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:

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*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:

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*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:

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(*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:

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