Monday, February 6, 2017

Common Hospital Charges Associated with Birth

Let's dive into the murky world of hospital billing... 

I will explain common line item charges found on Hospital bills for labor, delivery, post-partum, and newborn services. 

I was hesitant to write this post because of potential variations in hospital billing. I saw an article online where a woman was charged $300 for Ibuprofen tablets(!) when my experience is that 200 mg tablets are free (the over the counter ones) and 800 mg tablets (prescription dose) are only $3 each. 

The information in this post is only an example of how a hospital system may bill for maternity costs. The facility you deliver at may not be the same.

Please note, I am employed by a large hospital system located in the southeast United States. For the past decade, I have spent a lot of time reviewing medical records and medical bills. The below information is based on the system I work for. I do not know how other hospital systems operate. 

This post is not going to address specific dollar figures as those can vary greatly depending on the hospital facility, even within the same system. The system I work for has larger "Metro" facilities and smaller "Outlying" facilities. The prices at the metro facilities are significantly more expensive. As you move away from the metro area, smaller hospitals which offer fewer services and less high level of care services, have less expensive pricing. For example, a hospital in a small town might offer only a single ICU unit with 10 beds, no Neonatal ICU at all, and a lower level Emergency Department. They operate with significantly less staff and their overall operating costs are much lower than those of a large, metro facility and you can see that reflected in their pricing.

Where your bills will come from...

Hospital Bill - One for you and one for baby (Inpatient Services)
Physician Office - A global fee for your doctor (including prenatal visits and delivery) which is usually paid prior to delivery. 
Ancillary Providers - Anesthesiologist, Radiologist, and/or Laboratory 

You can always call the customer service number on any statement and request a "Detailed Bill" from their billing office. The detailed bill will show all the line item charges you were billed. Even if you don't know what the lines mean, it's still a good thing to request and peruse. If you don't understand it, call the billing office again and ask questions. The representative should be able to explain it to you or refer you to someone who can.

One of the most confusing things about a hospital bill is a statement which says: Insurance Payments and Adjustments. The majority of insurance companies will have a contract with the hospital system. As part of their contract they take a discount on the total cost of the bill - often around 30-40%. It may look like your insurance company has made a payment because the bill is reflecting their discount. The best way to ensure what your insurance company actually paid, is to review the Explanation of Benefits (EOB) which you should receive from your insurance company. The EOB is very important for you to review because it will also show you where your responsibility is coming from - if it is a copay, a deductible, or a coinsurance amount. Your insurance company must provide you (online or in the mail) with a copy of an EOB for every claim they pay. 

The Physician's Office Detailed Bill - Will contain the date of the office visit (or delivery service), the name of the provider (doctor or nurse midwife), the visit level, and any tests done in-house - such as a urinalysis dipstick (UA Dip) where the nurse checked your urine for protein, white blood cells, etc. or a Hemoglobin (Iron) check. They may also bill for ultrasound testing done in the office.

Below are common line item charges found on Hospital bills for labor, delivery, post-partum, and newborn services. On a detailed bill you will likely see per each line:

  • Date of Service
  • Charge Code
  • UB Code - a categorization tool used for billing
  • Charge Description
  • Price PER Unit
  • Number of Units Billed
  • Total Price

Vaginal Birth Costs:
Daily Room:
Maternity Room - most facilities these days have private rooms where you labor, deliver, and then stay with the baby until discharge (called suites). There is a charge each night at midnight if you are admitted to the room.

IV Fluids - routinely administered at most facilities, especially for extended labor. At the minimum, they will want to put in an IV line so they have quick access in the event of an emergency. 
Oxytocin (Pitocin) - is routinely administered after every delivery and is often part of a patient safety initiative for a maternity unit. It speeds up the natural contractions of your uterus thus minimizing the risk of post partum hemorrhage. 
Docusate Sodium (Colace) - stool softener, as an over the counter drug, it should be free.
Simethicone (Gas-X) - reduces bloating and gas, as an over the counter drug, it should be free.
Ibuprofen 800 mg - prescription dose will have a small fee associated with each pill.

Labor and Delivery Services:
Labor Hours - you are billed for each hour you spend in labor from the moment you walk in the door until delivery.
Vaginal Delivery - this is the Hospital delivery cost. Your OB will also charge you on a Physician bill to deliver your baby, typically part of the Global Fee I mentioned above under physician billing.

Syphilis (STS) - syphilis testing at every birth may be required in your state (even if negative in the prenatal workup)

Epidural Costs:
Bupivacaine/Lidocaine/Fentanyl - relatively inexpensive drugs, these are usually the medications delivered by the epidural.

Medical Supplies:
Foley Catheter - a urinary catheter is placed because the epidural numbs everything down there.

Epidural Placement - both the facility and an anesthesiologist will bill you for the placement of an epidural.

Labor and Delivery Services:
Intense Labor Hours - labor hours are billed at a higher rate for each hour you are in labor from the time the epidural is placed until delivery. These are billed instead of regular labor hours and represent the increased cost of monitoring and caring for a patient who has an epidural.

C-Section Costs:
Daily Room:
Maternity RoomThere is a charge each night at midnight if you are admitted to the room.

Ketorolac - intravenous pain reliever similar to ibuprofen. This may be offered every six hours for a few doses after delivery. 
Morphine - pain medication given in the operating room.
Ondansetron - anti-nausea medication given in the operating room.
Cefazolin - antibiotic given in the operating room. One dose is standard at the start of the c-section.
Oxytocin - given as an intravenous infusion after delivery. (See above under Vaginal Birth Costs)
APAP/Oxycodone (Percocet) - oral narcotic pain reliever offered after delivery.
Docusate Sodium (Colace)/Simethicone (Gas-X)/Ibuprofen 800 mg - (See above under Vaginal Birth Costs)

Operating Room Supplies:
Dermabond - the glue used to close your incision.
Compression Stockings - exactly what they sound like, these compress and release around your legs during surgery and afterwards until your legs are no longer numb. They are used to prevent blood clots forming during surgery.
Foley Catheter - urinary catheter placed for surgery, usually after you receive your spinal block (or epidural if you are having a c-section after attempting labor). This will be removed 8-12 hours after surgery.

Syphilis (STS) - See above under Vaginal Birth Costs.
Blood Count Complete (CBC) - checks your hemoglobin level and for infection.

Operating Room Services:
1st 30 Minutes of Surgery
Each additional 15 minutes of Surgery

Recovery Room Services:
Recovery per Minute - can vary by facility. If you are in a recovery unit you will pay per minute until transferred to your permanent room. If you recover in your own private room, they may charge a routine fee of 60 minutes and possibly extend it if you need ongoing recovery level care.

Labor and Delivery Services:
Labor Hours - From the moment you walk in the door until your operating room time starts. (Intensive hours will be billed if you are laboring and get an Epidural, see above under Epidural Costs.)
(There is no Hospital delivery fee. Your doctor will charge to deliver the baby via c-section on a physician bill.)

Nurse Anesthetist Services:
Base Procedure Units - a number assigned to every procedure based on the acuity of the procedure by the American Society of Anesthesiologists. A C-Section is a 7.
Anesthesia Minutes - the time the nurse anesthetist is attending to you.
Anesthesia Technical Fee - a fee determined by the acuity (base units) and total minutes of the procedure which includes supplies, monitoring devices, etc. Typically the most expensive of the three anesthesia related charges.
(You will also receive a physician bill from an anesthesiologist. If there is no nurse anesthetist, charges may appear different.)

Newborn Costs:
Daily Room: 
Nursery Charge - There is a charge each night at midnight if baby is in the hospital. Even if baby stays in the room with you and never goes to the nursery, you will pay a nursery charge. Think of it as the charge for the movable bassinet which baby has access to. The charge covers nursing care for the baby and supplies among other things.

Phytonidione Injection - Vitamin K injection, given within 6 hours of birth.
Erythromycin Ointment - Antibiotic eye ointment, applied within 6 hours of  birth.

Newborn Screening - a nurse will squeeze some blood after pricking baby's heel onto a piece of paper with several circles. The screening tests for 30+ conditions, including a metabolic disorder known as PKU. The results are sent to your pediatrician. Find what tests your state screens for HERE.

Pulse Oximetry - a single check of baby's oxygen level, using a light held against their hand or foot.

Hearing Screen

Hepatitis B Vaccine 

If this post was helpful to you or not helpful at all, please comment and let me know, thanks!

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