freelancers, the newly unemployed, the entrepreneurs, the people who are transitioning out of college or grad school or between jobs, or the ones who work for employers with fewer than 20 employees. Our numbers are growing. An estimated 14,000 Americans lose their job-based health insurance every day.
The individual insurance market is like that old joke about the food being terrible and the portions too small; it's expensive, shoddy, and deeply unsatisfying. Those of us who buy into it are not protected by the federal and state laws that govern employer-based health care. In fact, there's no one looking out for us at all.
Pregnancy on the individual health insurance market requires an additional rider that must be purchased before the pregnancy begins. Without this rider, the fetus becomes a pre-existing condition. Prenatal care, delivery, hospitalization, and any complications are not covered. Not a cent.
Wildman discovered that her maternity rider covered her daughter's birth, but with a limit of $3,000. That is not a typo. Her story ended with the company covering 90% of the bills, but, she suspects, this is only because she happened to be writing a story about it.
We've written before about the problems with the individual insurance market—how everything from your health history to your credit score can affect premiums, and many seemingly necessary services have absurdly low caps or aren't covered at all. Our sister publication, Consumer Reports, has studied the individual insurance market extensively, and doesn't like what it sees. They call such plans the "Wild West of insurance," and until the individual market is better regulated, their best advice is to research your options carefully and choose the most comprehensive plan you can afford.
Health Insurance Woes: My $22,000 Bill for Having a Baby [Double X] (Thanks to everyone who sent this in!)
Hazardous health plans [Consumer Reports Health]
Guide to Health-Care Reform [Consumer Reports Health]
RELATED:
Four Unexpected Situations Where Bad Credit Hurts
Blue Cross Blue Shield, Aetna: Sorry, Your Pregnancy Is A Pre-Existing Condition
Blue Cross of California Hates Pregnant Women and Sick People
Individual Insurance More Horrific Than Employer Plans
(Photo: trec_lit)
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Comments:
I want to know what kind of world this insurance company lives in that it thinks $3000 will make a dent in baby delivery bills.
Wow. Very scary. I have worked at my present job for 8 years, and in the last two years have seen my insurance benefits slashed while my premiums have risen steadily. Our present plan doesn't cover prescriptions at all, and we must pay out of pocket until we reach a deductible over $2000. If we require emergency care, we must pay $4000 of our own money before insurance kicks in. It's insane.
My husband is not insured at all. We've been shopping for plans but have had little luck finding a reputable insurer with premiums we can afford. Maybe Consumerist should do a side-by-side comparison of the popular plans? Hmmm? WINK
Oh, private enterprise! Save us from the ineptitude and tyranny of national health care.
Wait.
One of the problems also lies with COBRA, or the continuation of benefits most employers offer after resignation. It continues your company plan for a amount of time but it costs waay too much. At a job where I made 11.76hr the COBRA plan was $800/mo.
If we are going to look at individual insurance perhaps COBRA needs a good look too. The benefit cost isn't subsidized by the employer after termination; perhaps some amount should be set aside by the insurance companies to provide subsidized coverage for a few months, perhaps until a new job is established and new benefits can kick in.
I really feel for this couple being in such a situation when my wife and I were lucky enough to qualify for Arizona's social health program (yes, we're techinically impoverished). We're both hard working individuals who at a time in our young lives could in no way afford private health care, yet we were fully covered because of our lower income level.
There's definitely a need out there to insure all of Americans and not just the ones who make too little or make too much and it's obvious the private sector isn't going to get it done.
We need to act quickly before we destroy the "middle class" which is so quickly disappearing.
I'm waiting for the first person to blame the OP without reading the article.
@citking: You realize your employer was paying a vast majority (if not all) of that $800/mo while you were working there, right? So while your on-the-check income was $11.76/hr, your total benefits may have been double that.
How come nobody is discussing WHY a child delivery costs $22000 in the first place? They should cap salaries and costs. All this talk about insurance coverage and yet nobody is asking why things cost insane amounts.
@SybilDisobedience: There's no such thing as a popular private plan. The only way to get a good plan is by paying through the teeth or collective bargaining by an employer.
@citking:
That $800/month is just the combination of whatever you were paying and what the employer was paying on your behalf.
@hegemonyhog: If she would just get a real job she wouldn't have to worry about private insurance.
/Trolling
I hate to beat a dead horse, but Damn. Glad I live in Canada.
My wife works in community health as a nurse, and she goes and visits new moms at their house the day after they are discharged from hospital to make sure everything is going okay, and does followups soon thereafter. - all covered.
You can look into this yourself because I doubt you will believe me. My Chinese wife had a C-section in mainland China for 8,000 RMB or a little over $1,000. My wife was in a room with 8 other expectant (or just delivered) mothers. We wanted a private room, but none were available.
My wife received good medical care. However, I had to bring food because the hospital's food was not very tasty. I also had to drain her catheter bag.
Communist China can provide more affordable health care than the U.S. It is not right that a new family--in the U.S.--should have a large debt after a baby is born.
Ow. Ow. Ow. It's crazy what they exclude in most policies. My wife had to have emergency surgery and not only did we have to cough up $3k as she was wheeled into the hospital (now that's a cover charge!) we were hit with a $100K bill after the fact (We're still paying on it - only $2k to go!). Her policy covered 30% of nothing, really.
We dropped that carrier of course and were pleasantly surprised at the lack of bills received after the birth of our son. He spent 10 days in the NICU post-birth, the cost of which would probably rival the GDP of some countries. Cost to us - zero.
Now I'm all for reform, capping costs and reducing the bureaucracy, but not at the expense of loosing a plan we're very happy with (and affordable by our standards).
Consumerist wrote, "Pregnancy on the individual health insurance market requires an additional rider that must be purchased before the pregnancy begins." This is not always true. Regence Blue Cross Blue Shield in Oregon does not offer a pregnancy rider; it is already covered. From my contract: "Pregnancy care, childbirth, and related conditions are covered for you or your enrolled dependents."
When I was on Anthem Blue Cross Blue Shield in Virginia, they did not cover pregnancy without a rider, which you had to purchase 6 months before you could actually use it. (Why 6 months? Why not let you take a pregnancy test when you sign up to show you're not already pregnant? I guess they want to collect all that money first!) I took a gamble and did not buy the rider and knew other women who did the same. We were all lucky and did not get pregnant, but it's scary to think about what might happen to women who do get pregnant and don't have coverage. They don't get prenatal care and their babies might have expensive, life-long health problems that will cost a lot of money that could have been prevented.
Wildman said, "The 'maternity' coverage we purchased didn't cover my labor, delivery, or hospital stay."
I'm sorry but if all thsoe things are excluded, what part of "maternity" DOES this plan cover? On what basis can it even be called "'maternity' coverage"?
I do contract work (meaning I am not an employee, I work on a project basis), and so I have to buy my own insurance. Even though I have "insurance" I don't go to the doctor for anything precisely because I fear getting socked with a large bill on something that should be covered. This of course is what the insurance companies want, people not using their insurance, because that is how they make their money. So, I'm essentially paying $200 a month for something I don't use, just so I don't have a lapse in coverage and get screwed out of insurance coverage should I find a real full time job that provides insurance.
I think most insurance is a scam, you pay them tons of money and they look for every way possible to not help if you ever have to use the service. Just like - "the fetus becomes a pre-existing condition" do they understand how stupid that sounds. Sadly with the cost of health care so high its a necessary evil.
The blame isn't entirely on the insurance company's shoulders though, example last summer i went into a Instacare facility for a dislocated shoulder wanted to make sure i didnt break anything in the process. They did some xrays(no breaks or fractures) and the doc popped it back in, it went so easy i couldve done it myself and after i saw the bill i should have. Thankfully my insurance actually covered almost all of it but i couldnt believe it when i saw they charged $550 to pop my shoulder back in. When i called and asked about it apparently keeping my arm straight and raising it above my head is considered an "invasive procedure" aka minor surgery! I would hate to see what i would've ended up paying if i had to go into the ER!
@AgitatedDot: Free market argument, etc. Not that I buy into it.
I think the idea behind health insurance reform in congress is that they will continue to pay today's prices until inflation catches up to make them reasonable.
@aswearengen: I'd be worried about coverage at $200 per month not covering anything at all, period. Most of these horrible plays that make the press cost 3 to 4 times that amount.
@hegemonyhog: Maybe she should have thought about the cost before putting out. Birth control is affordable and accessible.
/Trolling
There's a lot of confusion here between "excessive costs", with which I can agree, and "didn't read the policy", which is just a shame. Ms. Wildman clearly did not read her policy, a legally-binding contract, or she wouldn't have been caught by surprise by the uncovered expenses.
@AgitatedDot: This is what boggles my mind. Our first kid cost that much. Similar situation. Our insurance had a loophole, nobody said a word to us and we had no clue. We also never received a benefit book, policy info was only available at work via the intranet.
The same hospitals still list a complicated delivery as costing less than $8000 a decade later. An average delivery as $3000. I would love to know why a standard delivery today costs $22k. It was insane then and is insane now.
@SybilDisobedience: It is ridiculous. Conservatives have pushed these high-deductible health plans as the solution: pricing is transparent so people become aware of what healthcare costs and will tailor their lifestyles accordingly, right? Sounds good. My wife and I are in great shape, so we'll save money and get one.
But just the other day, we find out our new (started July 1) HDHP plan's 'negotiated' rates for prescription drugs are MUCH HIGHER than the already inflated rates charged to those without insurance. Of course no pharmacy tells you that, they charge you the negotiated rates. There is a built-in assumption I'd guess most of us have that an insurance company has negotiated better rates than the pharmacy's top rate. Who knew? They have to be in bed with the insurance companies. We only found this out after nearly falling out of chairs when hearing the price of a generic my wife needs daily and then asking them to reprice it without insurance. It's half if we don't have insurance. Buy it outside of the insurance, of course, and it doesn't apply to our deductible. Ahh... nice trick.
@citking: Insurance should not be tied to employment. People also should not be forced into the open market.
@AgitatedDot: That's another thing I don't get. I go overseas a lot, and sometimes have to visit a doctor. No insurance in India? No problem, a standard doctor visit with no insurance is about 200 Rupees. By comparison, my "fully insured" co-pay in America is $20, or about 1,000 Rupees. For the copay. The uninsured, full self-pay for the same doctor visit in India is about 1/5th.
Oh and the argument that India's cost of living is lower doesn't cut it. I've had the exact same experience in Hong Kong.
Most health insurance is a sham. You pay huge premiums for months/years/decades, and they screw you over the second they can get away with it.
"Oh, you need a surgery that could potentially save your life? Well, sorry, your premiums don't cover it because of this loop-hole we've found. Hope you feel better, soon!"
Think about the hundreds of thousands of illegal immigrants birthing babies here. Then think about that cost being passed onto the taxpayer.
@ThatSteve: Food for thought: When a contract is intentionally obfuscated to hide but still contain information, who should be held responsible for the contract signee not knowing that information?
Even further proof that once I have to be a federal employee until there is true universal health care. I'm not taking my chances on shit like that.
years ago, I was in the same boat as the author, non-group insurance. It's a bad place to be. I had some medical issues and filed claims, then promptly got tossed for doing so. Then I literally could not get a policy with any company. Ultimately I ended up on a state-run CHIP (Comprehensive Health Insurance Pool) for those who were 'uninsurable.' Sky-high rates since it only had those nobody else would take... I think it was ~1.5K per month at the time, and this was late 80s or early 90s.
When I was pregnant with my first child, I was cared for by midwives. Their total charge was $3000. The total price tossed around then - 1995 - for a hospital delivery was $10,000. Midwives provide great care for normal pregnancies. They will refer you to a doc if it becomes clear yours is not a normal pregnancy. [www.midwife.org] Extensive use of midwives is part of how the NHS in Britain keeps obstetric costs down. Where I live now in Alabama, midwives are illegal for those with insurance, however, they are allowed to treat Medicaid patients in hospitals. Bizarre.
People in the 1200's didn't need to go to the hospital to give birth and neither do we. Its just more comfortable if you go to the hospital. Child birth is a natural event that has been occurring for millions of years
@AgitatedDot: They can't cap salaries and hospital bills without putting a stop to incredibly high malpractice insurance premiums. And to do that, we need to stop awarding multi-million dollar malpractice settlements. It saddens me that so many doctors that genuinely want to help people are getting sued right and left in this country and losing.
We fix the laws regarding malpractice lawsuits, and hospital and insurance rates will drop.
Why is it so expensive? Well the people caring for you need a decent salary. I do a lot of OB anesthesia and there is nothing glamorous about a nurses job in L&D. It is pretty gross people. If you want a safe delivery you'll have it somewhere with 24H anesthesia coverage (Nurse anesthetist or anesthesiologist). Because as cool as your surgeon is, nothing happens in an emergency unless the anesthesia providers are close by. God help you if you have bad surgeons and anesthesia providers. Who wants to enter the healthcare field when you can just rip off joe public as a fincial products VP for some wallstreet bank? Then everyone caring for you has to cover the costs of potential litigation, i.e. malpractice insurance. And nothing is more expensive than having a bad outcome in L&D. Nothing is without risk but it's pretty tough to explain to someone that their child or wife didn't quite have a perfect delivery. I'm sorry but not everyone can have a private room. Not everyone can get their epidural the minute they ask for it. So for us to have a legitimate discussion on controlling healthcare costs we have to toss in: Fair wages, tort reform, and RATIONING! Sorry but that's part of the ugly truth to true health care reform. I want to see improved health care with a national payer option. But we have to widen the discussion.
Aaand this is why I will never move to the US again. Ever. My visit to the hospital will immediately mean a second visit to the hospital because I'll get a stroke from seeing the bill.
Thank god my hubby is from one of those evil socialist countries in which healthcare is free, and what's not free (i.e. glasses) are really cheap.
In most cases with private insurance, when you purchase a maternity plan there is a clause that requires the insured to be covered for at least one year as a sign of good faith that you will be with them for the long-term, rather than someone that will sign up for the maternity benefits and drop later when they find benefits through an employer.
I'd suggest going through your paperwork again and looking for a global wait policy that would indicate this.
@Gorphlog: Except when something goes wrong. I (and my mother) wouldn't have made it a day past delivery - we were both extremely sick, and were pretty much in the icu for 5 days afterwards. I, for one, welcome scientific advancement.
@Gorphlog: It wasn't that they didn't need to, it was that they couldn't. So they died in considerable numbers. I don't think we're really prepared to go back to that infant and maternal mortality rate. The bastards! They've got us hooked on not dying!
@ohenry: A world like Europe Australia, New Zealand, Japan, etc. where the majority of births are done by licensed and highly trained midwives (about $4000 for the whole pregnancy, facility fees, etc.) instead of obstetricians (surgeons...ca-ching!) unless something goes wrong, there are complications, or the pregnancy is high-risk.
You know, if the insurance company had half a marketing brain, they'd adapt a razor pricing model: all the kids you want FREE!
(See you every two months for the next year, suckah!)