August 6, 2009

DTQ: How Much Did Your Kid Cost?

Ever since reading Sarah Wildman's article about getting blindsided by a $22,000 hospital bill for the birth of their child, after they'd been paying $126/month for a carefully researched maternity care rider on their high-deductible, high-copay insurance policy, I've wondered how much people are paying for these babies they're getting.

I mean, I know plenty of people who've spent plenty of money on fertility treatments and adoptions, international adoptions, too, that can take years and tens of thousands of dollars.

But I guess because we've always had pretty solid insurance through work--either mine, or these days, my wife's--I've taken it for granted that having a kid the old-fashioned way is basically cheap-to-free. After reading the responses on Chris's broader, related question, though [Where do you get your insurance, and how much does it cost?, questions which were soon expanded upon by metafilter] I realized I am living in a fantasy world.

Our insurance costs about $200/mo $300/mo [says the wife]. We don't pay any extra for maternity coverage, and except for a couple of lactation consultant visits after the kid was born, I can't think of a single bill during either pregnancy or delivery [hospital, epidural, no complications] that wasn't covered. So for us, our kids were basically free. At least until they got home.

How about you? And yes, if you live outside the US, you are welcome to complain about your communist birthing expenses as well.


When did you have kids! Wow.
1. That's cheap for insurance.
2. You had no deductible? at all?

We had to pay ours obviously, I think it was around $1500 for the year. We don't pay extra for maternity.

The overall bills though that we got that went to insurance to pay probably equaled $15-20K for c section, 4 nights in hospital etc. basic stuff.

I couldn't imagine what to do if we didn't have insurance. I hear folks set up payment plans and never really pay the full amount that's billed to insurance and that you can even negotiate it. Maybe that's all media hype though.

Cost = $0 for us (in Canada).

Oh, we did get one bill from the hospital, but it was for something 'optional'. We specifically requested a private room, and our extended health insurer didn't cover the whole bill, so we made up the difference. There's a very good chance I'd have been given a private room anyway (since obviously there was one available) in which case the hospital wouldn't have billed for the difference in price, but we didn't want to take the chance of having to share a room.

Of course, we don't pay for any of my prenatal care, either; obstetrician visits, all tests, etc., are fully covered. I pay 20% of the bill for prenatal massage therapy and our extended health pays for the balance. I (and our son) have always had the care we've needed, when we've needed it.

Short answer: about $750.

Long answer: We had my employer's "low" plan (where we paid less per month for coverage but paid a larger share of expenses actually incurred). I don't remember the exact numbers, but I believe we paid one ~$20 co-pay for all prenatal visits to the OBGYN/midwife office. We then got bills for 10% of everything else, which came to about $30 for the in-hospital pediatrician visit, $350 (give or take $50) for the hospital and $350 (give or take $50) for the OB for the actual birth. $3500 is very low for a total hospital bill, but it was because we used the hospital's "birthing center" rather than the traditional labor & delivery ward so we stayed less than 24 hours and almost no equipment was used.

We had an extended fight with the OB's office over the fact that we were billed for the OB when the OB sent a midwife from her practice after telling us the OB herself was on her way. According to the OB's office, they bill out ALL births as if the OB delivered them, even when the midwife actually did it. Medical professionals in my family suggested this was likely fraud (an anesthesiologist and a nurse anesthetist, for example, are typically paid very different rates for similar procedures), and after digging deeper with our insurance carrier we learned that there probably were different rates for the OB vs. the midwife (we never got a straight answer, despite escalating through my employer's benefits department). It turned out, however, that the midwife wasn't in-network, so we eventually dropped the issue rather than be forced to pay the much higher out-of-network bill.

The insurance system in the US is completely busted.

Let see...agreed $300 a month is cheap...My insurance through work is $600+ per month (PPO).

Paid the deductible ($600) on top of the regular per month payment and then payments to the OBGYN (which I overpaid because of my job change and then never got back because it was sooo much of a fight to even try).

We got billed a percentage from the epidural ($350), all the freaking tests ($150), other things they do to boys ($50), and then the hospital stay for natural birth was about $2500 (I think, I was losing lots of sleep).

I started thinking about diapers and how many we use/spend money on and that is even staggering.

New Zealand: you get a midwife for free on the public system, who can refer you on to an obstetrician if she expects complications (then also free). But many of the midwives are of very low standard: you have to move very quickly to get one that's qualified, and the govt pays the qualified ones the same as the ones who've taken a 5 week course. Birth in hospital with a midwife: there's a floating obstetrician who can help out if needed.

We opted instead to go for shared care; got a good midwife early, and paid an additional $2K for the best obstetrician in town (cheap!). When it turned out we needed a caesarean due to a rather large Ira, was part of the $2K all inclusive fee.

Oh: our health insurance, for the three of us, is $90/mth. High deductible ($5K). Strongly prefer paying for med services out of pocket and keeping insurance for emergencies. Gets you much much lower rates. Since health insurance here isn't mandated to cover a bunch of stuff you don't necessarily want, it's a lot cheaper.

We have crap insurance through my husband's job ($5000 deductible per person), so it's really just emergency/keep us out of bankruptcy coverage. We paid out of pocket for our home-birth midwife, $3500 for prenatal/delivery care. Plus we had to pay the co-pay for my two state-mandated OB visits and necessary bloodwork.

United Kingdom, absolutely free everything. We had extensive pre-natal care, a complex birth (from super-swish birthing centre to emergency caesarean and 3-4 days in hospital), a lactation consultant, and lots of post-natal care.

Greg, your insurance isn't "basically free" -- your employer is paying for it. Instead of the total value of your compensation coming to you in cash, part is in cash and part is the insurance benefit. If America had a nationalized health system, you'd probably be earning more money.

The bottom line is that funding health care through taxes is much more efficient than the every-man-for-himself profiteering model in America. The variation in what people pay cited on this blog alone is pretty telling. Why should having a baby be like buying an airline ticket -- one service, a thousand different prices?

I work for a large, private university with virtually unparalleled benefits. My insurance costs me about $265/month (for the whole family) and I have no deductible. I paid $0 to have each baby.

3 c-sections in Canada. All I had to pay was 20% of the room charge ($60/night) and my travel when I had to go to the big hospital 5 hours away.
Of course, the OBs for 2 births were semi-competent jerks but I attribute that to having locums out in the boonies, rather than to a sub-standard medical system

Homebirth in Manhattan - c1500. We had crappy grad school health insurance that would have covered everything in hospital but did not have any in- network miwives who did home births. They still said they would cover most of it, but we just kept getting the bills. So eventually I paid them.
Homebirth in New Zealand - c250. We were not on the national health care program bcause I had a limited term contract, but that is all we paid. Maybe the midwife just pretended we did have national insurance. I didn't bother to submit the bill to above crappy grad school insurance, which was providing us with international coverage. Fwiw, our midwife was awesome and we didnt have trouble getting on her schedule, but we were on Waiheke - a small island 1/2 hr from Auckland - so maybe the 'market' ws different - ie nit many people having babies. One the super popular ones in Auvkland we were referrd to early on was annoying and bossy, we were happy to leave her behind.

C-Section Turkey free. We both worked for the University which luckily enough had a medical school.

C-Section Germany via Army hospital free.

We were very lucky as I know people with 8 year olds who are still paying off the births.

$300 a month? Can you claim us as dependents? We pay $800/month for private health insurance for two very healthy adults and one perfectly healthy kid, and that's with a $4000 deductible.

When we had our kid, we had pretty good employer provided insurance. Used a midwife and OB/GYN (planned a homebirth), ended up taking an ambulance to the hospital, and spent one night there. We paid the midwife ourselves, but didn't pay anything for the rest of it.

We had some supposedly high end PPO healthcare they give university professors and they warned us ahead of time that having a child on the insurance would still cost us about $3k. We saved up a few grand expecting this and the bills started coming soon after the birth. In total, we spent about $4400 out of pocket on stuff that supposedly wasn't covered by our health insurance. If you added all the bills together for what the total cost was (what got billed to insurance) I'd say it was somewhere in the 10-15k range.

This was for a conventional childbirth with no complications, though a spinal epidural was administered (I think that added about $1500).

€ 0,-
National healthcare system in Austria.

I'm in The Netherlands. Our healthcare insurance runs about EUR 220 a month for the both of us including any children we might have under 18, so not too dissimilar from what you're paying. This includes dental coverage by the way. Our son cost us nothing at all, all expenses were fully covered, *including* 4 hours a day of postnatal care at home for a week.

Another Brit here
9m of 'high risk' antenatal care (community midwives, hospital obstetricians, phlebotomists, one extremely nice professor of obstetrics, two routine scans and one additional one.
Perfectly straightforward and easy waterbirth in hospital, one night stay.
6wks postnatal care (midwife home visits, LMW heparin)
Continuing care from health visitors and breastfeeding counsellors.

Cost: £0
(Admittedly we did pay for National Childbirth Trust antenatal classes but we could have gone to a free national health one.)

And do you want to hear the best bit? I was able to take 6m maternity leave at full pay and 3 further months at 'statutory maternity pay' of £534 pcm (that's about $890).

My employer was generous, but even if yours gives the absolute minimum, you are still entitled to 52 weeks leave: 6 weeks at 90% pay, 33 further weeks at 'stat' and the last 13 weeks unpaid.
And be guaranteed to go back to the same job afterwards.

I paid one $15 copay for OB visits and $300 for L&D at the local hospital. My insurance is completely paid for by my employer but covers none of my dependents. My husband's policy covers him and the kids (we pay $132/month and could cover up to five people on that policy).

Interestingly, the explanation of benefits for my insurance company shows that they paid $3300 to the hospital for my first baby's birth, while the hospital's total charges were less than $3000. I did a little digging and found out that lots of health plans have standard negotiated amounts they pay for vaginal deliveries, regardless of the cost. So between me and my insurance company, the hospital collected $3600 for a birth and two-night stay that would have cost less than $3K. I helped them turn a profit by skipping the epidural--which is funny because our childbirth teacher told us in no uncertain terms that hospitals routinely push epidurals because they're a profit center.

I am in Ontario and 2 c-sections 5 days in hosptial each time, lactaion consultant 2nd time, , 1 had light treatment for jaundice all free.

For the government to get rid the heathcare and we pay for it ourselves would end up costing me moeny. Right now it is shared by all so we are saving money in the long run. That is why I don't understand how Americans can be so against it. You pay more for your "coverage "( then they decided it is pre-existing so not covered + deductables) then I do in taxes. Most people would end up saving money if everyone paid a share. Mind you that means regulating how much a Dr. can charge for each procedure. No more charging $22,000 for the same thng that someone else paid $3000 for.

1st child: (2000) long in-hospital labor w/ epidural and eventual c-section (that kid was not coming out any other way, yo), otherwise no complications, out of the hosp in 2.5 days total. I think my deductible (PPO) was about 1500 at that point, and we saw some bills from the hospital that led me to believe that our total would have been around 12000, but keep in mind these are the discounted prices that my insurance company would pay the hospital. For a cash on the barrel head c-section, who knows?

Second time around, (2004) full term twins, c-section, no complications, again about 2-3 days in hosp, I think my deductible was in the 2-3000 at that point, but I never saw any kind of total bill from the hospital, doctors, etc. One thing I did wonder was: is it cheaper to have twins than two separate births? Only one hospital visit after all. Does the OB charge more for a twin birth than for a single? Never found out.

One thing I do know is my brother owns a small company with about 5 employees, and it is KILLING him to keep everybody insured. Last time I checked (a few years ago) it was costing him $16000 a year just to insure his healthy family of four and his annual increases usually run between 6-15%.

I wish we had a national single payer system. I think the United States should model our new system from the UK one. Too bad it will never happen. Every time someone mentions single payer, the Republicans and the more conservative people scream socialism, and accuse others of being a socialist. The US is to self centered. Nobody wants (I and other like minded people don't mind) to have any other their taxes go to help others. I don't care, I'm sick of my health being a number of Blue Cross's quarterly statements to Wall Street. For some reason, everything in this country has to be for profit. Seeing a doctor should be a right, not a privilege.

My health plan is totally covered by the school district where I teach. To add a dependent to my plan, wife, a child, or the Dugger clan would cost me $965 a month. I have a $10 co-pay and a $2000 deductible at an 80% coverage. After my 20% equals $2000, they are supposed to cover it all.

My wife works so she can have health coverage. They baby, when it comes in a few months will be on her plan. We can't afford to pay $965 per month for insurance.

Her plan is very similar to mine, but her co-pay is a bit higher. So far, we've payed the ob $780 in $130 installments. The hospital and the anesthesiologist will be two separate bills 20% of their charge. Two years ago we had a stillbirth and the total charges for the three, ob, hospital, and anesthesiologist, were slightly more than $3000.

It's almost as if the governments in countries other than the US... gasp... are working for the good of the people, rather than the corporations!

So I wrote the somewhat self-congratulatory sounding entry above about working for a university and enjoying low premiums and free births.

In retrospect, there's a Part B to that story: I would love to work less (or maybe not at all at some point), but the health insurance for our family is from my job. My husband's company could provide insurance but it is far more expensive than my plan and, for that matter, his job is much less secure than mine and I would always worry about him being laid off and us being w/o insurance.

So as much as I enjoy and appreciate my excellent employer's excellent benefits, I also feel vaguely trapped by it and wish I had other options.

I've had 2 planned c-sections in Alberta, where we pay $264 a month in insurance premiums. In other provinces, this premium is hidden in taxes but in Alberta, everyone is billed. There are very generous subsidy programs available for anybody who is a student, low income or part time. We are self-employed and have no other insurance. In addition to the premium, each hospital stay cost $24, first time for 2 nights is a semi-private room, second time for 3 nights for a private room because I had twins. With the twins I had about 10 ultrasounds, saw an obstetrician monthly and then weekly and had two delivery teams on standby in the operating room. Standard practice also includes a home visit from a public health nurse to take the stitches out and a 6 week post-partum depression phone call. There is also free pre-natal classes and 4 free post partum community classes available so that new parents can meet other new parents in their neighborhood. Baby 4 is on the way and I don't even have to give the costs a second thought. Pretty lucky.

About $500/mo for coverage (BC/BS)Coverage through work (a hospital)...
and $350 for each birth + $20 initial OB copay.

I work at the medical center of a state university and we have outstanding health insurance. My insurance costs are $172/month for two adults and an unlimited number of kids, which includes vision and dental. When I was a postdoc at the same university it was $0 (the university paid all premiums).

The out-of-pocket costs for my son were $15 for the prenatal visits and $0 for delivery (this is when I was a postdoc). The out-of-pocket costs for my daughter were $15 for all prenatal visits and $100 for the delivery. Both pregnancies were high-risk and I saw specialists (perinatologists, hematologist) throughout, plus had twice-weekly ultrasounds in the last few weeks, not to mention a couple of hospital visits due to premature labor scares. I would not be surprised if the actual costs were over $100k per baby.

We are lucky, lucky, lucky. I'm glad I love my job because I'm not sure we could ever afford for me to leave it.

Wow. I can't believe anyone has to stay with a certain employer just to have adequate health coverage. {shakes head}

BTW, Andrea, in BC there are premiums, too. I honestly wasn't even sure what we pay, but found this link:

Melanie, you are obv not from around here.
Based on my personal experience and talking to people I know, I would say between 1 in 5 and 1 in 10 people here would tell you that they would love to change jobs, or work part-time to take care of their kids more, or maybe open their own business, but they can't afford to leave their insurance behind, because of cost, or the inability to get any at all due to the infamous pre-existing condition" which basically is anything the insurance company says it is.
If there was universally available, affordable insurance in this country, I really believe that entrepreneurship would explode, why aren't the Republicans screaming about that? I guess the Ins Co.s/Hospital conglomerates must be spending more lobbying money than the NFIB this year.
Sorry, I have gotten a bit off topic here.

Two completely natural hospital births which cost us nothing due to our wonderful health insurance we get through my husband which is mostly covered by his company. I think we pay around $200 a month for our family.

I see the ups and downs to "socialized" health care as I have relatives that live in countries that have these systems. I think it works for smaller countries (Iceland, for example), but to try to implement something in the US right now would just be a nightmare. I have a relative who literally died of cancer while waiting to get care. It's not all free births and roses! However, in these countries, the government really has peoples' health in mind (really supporting breastfeeding, etc.)

As for lactation consultants, my ped. basically wrote a prescription for three appointments with lactation consultants if we needed them, so they'd be covered by insurance. That rocks.

JJ Daddy-O, I am Canadian. I've also lived in the UK and Germany. Have never experienced the kind of health system you've got in the US.

I'll play.

Baby #1 in 2001, we were on COBRA from my husband's last job, in an era when COBRA was affordable. We ended up paying about $1500 for the (emergency) c-section and 4 night stay. The insurance paid $9-$10,000 and the bill before discount was about $15,000.

Baby #2 in 2004, we had strange insurance from my husband's job. Premiums were never much more then $300/mo. That year we had a $1000 deductible and a max out of pocket of $5000...we spent $4400 on that c-section and 4 night stay. I am still bitter the doctor really pushed me to stay the 4th night and then we were dinged by the insurance for violating the 96 hour plus grace period. The insurance company did not negotiate any prices = they paid $15,000 on top of our $4400.

Baby #3 in 2008. Lovely insurance - $250/mo premiums. $200 family deductible. $400 max out of pocket. Another c-section. 3 night stay because I insisted. I think the birth cost $21,000 and she was a fall baby, so we had easily hit our $400 max out of pocket. I think we did end up with a $3 bill for something.

I love our current insurance, but I still support healthcare reform. The company that provided the insurance we had for the middle baby was a small business. They meant well and were determined to offer insurance. But it was so expensive - for us and them. And what they could afford was crap. And that's not fair.

OK, I feel like I have to weigh in here!

As an independent contractor, I have maintained private health insurance for myself and my family for more than ten years. I've kept a "good" PPO plan -- not absolute top of the line, but far from the bottom of the barrel.

2004 - Child #1: $4,000 + $1,500 Doula (not covered by insurance)
Natural child birth, no epidural, no complications or interventions, 2 nights hospital stay
Born at Cedar's Sinai in LA
Total billed to insurance by hospital: $16,000

2007 - Child #2: $17,000
Complicated pregnancy, 2 months home bed rest, 10 days perinatal hospital stay, c-section delivery of healthy preemie, 5 days post-partum hospital for mom, 5 weeks NICU stay for healthy preemie with no medical interventions necessary.
Born at Good Samaritan in LA
Total billed to insurance by hospital & doctors: $250,000

Here's the breakdown of my monthly premiums:
2003 - $106/mo for one adult, aged 30 or over
2005 - $266/mo for one adult and one child
2007 - $478/mo for one adult and two children

I have now removed my maternity benefit.
2009 - $313 for one adult and two children
that includes two doctor visits per year at $35 co-pay and a $2500 deductable

All of my savings has gone towards medical bills and premiums. Obama, help!

ok so baby with no pregnancy complications, but a c-section was a total of about $5000. We have BCBS PPO, with no deductible but an annual out of pocket. We pay about $300/month for 2 adults and now 1 baby.

About leaveing jobs ... most companies will either offer a group policy that do not limit the pre-existing conditions. The biggest issue is when companies do not offer benefits from day one and have a waiting period. One more thing I have learned from HR department, is that while being insured, it is easier to access other insurance, one more reason to look at the COBRA when changing jobs if needed. Always check with employers about the group policy and pre-existing conditions.

We get our insurance from a well-known HMO as a benefit from my employer. I don't know if this story is a typical HMO story but it might at least reinforce some stereotypes.
First child: All prenatal exams, hospital stay, lactation consultation, and well-baby visits for first two years were covered. Reasonably uncomplicated delivery, but there was a preeclampsia risk. Otherwise everyone was healthy. Epidural. Deliver fell between shifts which made it more interesting. One night in hospital.
Second child: Pretty much carbon copy of the first.
Vasectomy: $15 copay, surgery performed in-office. No charge for followup testing to verify vasectomy was successful.
Third child (surprise!): All prenatal exams and well-baby visits were covered. However, my employer's benefits changed and there was a $500 hospital admission fee this time around. No preeclampsia, two nights in private room, lights.
Second vasectomy: $15 copay, surgery performed in operating room. Same doc as the first time. The anesthesiologist was present but I opted for local anesthetic instead.

Makes me think there should be a separate vasectomy insurance, or at least a money-back guarantee or free do-over or something.

And I'd say it should be included in the current health industry reform debate, but it'd probably get relabeled as forced sterilization. So oh well.

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