I recently gave birth to our first child, a beautiful and blessedly healthy baby boy. I was fortune to deliver at one of the top hospitals not only in Southern California but nationally, at Cedars Sinai, ranked #7 in the U.S. News & World Report’s Best Hospitals 2020-21. I also work for the largest payer in the country and yet found it exceedingly difficult to 1) navigate the healthcare system including finding the best care covered by my plan, 2) understand and estimate the costs of care and, 3) make cost-conscious decisions on where to receive care.
The road to healthcare price ‘transparency’ will be a marathon, not a sprint.
I hope by shining a light on the costs I incurred for healthcare through pregnancy and delivery, that this post helps others prepare. I’ve split care into two groups: 1) care necessities (e.g., required prenatal OB visits, growth scans, NIPT and carrier screening) and 2) care nice-to-haves (e.g., doula, prenatal chiropractic work, acupuncture). My aim is to reduce the opacity of healthcare pricing by providing an additional data point on the cost of delivering in the U.S. so others can better navigate our complex and broken healthcare system.
Before I dive in to the data, a few caveats:
- I had a natural (no epidural or other pain meds), vaginal birth and stayed in the hospital for 2 nights following delivery; I required no stitching or other post-partum care
- I had minor pregnancy complications including a gestational diabetes diagnosis which required multiple “required” growth scans; as a result of my gestational diabetes, my OB recommended I be induced by pitocin four days after my “due date”
- I was on a PPO plan and also had an HSA which with maximum contributions ($7100 for 2020)
- The “nice” to haves below are typically out-of-network, though I firmly believe all mamas-to-be should have access to these “ancillary” services in order to improve maternal and child health outcomes while also reducing the total cost of care to the health system.
- In the spreadsheet below, I’ve included some evidence-based studies and links on how these “nice to haves’ are associated with better outcomes in the hope that payers will start to cover some of these services to incentivize a healthier journey (for mama and baby) from conception through the post-partum and healing period
- Request access to the raw data and google sheet here
Now, the data:
Finally, the takeaways:
- To give birth in the U.S., I ended up paying over $20k in charges for both required care necessities and the “nice-to-haves”
- Nice to haves, including a prenatal chiro, hypnobirthing class, and doula amounted to just over 5% in amount billed to insurance, yet have strong evidence showing an improvement in health that would likely lead to lower downstream costs to the payer (e.g., reduced risk of C-Section, no anesthesia, fewer ER or urgent care visits post-partum)
- It was incredibly difficult to estimate the costs of care before the fact (e.g., what would it cost to deliver vaginally at Cedars? At an accredited birthing center? With an OB? With a midwife?) since pricing and plan discounts vary widely by care setting and provider choice; as the current administration has just finalized the rules requiring payers to disclose cost sharing information, I am excited to see innovations in this area in the near future
And finally, some questions for you:
- How much did it cost to give birth in your country?
- Were you able to get a sense of costs ahead of time? If not, what data did you use to estimate or budget?
- What tools (e.g., apps, websites) made it easier to plan for your pregnancy or birth?
Thank you for reading!