How much does it cost to have a baby in the San Francisco Bay Area?

Healthcare costs are a confusing mess.

Hey everyone.  I usually use this blog to share photos, but I wanted to share some of the crazy associated with the healthcare system in the US.  I hope to update this more and add details as I am able, but I wanted to throw some information out there to start.  The bills that we’ve received are frustrating, but I am trying to make an effort to understand them more.  And I’m sharing the results here.

What we are paying for: An uncomplicated vaginal delivery with no medication except Pitocin after the baby was born, and a 2 night hospital stay.  We had a decent delivery, with one pretty crappy nurse, and good staff otherwise.

What we expected: I had done some research online and came across a couple of forums where mothers shared their birth costs.  From reading that, I expected to pay maybe $1000-5000 out of pocket.  There were some funny (and I mean funny in a sad way) responses that took pity on mothers in the US, because they paid nothing at all or very little.

I learned from WebMD that in 2008 an uncomplicated vaginal birth cost about $9,600, though it was unclear if this was the out-of-pocket cost or the hospital-billed cost.

The New York Times has an article that was written in 2013 that listed the “actual payments agreed to by insurance companies or other payers for services” in the USA to be $9,775 in 2012.

Here’s our bill:

Total out of pocket costs so far: $2740.98, but we owe more than this.  This includes $1,759.95 to Alta Bates Summit Medical Center and $981.03 to our OB.

Our total out-of-pocket bill is $6,845.93. 

Our out-of-pocket costs plus the amount that our insurer paid is $22,102.13.  This is more than double the national average, according to the New York Times. (The math: 6845.93 + 11332.07 + 3924.13 = 22102.13)

The total amount billed by service providers to our insurance company: $33,115.78 (28,057.78 + 5,058.00)

Update Feb 12 2015:

Alta Bates Summit Medical Center issued a partial refund for $858.07, with the text: “Your insurance company indicated your patient responsibility amount is: $1,759.95.  You are entitled to a refund of your overpayment.”  I’m still not sure what our $1759.93 is for, given that the Blue Shield Explanation of Benefits lists our patient responsibility at $4,127.93.

Update Jan 14 2015:

$2718, paid directly to Alta Bates Summit Medical Center in Berkeley.  For what?  I don’t know.  They first called us before our baby was born to ask us to pay in advance, somehow telling us that the amount they are billing was not something covered by our insurance, Blue Shield of California.  I called their Patient Financial Services department to determine what the charge was.  I was told it was like a “down-payment” for my portion of the bill.  Somehow this $2718 was not factored into the bill from Blue Shield, though, and that there may be a mistake.  We will see.

Hospital bills for the mother:

Total billed by Alta Bates Summit Medical Center to Blue Shield for our hospital birth: $28,057.78.  Yep, that is TWENTY EIGHT THOUSAND DOLLARSFor what?!  I don’t know, because Blue Shield’s website has a broken link where the bill is supposed to be.  Blue Shield sent a paper version of the Explanation of Benefits, and now I can see.

Here is the breakdown:

Service/Procedure Amount Billed Amount Blue Shield paid Amount we're responsible for
Room/Board Semi-Private 2 Bed General (*1) 10140.00 11332.07 1859.93
Nursery Newborn – Level I (*2) 4834.00 0.00 0.00
Hospital Misc(*3) – Pharmacy 571.48 0.00 0.00
Hospital Misc – IV Solutions 114.60 0.00 0.00
Hospital Misc – Lab Chemistry 111.70 0.00 0.00
Hospital Misc – Lab Immunology 470.00 0.00 0.00
Hospital Misc – Lab Hematology 394.00 0.00 0.00
Hospital Misc – Lab Other 6.00 0.00 0.00
Hospital Misc – Pulmonary Function 476.00 0.00 0.00
Hospital Misc – Clinic General 344.00 0.00 0.00
Hospital Misc – Labor/Delivery Room  Labor 3320.00 0.00 0.00
Hospital Misc – Labor/Delivery Room Delivery 5008.00 0.00 0.00
Hospital Misc – Room and Board Private OB (*4) 2268.00 0.00 2268.00

*1 – I have no idea why Blue Shield paid more than the amount billed.

*2 – Nursery?  Our baby spent no time in the nursery!  Why was Blue Shield billed for that??

*3 – Hospital Misc – there is a numeric code that goes with these, called a “Revenue Code” and there is no explanation for them on the bill.  You can however look them up online.  This is probably for pitocin, ibuprofen, and stool softener?

*4 – I do not know why we were billed for Room and Board twice.  We stayed two nights in a private room.  You’ll notice that one room and board room is for a private room, OB, the other for a semi-private room.  I don’t understand this.

Total that Blue Shield of CA is paying Alta Bates Summit Medical Center: $11,332.07.  We know that the value of most hospital bills is completely made up.  That 28 grand billed was wishful thinking.  As we should expect.

Total that Blue Shield of CA is billing us: $4,127.93.

Obstetrical bills for the mother:

Service/Procedure Amount Billed Amount Blue Shield paid Amount we're responsible for
Surgical – Routine Vaginal Delivery and antepartum and postpartum care First Newborn(*1) 5058.00 3924.13 981.03

*1 – Once again, you may notice that the numbers do not add up.  This is because Blue Shield has an “Amount Allowed”, the amount they will actually “pay” for a procedure.  Also, OB revenue codes are separate.

Hospital bills for our baby:

Service/Procedure Amount Billed Amount Blue Shield paid Amount we're responsible for
Inpatient Medical(*1) – "Initial hospital or birthing center care/day" 225.00 0.00 60.97
Inpatient Medical – "Subsequent hospital care for the normal newborn per day" 80.00 0.00 32.67
Inpatient Medical – Discharge services 230.00 0.00 114.36
Home Care – Skilled Nurse Visit Charge(*2) 355.00 14.40 295.60

(*1) – There’s a separate set of revenue codes for neonatal care.

(*2) – I don’t feel great about the home visit.  It was a “nice to have” thing, but for $296 out of pocket, I’d have done without it.  We definitely didn’t get much value out of her visit.  She asked us some questions, weighed the baby, and gave some breastfeeding tips.  That’s about it.  She was here for about an hour.

I’m curious about how you’ve paid to have a baby.

How much did you pay out of pocket when your baby was born?  How much did the hospital bill your insurance company?  How much did your insurance company pay?  What’s your story?  Or, if you know more about healthcare billing that I do, tell me if I’m doing this wrong.  Add a comment if you’d like, to help us all out.

I’ll make a table of responses that I get:

Name Out of Pocket Cost Insurer Paid Hospital Billed Insurance Type Description
Us $6845.93 $22102.13 $33115.78 Blue Shield PPO See above!
Mike $30 For the cable TV in the room. It’s the only thing that wasn’t covered. No co-pays. I couldn’t believe it.
Erin $2549.65 $11256.70 Uncomplicated water birth.  Only drugs were $12 ibuprofen.  Charged $833.60 for 8 cold packs!
Robin $175 $7595.96 First child
Robin $525 $1697.71 Second child
Kerry $0 $10000
Edward $2500 $35000
Myung $3000 $35-$40000 Twins!  Includes spinal + c-section + short stay in NICU for one.
Yans $3.60 Not in the US but in Australia.  Billed only for acetaminophen.
Richard $200 $50000 Kaiser Included 1 month NICU stay
Oz $2000 C-section
Camille $2800 $0 $0 Home birth – all out-of-pocket.
Kumar $1200 $7000 about $3500 for anesthesiologist and $3500 for labor/delivery
Michele $200 Includes the 9 months of maternity care and private room.
Greg $3000 $30000 employer-sponsored healthcare plan
Lisa $3500 $1500 $0 Home birth
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Where to drink coffee in Vancouver: Part One – Mount Pleasant

Vancouver has a impressive coffee scene.  We got some great coffee in the Mount Pleasant neighborhood of East Vancouver from 49th Parallel, Elysian, and Aperture.

49th Parallel:


Forty Ninth Parallel’s
Mount Pleasant spot is centrally located on Main St and E 13th Ave.  We walked over here from the place we were staying.  Someone with a bike rolled up to the shop at the same time.  This is a good sign.

49th parallel coffee roasters vancouver

It’s busy and bustling in there.  It was not a quiet coffee shop, at least at the time when we were there.  But there were still some people working quietly on their computers.  There were three or four people behind the counter taking orders and making coffee and an additional person restocking the shelves.  And then there was an additional person adding crazy toppings to Lucky’s doughnuts in the back kitchen.  There’s plenty to gawk at in the doughnut case while waiting to order your coffee.

49th parallel coffee roasters vancouver

There was a mixed crowd of people meeting up, people working on their laptops, and others from the neighborhood just stopping in to grab a coffee.  It felt cozy inside with dark wood and warm lighting in some areas, but with outside light spilling from the large northern windows.

49th parallel coffee roasters vancouver

We got a latte and an espresso and a glazed raised doughnut.  All were excellent.  We were especially surprised by the doughnut – perfectly yeasted and chewy, with slightly less sugar than one would expect.  My mouth is watering as I write.  So good.   And the latte – the combination of the light coming in from the side windows and the dark wood community table, and the teal cup and saucer made for a nice photo.  I bought an espresso demitasse home for a souvenir.

49th parallel coffee roasters vancouver

49th Parallel serves their espresso on a plank with sparkling water and a spoon for sugar:

49th parallel coffee roasters vancouver

We spent a bit of time on Main St, but wish we had more.  We wanted to explore more to the south, (the SoMa neighborhood as was explained to us by the internets) but our timing didn’t work out that way this trip.  But there were plenty of interesting shops and things to see north on Main towards Gastown.

 Elysian Coffee

Elysian Coffee lies on the west boundary of Mount Pleasant, just a block west of Cambie St.

The Elysian Coffee on West Broadway was much quieter than 49th Parallel.  There was a steady stream of customers, but it wasn’t so busy that you couldn’t talk to the baristas.  The building had a brown exterior, and they sport a logo that doesn’t quite match with others who serve specialty coffee.  But the coffee experience was very nice.elysian coffee vancouver

In contrast to the dark wooden walls of 49th Parallel, Elysian felt much brighter.  Their windows look out onto West Broadway, which is a busy street with much more car traffic than pedestrian.  Canadian Thanksgiving was coming up, and our baristas showed off a few photos of skillfully-made turkey latte art that they were posting to their instagram account.  Our barista gave us tips on other places to check out and not check out, so we took notes to fill out the schedule for the rest of our stay.  We decided that we’d check out Lynn Canyon, try to hit Timbertrain Coffee Roasters and Revolver Coffee and visit the Old Faithful shop, but maybe skip over Pallet coffee roasters.  And to look out for coffee from Phil & Sebastian if we could find it.

We got an espresso and macchiato, pulled from their Synesso machine.

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Aperture Coffee Bar

49th Parallel and Elysian roast their own beans, but Aperture Coffee Bar serves Chicago-based Intelligentsia.

IMG_5887m

Also situated on West Broadway, in addition to the coffee, Aperture is stocked with a beautiful bookshelf area that looks amazing when the rays of sun stream in through their southern window.

IMG_5885m IMG_5625m

The coffee itself was fine.  Intelligentsia is special, but not rare, and I guess I wasn’t too impressed with the preparation of their black cat espresso, at least compared to 49th Parallel and Elysian.

But it was definitely a pleasure to hang out in the shop for a bit and enjoy the ambiance and friendly barista vibe.

One thing that was funny to us about West Broadway was that there was such a high density of sporting goods stores.  There seemed to be two or three per block from the massive MEC to smaller ski/snowboard shops.  We stopped into MEC to look around and maybe shop and then continued on our day.

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Lower Antelope Canyon, Page, Arizona

lower antelope canyon page arizona

When you start looking up information about visiting Antelope Canyon , one of the first things that you will discover is there is an Upper and Lower portion of the slot canyon.

It was kind of funny to me, because I thought to myself, “wow, this place really exists!  And not only that, but there are two of them?!”

I think I must have seen a photo a number of years back of a narrow canyon with smooth yet gnarled, orange and purple striated sandstone walls that ended in abrupt jagged corners and a beam of volumetric light from above illuminating a small space on the ground.  It looked like such a special place.  I think a while later, my friend Sarah shared a photo of her visit to Antelope Canyon, and I realized, “wow!  people actually go there!  I want to do it too!”

Upper or Lower Antelope Canyon?

I started researching Upper Antelope Canyon vs Lower Antelope Canyon (Hazdistazí in Navajo) and learned that apparently Upper Antelope Canyon gets way too crowded.. and so does Lower Antelope Canyon.  But less so.  I also learned that if you pay more and bring a tripod with you (strange requirement, but sort of understandable since it’s a bit darker down there and it helps to stop down to capture all of that amazing detail) you can go on a self-guided tour of Lower Antelope Canyon – but the same isn’t possible for the Upper canyon.  I still wanted to see the Upper canyon, though, because that one beam of light that I saw in that one photo was taken in the Upper section.  I did more research and found that thankfully, there are light beams that come through Lower Antelope Canyon as well.  So, I decided to try the Lower canyon.

Do you need reservations?

Next came the question – do you book in advance?  Or just show up?  I didn’t want to get all the way to Page and not be able to see the slot canyon.  The website for Ken’s Lower Antelope Canyon tours tells you to just show up.  So that’s what we decided to try, though I was worried that it’d be hard to get a spot on a tour if I had nothing booked in advance.

Lower Antelope Canyon was a very short drive from our hotel in Page.  Heading East out of Page on Highway 98, you turn left at Antelope Point Rd, which is the first left if you’ve taken Coppermine road out of town.  If pass the power plant/Navajo Generating Station, you’ve gone too far.

Which tour company?

As of our visit in June 2014, there were two tour companies that had set up shop – Lower Antelope Canyon Tours and Ken’s Lower Antelope Canyon tours.  I think the price was the same at both places.  I was informed that the Lower Antelope Canyon Tours folks were operating without a proper permit from Navajo Parks, so we went with Ken’s tours.

We didn’t have to worry about making a reservation.  We waited about 15 minutes for a tour to start, and the followed our guide Brian into the canyon.  I had read about the tour groups being crowded when doing research before the trip.  Our group had about 12-15 people, which felt like an okay size.  It would have been great if there were less people, but people were patient and waited for each other to take photographs.  Brian was also very helpful in managing the group.

Before you even descend into the canyon, you can see the layers of sandstone in the rocks that lead the way.  Foreshadowing.  The canyon isn’t obvious – from about 20 feet away, you can’t even tell that it is there.

lower antelope canyon page arizona

There are steel ladders leading down into the canyon.  Past ladders had been swept away by flash floods – eleven tourists were killed in 1997 when a flash flood hit.  In 2010, tourists were stranded for hours when another flash flood hit.  Brian explained that these days, they get a radio message from Navajo Parks if a storm is expected.  It’s amazing to think about the amount of force that such a huge rush of water can exert – but it’s the same type of forces that carved the canyon into the stone in the first place.

lower antelope canyon page arizona

If you’re wondering how strenuous Lower Antelope Canyon is, it’s not too bad.  There is some climbing up and down ladders.  If you can handle that, you should be okay.  There are also some areas where there is not much head clearance.  I did bump my head lightly against some sandstone.

lower antelope canyon page arizona

I admit, I started to get pretty giddy after we had descended the ladders.  “Wow, it’s so crazy that this is real.”  The rocks really do have amazing purple, red, and orange hues.

lower antelope canyon page arizona

There are pits in many of the otherwise smooth sandstone walls – this is due to rock impacts during flash floods.  There are small bumps  on some of the walls also, caused by limestone deposits over the course of time.

lower antelope canyon page arizona

The canyon is not too deep.  It’s maybe 50 feet from the surface at its deepest.  In most places, you can look up and still see part of the sky.  It felt nice and cool inside.

lower antelope canyon page arizona

Brian was a nice tour guide.  He stopped briefly at many points to show us various features in the canyon – a profile of a lion’s head, a woman’s face, a fish, and other interesting shapes.  He offered to take everyone’s photos at a number of interesting points along the way – and made sure to set everyone’s iPhones on the “chrome” filter setting to make the colors pop.  He had some general pointers for SLR users also, though they were mostly targeted towards the crowd who leave theirs set on auto.  He said he didn’t have any photography experience before leading these tours when I asked.  He seemed to have picked things up pretty quickly in his three months of experience.

lower antelope canyon page arizona

The walls look like pointy rainbow sherbet!

Photography tips

If you are curious what the lighting is like in there, I took most of my photos on manual mode with auto ISO.  I had the shutter mostly at 1/60 and aperture set anywhere from f/4 to f/13.  I tried some wide open just to see what the photos looked like, and I was disappointed.  All of the detail in the many layers of sandstone is worth stopping down to capture.   A tripod would definitely help, but you have to pay extra to bring one down.  I think this is due to space constraints.  (Oddly, as I mentioned in the beginning of this post, to qualify as a “photographer”, you need to have a tripod and put down $50 for a special permit.  This allows you two hours in the canyon without a guide where you can explore on your own.  Not too bad of a deal, but I wanted to be able to experience the canyon with my Dad, and I wasn’t sure if they’d let him accompany me.)  In the photo above, here were the settings: 24mm f/11 1/60s ISO12800.  Crazy high ISO and you can’t really see any noise.  The Canon 6D is nuts.  Even at full resolution, the photo doesn’t look too bad.

Lenses:

I brought my 50mm and 24mm lens into the canyon with me.  I used the 24mm for 80% of the shots.

lower antelope canyon page arizona

I think that Brian said that each line in the standstone represents about 1000 years.

lower antelope canyon page arizona

There’s one light beam that comes into Lower Antelope Canyon.  In June, when we went, the sun shines through around 11am.

lower antelope canyon page arizona

Brian threw some fine sand up in the air to make the effect of the light beam more dramatic.  I asked him about the sand in the canyon – he said that in some places, there is a foot of sand between our feet and the rocks below.  When flash flooding occurs, the sand is all washed away by the water.  People dump sand back in to make it easier for us to walk through.

lower antelope canyon page arizona

Here’s what the canyon really looked like most of the time.  Though there were a decent number of people in our group, we all took turns when we got to special areas that would have looked better empty.  I remember there being a few people from Singapore, a couple from Italy, some Americans, and a few others.

The tour lasted about an hour.  The ladder out of Lower Antelope canyon was much shorter than the one we descended on the way in.  There are a few dinosaur tracks on the surface that Brian showed us on our walk back to the ticketing building.  We thanked Brian, said “ciao” to the Italians, and were then on our way to Monument Valley.

 

 

 

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