Are you thinking you’d be better off financially if you use your insurance at the hospital? Hold on! While sometimes that is the case, most of the time it’s not. The world of insurance and hospital charges is a strange and convoluted one. The most frustrating aspect is that you don’t know how much it’s going to cost you until it’s too late. Our cost calculator will help you estimate in advance what you are likely to pay out of your own pocket if you use your insurance.
Utah requires by law that hospitals submit their average charges for various types of births to the state for publication by the health department. While these aggregate numbers may vary substantially on a case-by-case basis (depending on what kind of complications develop, how long you stay, how long you are in labor, etc.), they are nevertheless a helpful guide when planning your own portion of the costs when using your insurance. Our cost calculator uses these figures to estimate your portion. Keep in mind that these are hospital charges only. In addition you will have charges from the doctor or midwife who cares for the mother and the doctor who cares for the baby, plus fees from the anesthesiologist if one is used.
There are several key pieces of information you need to know about your insurance to estimate your costs:
Do you have maternity coverage?
It is common to have medical insurance, but not maternity coverage. If this is the case for you, none of the expenses related to the pregnancy or birth will be covered.
Is it a personal or family policy?
Medical insurance is very specific about who is covered. If you have a family policy, the baby should be covered as long as you add the baby within 30 days of birth. BEWARE, if you miss this window, the baby’s expenses will NOT be covered, and you will not be able to add the baby to the policy until the next open enrollment period or for a full year, depending on the policy. Be sure to check with your insurer about the time lines and process for adding the baby to the policy. If you have an individual policy, you may not be able to add the baby, and the baby’s expenses will not be covered.
The deductible is the amount you must pay per year before the insurance will pay anything. It is quite common to have a $5000 or higher deductible. This means if your birth costs $8000, you will pay the first $5000 before the insurance will pay anything. Keep in mind, deductibles are often calculated per person covered under the policy. That means there may be a separate deductible for the mother and the baby. If the deductible is $5000 per person, you’ll pay the first $5000 of the mother’s expenses, and the first $5000 of the baby’s expenses.
Sometimes the maternity deductible is separate from the regular deductible, which means any deductible satisfied by other medical expenses are not applied to the maternity deductible, and you have to start over for the pregnancy. Deductibles are calculated annually, starting over on the renewal date of the policy (usually, but not always, January 1 of each year). If you are due mid-year, some maternity expenses may be incurred in one policy year and some in another. In this case, you will have to satisfy two deductibles for the mother. Sorry. Our cost calculator only includes a single deductible, so keep that in mind and adjust your estimate accordingly if you will have two.
What is your maternity co-pay or coinsurance?
The co-pay or coinsurance is the percentage of the expenses you will pay after the deductible is satisfied. A common co-pay amount is 20%, although it might as easily be 50%. Check this with your insurer.
What are your out-of-pocket maximums?
Some policies have an out-of-pocket maximum (the one ray of good news in all this). That means that once you pay a certain amount out-of-pocket, the insurance picks up 100% of the rest. Often there are both individual and family out-of-pocket maximums, and sometimes there is a separate maternity out-of-pocket maximum. Consult your insurer to find out how this will be handled under your policy.
It's Like This
Here is an example of the out-of-pocket costs for a natural (no epidural) delivery at a hospital with insurance that has a $1500 deductible and and 80/20 co-pay (meaning the insurance pays 80% of costs after the deductible is satisfied):
(These charges do not include the cost of an epidural.)
|Doctor or Midwife Charge||$2,500*|
|Newborn Facility Charge||$1,813*|
|Newborn Provider Charge||$2,500*|
|Deductible for Mother||$1,500|
|Deductible for Baby||$1,500|
|20% of remaining balance||$1,807*|
|Total Out of Pocket||$4,807*|
*These figures are estimates only (but based on actual hospital reported charges), because unfortunately, when you birth in-hospital there will be many fees you cannot predict.
"I had such a wonderful experience at BetterBirth in Orem! The midwives were amazing! I couldn't have asked for a better birth and it was so much better than my other two hospital births. I highly recommend this birth center to anyone looking into it! The midwives are SO knowledgeable and know exactly what to do in all different situations. I am very glad I chose to go to BetterBirth!!"
- Campbell February 2013
Seriously? That's terrible.