My Costs for Pregnancy and Labor   Leave a comment

I have found myself missing blogging very much during the past year. On a regular basis my mind comes up with ideas for blog posts, but the reality of being a new mom has meant that I never managed to get any of those ideas typed up. I’m hoping to resume blogging, maybe on a monthly-ish frequency, now that Conan is a year old.

Shortly before Conan’s first birthday, I finally got resolution from my health insurance company regarding coverage for the cost of his birth and I’ve been wanting to write about my experience with the cost of homebirth. I must emphasize that this is my experience and should not be generalized.

Cost was not a significant reason for why I chose to give birth at home in the first place, and it probably doesn’t make an difference to someone who is not comfortable with the idea of homebirth. In retrospect I feel that within my values it is a strong plus in the homebirth column, though. There is a lot of complaining going on now about the cost of health care, and this is an example of how we have the power to make choices that affect the cost of health care for ourselves and others.

When I looked up the cost for a normal vaginal delivery last summer while writing my grievance letter to my insurance company (story to come later), the estimated range for Sacramento was $10k-21k. Checking again right now the website says the estimated range for three major hospitals in Sacramento is $15k-23k (approximately $3k of that out-of-pocket and the remainder paid through insurance). My total cost was $4,955, with $2,932 of that ultimately out of pocket. Yes, my cost was $5k. Between one fifth and half the cost of a normal hospital birth. My out of pocket expenses ended up being on a par with what they would have been for a hospital birth, but that is because I fought for reimbursement.

What was included in my total cost?

  • Midwife care (13 prenatal checkups, attendance of 2 midwives for the birth, 6 postnatal mother & baby checkups)
  • Two ultrasounds (nuchal translucency and 2nd tri)
  • Genetic Disease Screening Program
  • California Newborn Screen
  • Other lab tests
  • Birth kit
  • Six visits to a chiropractor

Nearly all of our costs were initially out of pocket. We paid our midwives out-of-pocket because the total fee is less if you pay out-of-pocket instead of having them go through insurance. And since I assumed that my insurance company would reject the claim, it just made sense to go the route with less cost even if it meant more effort on my part (to submit a member claim to insurance). I have a high deductible health insurance plan, so for the first $1.5k (in-network) each year it is all out-of-pocket, and the only thing that put us over that deductible was the charge for midwifery care.

When I submitted my member claim, my insurance company applied the charge to the out-of-network deductible ($3k) and stated that only half of the fee was allowed for the procedure. I submitted an appeal arguing that since there are no in-network midwives I couldn’t choose an in-network provider so I should not be penalized and the cost should be applied to the in-network deductible. I also pointed out that even applying the cost to the in-network deductible and reimbursing me at that rate, their total cost is still significantly lower than it would have been had I had a hospital birth. I’m guessing that the reason their allowed cost was so much lower than my actual cost was because their allowed cost was for the “childbirth, normal vaginal delivery” procedure only. When I got a $2k reimbursement check I figured that was good enough.

I did get a laugh when I got the response to my appeal. It read: “This administrative decision represents an exception and does not change Anthem’s position regarding plan benefits, as detailed in your EOC form. … Please note that your EOC specifically states that if there are no contracted midwives you may call customer service for a referral to a participating OB/GYN. …” Why on earth would I trade the awesome care I received from my midwives in my comfortable home for mediocre care by a doctor in a medical facility? (No offense to the vast majority of people who prefer birthing in the hospital. I’m just a li-i-ittle bit jaded about medical doctors having had more negative experiences than positive.)

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Posted February 1, 2014 by mayakey in money, pregnancy

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