Pregnancy cost data for those of us with fancy “high-deductible” medical plans.
So, here’s an interesting lessen: Don’t pay your hospital bills quickly.
I got a call the other day from the hospital. They offered me a 25% discount on my bill if I paid by the due date (which was in a couple weeks). Of course I said yes.
The baby’s hospital bill really is: $678.62.
Still, this medical billing remains an exercise in silliness. No wonder why doctors and hospitals complain so much about billing. They keep doing silly things to themselves.
For fun, and before my insurance reduction, here’s the bill for my wife’s caesarian section delivery:
| CPT | Rack | Greedy | Net | ||
| Code | Rate | Markup | Cost | ||
| OB/2 Beds | $3,507.00 | ||||
| Pharmacy | $2,018.00 | ||||
| Med/Sur Supplies | $296.00 | ||||
| Non/Ster Supply | $67.00 | ||||
| Sterile Supply | 220.00 | ||||
| Laboratory | 19.00 | ||||
| Lab/Immunology | 326.00 | ||||
| Lab/Hematology | 186.00 | ||||
| Anesthesia | 329.00 | ||||
| Drugs/Detail Code | 500.75 | ||||
| Recovery Room | 1,766.00 | ||||
| Labor | 1,265.00 | ||||
| Delivery Room | 2,737.00 | ||||
| $13,236.75 | TBD | TBD |
As you will see, my insurance company negotiated a bulk 67% discount on the “rack rate” bill from my hospital. The final level of detail was not itemized.
Again, this is only for the baby. My wife’s care is in another bill.
(In case I don’t get back to posting for a while, the “rack rate” on my wife’s bill is only $13,236.75. And this doesn’t include any doctor’s fees, lab work, etc.)
This a summary level bill. I’ll request an itemized bill in bit (hey, I’m paying for it).
| CPT | Rack | Greedy | Net | ||
| Code | Rate | Markup | Cost | ||
| Nursery Level 1 | $1,938.00 | ||||
| Pharmacy | 75.00 | ||||
| Laboratory | 19.00 | ||||
| Lab/Chemistry | 147.00 | ||||
| Lab/Immunology | 122.00 | ||||
| Blood/Stor-Proc | 74.00 | ||||
| Audiology | 125.00 | ||||
| Drugs/Detail Code | 119.50 | ||||
| Circumcision | 139.00 | ||||
| 2,758.50 | 1,853.67 | 904.83 |
Here’s the details:
| CPT | Rack | Greedy | Net | ||
| Code | Rate | Markup | Cost | ||
| OB Office Visits #7 | 160.00 | 90.00 | 70.00 | ||
| OB Office Visits #8 | 160.00 | 90.00 | 70.00 | ||
| OB Office Visits #9 | 160.00 | 90.00 | 70.00 | ||
| OB Office Visits #10 | 160.00 | 90.00 | 70.00 | ||
| OB Office Visits #11 | 160.00 | 90.00 | 70.00 | ||
| 800.00 | 450.00 | 350.00 |
1. Buy lots of high quality baby bottles. Get same kind so you don’t have to mix and match. If you don’t have dishwasher, get one. Never have a bottle you have to wash by hand–it is inefficient and not environmentally friendly. [Parenting Note: feed a bottle--don't breastfeed--to your baby before bedtime -- since they'll eat more, they'll sleep longer through the night (yes, that could mean you'll have to pump or use formula)]. Same deal when it comes to sippy-cups (and if a sippy cup leaks – toss it out and buy a new one).
2. Create multiple diaper changing stations around you house. Have diapers, wipes, hand sanitizer. Saves time and effort. Don’t be stubborn. Your time is valuable. Act like it is.
3. The Diaper Champ. Really is the champ. Uses “normal” tall kitchen bags so it’s much cheaper in the long run. Doesn’t smell; only have to empty it once a week.
4. Strollers. Invest in a good one if you like to walk a lot. Pay for lighter weight ones as it is a pain to carry them around and lift into the car. Don’t need to spend this. But we had this. For baby #2 we might buy this, even though it is expensive (since Baby #1 will now be walking/strolling to preschool when it is nice outside). Yes we really wore out our first stroller.
5. Swings. Get one. Use it. Love it. Eat without holding the baby.
6. Rocking Chair. Invest in this. You’ll spend nights in it when you child is ill, so make sure it is comfortable. Get a glider, not a rocker.
7. Books. Many books = less insanity for parents. Never, ever, ever buy a “if you take a mouse to…” book.
8. These things. Get a few of em.
9. Outlet malls. Visit often for baby clothes. For example, Carters has the same stuff, only much cheaper.
10. Camera. Get a high quality digital camera like this one, not the brick-sized cheap one you got 4 years age for Christmas. Fast shutter speed is key, as babies change expressions quickly. If it’s small, you can take if everywhere and take lots of pictures. Organize your pictures using myPublisher — beats any homemade baby book.
Through the 28th week or so of the pregnancy; the visits are every two weeks. Here’s the latest bills. Also, we negotiated our rate with the physician doing the c-section. That will be a separate post.
| CPT | Rack | Greedy | Net | ||
| Code | Rate | Markup | Cost | ||
| OB Office Visits #5 | 160.00 | 90.00 | 70.00 | ||
| OB Office Visits #6 | 160.00 | 90.00 | 70.00 | ||
| Glucose Tolerance 1hr | tbd | 63.45 | 53.45 | 10.00 | |
| Glucose Tolerance 3hr | tbd | 114.70 | 91.70 | 23.00 | |
| 498.15 | 325.15 | 173.00 |
Try this site here. Great information on what each test is for. But of course, no information on cost.
If you have found this blog, you probably have costs related to a pregnancy. I would welcome sharing your data with others visiting here too. (yes, there are others, really)
Please, leave a comment below, and we could figure out a way to post more data.
Or, have you found a great article (related to pregnancy costs) that you would share if you had your very own, exciting and rewarding blog about pregnancy costs? Please, leave a comment with a link below.
Or, do you have questions or suggestions? Please leave a comment.
Many people are finding this blog through search terms such as “pregnancy cost of doctors visit.” Welcome to you all.
However, and I can’t say this enough, it’s the lab tests that are really expensive. Plan for those. And btw, your doctor probably has no idea how much they’ll cost you…
[As an aside, when your baby is born, it's the cost of immunizations that are really expensive, not you basic pediatrician 0 to 2 years old office visits. If I get some time, I'll publish some data on that, but not anytime soon.]
So, through 4 office visits, the ultrasound and a bunch of tests:
| Rack | Greedy | Net | |||
| Rate | Markup | Cost | |||
| OB Office Visits | 640.00 | 358.00 | 282.00 | ||
| 20 Week Ultrasound | 2,045.00 | 1,119.00 | 926.00 | ||
| Lab Work | 1,509.96 | 680.96 | 829.00 | ||
| 4,194.96 | 2,157.96 | 2,037.00 |
No lab tests this time. And no lab work is planned for the 5th visit. But the dreaded glucose tolerance test is due at the 6th visit.
Here’s the cost:
| CPT | Rack | Greedy | Net | ||
| Code | Rate | Markup | Cost | ||
| OB Office Visits | 160.00 | 90.00 | 70.00 |
We received the insurance EOB for the 20-week ultrasound; the details are below.
A few thoughts:
1) The cost to us of $926 for a 45 minute procedure? I could hire the best attorney in the state at a lesser hourly rate. (btw: attorneys have overhead, staff, insurance too)
2) Many in the medical field bemoan the cost of insurance; for example, some would say that a major part of the $926 is insurance. Here’s an idea: allocate insurance to the procedure. Then you would have pricing transparency; you could see how much was insurance and how much went to the medical office. It would allow a better judgement of what is a reasonable price and would allow us consumers to shop doctors based on insurance rates (with the assumption that lower insurance = better a physician).
3) A $2,045 price for the uninsured? Thats not very nice. From the looks of this office, they weren’t doing too many medicare patients.
4) Lots of employees were just hanging around this office chatting. Didn’t appear too productive. Being unproductive = higher cost for the customer.
Here’s the data. I’ll add more detail when I get the real bill.
| CPT | Rack | Greedy | Net | ||
| Code | Rate | Markup | Cost | ||
| X-Ray Services | tbd | 550 | 313 | 237 | |
| X-Ray Services | tbd | 395 | 264 | 131 | |
| X-Ray Services | tbd | 350 | 227 | 123 | |
| X-Ray Services | tbd | 350 | 165 | 185 | |
| Diag. Medical Exam | tbd | 300 | 150 | 150 | |
| Consultation | tbd | 100 | - | 100 | |
| 2,045 | 1,119 | 926 |
The WJS (subscription required) has an great article about one man’s health costs here after he reached his insurance cap. Basically, guy gets sick, health insurance runs out and the hospital bills him to death, until a reporter calls and then they write off his bill.
The WSJ Health Blog has some even more interesting comments here.
A commenter called drcrcarlson writes:
The practical result of this article it to point out how little understanding exists with respect to the underpinning of the current financial/economic model of U.S. Healthcare. What is portrayed as needless markups by hospitals and providers is not a function of random and usury practices. It is a function of Medicare utilizing reimbursement capping as opposed to value determination in setting reimbursement rates. As a larger segment of the population pays only 40% of the legitimate cost of an item or service (e.g. $250 for a contriction sock) it lies with the remaining population to make up those legitimate costs. Therefore, in order to ever receive the revenue necessary to recover actual costs, the marginal collection rates which must be applied to items and services are often 300% to 400% above the actual cost.
Since this blog has a data focus, is “40% of the legitimate cost” a good number? I kinda doubt it. It doesn’t “smell” right.
I suppose one could think of insurance reimbursement rates as a “market-clearing” price. Otherwise, why would doctors accept those rates? So Medicare is only 40% of those rates? I bet someone with right data could test this. Seems to me that healthcare providers charge by the spaghetti method: see what sticks.
The real value of the services provided is not the grossly mark-ed up price that is being charged to those of us who are underinsured. Wishing will not make this true. So, those in healthcare, cut the greedy mark-up. Billing is not rocket-science. Hire some cost-accountants to tell you what things really cost…invest in IT…retrain unproductive staff…and look to Wal-Mart for solutions, not the mirror.
In the WSJ a few months ago, there was a mention of a company called change:healthcare. They have blog, which is occasionally interesting, here.
Now, change:healthcare is a “health2.0″ company. What does that mean? Well, it means, 1) there are no capital letters in their name, and 2) they have a fixation about calling everything “health2.0″ or “web2.0″, as if it is relevant to their customers. It’s not.
But they do have a product called MedBillManager that is worth taking a look at if you are reading my blog for cost data.
It is tough to describe what MedBillManager really is or what it really wants to be. I think it is a tool to track your health care costs. But it has an unfriendly user interface, so I doubt too many folks will use it track all their costs — I know I quit after entering a couple bills.
But wait, there’s more…
However, it does have a feature where you can enter your bills and it will show you the average insurance reimbursement rates. Which is hugely useful to those of us who have to negotiate with our health care providers.
I entered: “Cesarean delivery, operation or section” since I think that’s what the OB’s fee would be called for a c-section (I used the autofill feature in the form). It told me that the average insurance allowed amount–what I call the net cost–is $1,381.65.
I entered: “Cesarean delivery without mention of indication.” It told me that the amount is $1,383.42.
(ATTENTION change:healthcare.com folks: I would pay for this information if it was packaged up all nice and pretty)
Now, our OB has told us her fee and it is about $1000 higher than what I just learned. So, I’m going to keep researching this data, trying to figure out if it is good data or not.
Then I’m going to negotiate with our OB.
Other stuff
Also, on the site there is an area (“Compare Your Bills”) which compares your costs to other who have entered data. However, nobody has entered any delivery data yet.
Got the bill from the lab finally. Codes are updated.
Ultrasound has hit my insurance, but has not been paid. Rack rate looks to be $2,045. We’ll see what the insurance knocks it down to.
Found a nice article here by Claire Vande Polder on revolutionhealth.com. More data points are always good.
However, Ms Vande Polder does not quantify costs for lab work and ultrasound. Too bad. That’s where the big money seems to be going.
She also cites some other interesting web sites in her references. If you are reading this, her article is worth taking a look at.
I can see that I’m getting some decent hits, but does anyone find this data useful? I’m sure my commentary isn’t useful, but, hey, you get what you pay for.
If you find this blog helpful, please leave a comment. Feedback is cool too; but remember, I only know about as much as you do, fellow health care customer.
I’ll update the current score as we have more visits.
Through the first innings, er, 3 doctor visits:
| CPT | Rack | Greedy | Net | ||
| Code | Rate | Markup | Cost | ||
| OB Office Visits | 640.00 | 358.00 | 282.00 | ||
| Laboratory Services | 1,349.96 | 590.96 | 759.00 | ||
| 1,989.96 | 948.96 | 1,041.00 |
Um, yes, but…he’s not born yet. Our medical cost odyssey continues. But, we’ll know the cost of the ultrasound shortly. I’m going to bet it’s going to be expensive because we got a dvd of the whole ultrasound. Perhaps I should post it on YouTube and embed a link here?
The 3rd office visit featured a lower bill from the physician. Or course, I don’t know why.
More tests were taken (and they proved to be of value, as they found something that was quickly treatable). The net cost of the 4 tests was only $28, but if we didn’t have insurance, we would have been on the hook for $128. A very greedy markup of over 400%. Nice.
| CPT | Rack | Greedy | Net | ||
| Code | Rate | Markup | Cost | ||
| Office Visit | 160.00 | 90.00 | 70.00 | ||
| cult, pres id ea isol uri | 87088 | 22.73 | 13.73 | 9.00 | |
| cult, bacterial (ur) | 87086 | 42.00 | 33.00 | 9.00 | |
| UA, complete automated | 81001 | 40.50 | 36.50 | 4.00 | |
| cult typing, serol | 87147 | 22.73 | 16.73 | 6.00 | |
| 287.96 | 189.96 | 98.00 |
We had the baby via C-Section
Published April 23, 2008 Pregnancy Commentary , Pregnancy Cost Leave a CommentEveryone is fine and doing well. But it’s time to pay the piper. The costs for us are broken out in 2 parts:
1) The Baby
2) The Mother
Because of some exclusions on our insurance policy (more on that later), we have resolved the baby’s portion of the hospital stay. Yes, he is weeks old and already receiving bills. Our cost will be detailed in the following posts.