Pregnancy care includes prenatal visits, addressing psychological and medical aspects, childbirth, and postpartum care. On average, this can cost nearly $19,000 without health insurance. Even with insurance, you might still face out-of-pocket expenses such as deductibles and co-payments. Here’s a breakdown: 

• Prenatal Care: Expect around 10 to 15 prenatal visits to ensure a healthy pregnancy. 
• Type of Birth: Vaginal births are less expensive than C-sections. 

• Hospital Charges: Mother’s hospital stay and complications can increase costs. 
• Special Circumstances: Factors like epidurals or inducing pregnancy can add to the bill. 

After childbirth, there are more charges for your newborn’s care, which can be significant. But it doesn’t end there. 

How to Minimize Childbirth Cost Stress 

While financial education for expectant mothers is not yet standard, there are ways to empower yourself. Planning for these costs is essential. Consider these tips: 

• Understand Your Insurance: Learn what your insurance covers during for pregnancy, childbirth and postpartum care. 

• Customized Payment Plans: Set up a payment plan with the hospital for manageable installments. 
• Ask for Discounts: Inquire about discounted rates, particularly if you’re uninsured. 
• Government Assistance: Check if you qualify for Medicaid or state-specific grants. 
• Create a Financial Strategy: Develop a personalized financial plan that aligns with your needs. 

By taking these proactive steps, you can better navigate the complex financial landscape of childbirth, ensuring a smoother transition into motherhood. 

Advocates for Affordable Maternity Care 

There are also organizations like “March for Moms” which are dedicated to supporting expectant and new mothers, recognizing the intimate link between mental health and financial stability during pregnancy.  

Remember that the healthcare system’s billing process can be complicated, but with preparation and understanding, you can navigate these costs more confidently. 

Check out The Hidden Costs of Health on EmpoweredUs.org, where you can find more tips and resources. 

Resources: 

• Connect with organizations like “March for Moms.” 
• Call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) 
• How to find government sponsored health insurance programs 
• How to apply for Medicaid  
• How to apply for your state’s children’s health insurance programs (CHIP) 
• Peterson KFF Health System Tracker 
• The statistics Allie mentioned about the costs of birth and postpartum care 

Read Less

[00:00:30] Allie: For many people, having a baby is among life’s most cherished experiences. While raising a child is undoubtedly expensive, pregnancy and childbirth also comes with a price, and sometimes the costs can be substantial.

[00:00:48] Hello and welcome to The Hidden Costs of Health. In this show, we’re exploring the burden of medical expenses in this country, and how a health event can quickly spiral into financial toxicity.

[00:01:00] I’m Allie Sandler, a producer for Empowered Us.

[00:01:05] [Music Ends]

[00:01:06] Pregnancy ranks among the most widespread causes of hospitalization for non-elderly patients. Beyond the expenses related to childbirth, pregnancy care encompasses prenatal visits and addressing psychological and medical aspects linked to pregnancy, childbirth, and postpartum care. According to a study conducted by the Peterson KFF Health System Tracker, pregnancy, childbirth, and postpartum care average a total of $18, 865 without health insurance, and the average out of pocket payments for insured individuals totaling $2,854.

[00:01:48] If you don’t have health insurance, you’re responsible for all of your medical expenses during pregnancy and after birth. If you’re insured, your out-of-pocket expenses may include a health insurance deductible, copayments, and coinsurance, depending on the particulars of your plan.

[00:02:06] If you’ve already met your annual deductible, your out-of-pocket costs might be lower. So, based on these statistics, it’s clear that the cost of preparing for and giving birth can be quite costly, even with insurance, and far more so without. So, let’s break down these costs.

[00:02:26] [Music]

[00:02:27] First is prenatal care. Throughout a pregnancy without complications, you can expect to visit the obstetrician’s office between 10 to 15 times. These visits play an important role in ensuring a healthy pregnancy and directly influence the overall cost of your journey to parenthood. The type of birth also varies the cost.

[00:02:49] According to the same study that I mentioned before, the costs for vaginal births are lower than those for cesarean births. The average out-of-pocket spending for a vaginal delivery is $2,655 compared to $3,214 for cesarean births. Whether or not you’re insured, vaginal births typically cost less than C-sections.

[00:03:14] The mother’s hospital charges can also add up. The average hospital stay is between 48 to 96 hours. That’s a lot of time in the hospital. These charges can also increase if there’s complications during the pregnancy or if you need specialty care. A birth with an epidural or inducing your pregnancy will also increase the cost of delivery.

[00:03:37] Once the baby’s born, there are even more charges, as if giving birth wasn’t enough. All babies need medical care once they’re born. The doctors will need to monitor the baby and get their vitals before the mother and child are discharged. If your newborn is born with any specific conditions that require additional care, you’ll incur costs for that as well.

[00:04:00] Woo! This is a lot! And that’s all before leaving the hospital. While the data and research emphasize the significant costs associated with the birthing experience, it’s better to hear from someone who’s experienced it firsthand.

[00:04:17] Rebecca: My name is Rebecca Deyo, and I am a chiropractic physician by trade, and I’m also a mom of a daughter.

[00:04:23] [Music Ends]

[00:04:24] One of the best things that we ever did was the second I found out I was pregnant we immediately knew that we had to save up money for whatever cost was going to come with our insurance plan. And at the time we had a decently high deductible, so we knew that it was going to be around somewhere between like 7 to $8,000 that we were going to have to spend.

[00:04:42] So, we knew that we would probably be spending most of our deductible amount, if not all of it. So, literally the second we got pregnant, we just started putting money away slowly every single month, every couple weeks, and so we were blessed to be in a position where we could prepare for that. I do think planning ahead is really, it just helped to take away a lot of that stress.

[00:05:01] Allie: Can you share a little bit about your prenatal journey and anything surprising that came up financially along the way?

[00:05:07] Rebecca: I was very fortunate that my pregnancy was low risk, no complications, and thankfully, you know, with the current legislation that was fully covered under my health insurance plan. So, that was really nice, especially because the visits are five to ten minutes most of the time with healthy pregnancies, so it was almost a bigger financial struggle for me to leave my work, drive all the way downtown where I live, drive my car, not see patients during that time, not work during that time, just for a ten minute appointment, but those visits are important obviously to just keep track of the pregnancy and make sure everything’s going well.

[00:05:39] But I remember feeling very grateful that it wasn’t something out of pocket that I had to pay. Even if you’re a patient who has no issues with money, it still makes you feel appreciated and valued, just to have that kind of healthcare be covered.

[00:05:51] I have had a quite a few patients in the last year who had the opposite experience, however, where somewhere in the middle of their pregnancy, something goes wrong, whether it’s abnormal fetal development or a suspicion that they find on an ultrasound, and it dramatically changes things because now you’re not just having regular prenatal care, you’re possibly working with maternal fetal medicine. You’re having additional appointments. You’re having additional tests and so it could really depend on your health insurance plan in that moment to know, okay, is this going to be an additional financial stressor before the baby even arrives?

[00:06:21] Allie: Let’s talk about the labor and delivery process for you.

[00:06:24] Rebecca: Yeah, so when it comes to the actual labor and delivery process, I can’t imagine going through something like this not being educated on what to expect. I don’t think we do a good enough job of educating women on what that process looks like. A lot of people think you just go in there, get an epidural, and have a baby. But there are varying protocols that can take place.

[00:06:43] I was thankfully advised to not take certain things from the hospital to help decrease my payments. So, for example, a lot of people don’t realize when you accept things like over the counter medication for your pain, that’s actually going to be an uptick on your bill, and it makes sense like when you think about it, but I don’t think a lot of people realize that.

[00:07:00] You know, if you take supplies, you’re going to pay for them. It’s just a very unique situation. But I do think we need to probably be a little bit more transparent with patients, like are you willing to accept this medication and understand that you will be paying for it?

[00:07:15] We actually did have one major financial change that really surprised my husband and I. So, we knew it was going to be expensive, right? But I gave birth at 11:06 PM. no complications, thankfully. And already by morning I was doing great. Like I, I personally felt like I could have gone home by noon the next day. However, of course there’s hospital protocols, right? So, we knew that we would be there for at least 24 hours. That’s their hospital protocol.

[00:07:39] They told us the next day that because I had a nighttime delivery, I had to stay two nights because they have a protocol where you can’t go home after a certain hour at night. And I remember thinking like, I’m fully fine. Like I can get up and walk. I am strong. I can lift my baby. I can breastfeed. I’m not sick. I have no complications. Why can’t I go home?

[00:08:02] I had family waiting for me at home that couldn’t come to the hospital because it was during the COVID pandemic. All I wanted to do was get out of that hospital. I was healthy. My baby was healthy. But they literally gave us no option and made us stay two nights. But it wasn’t until afterward that I realized that was another four grand on our medical bills.

[00:08:19] Allie: Oh my gosh, that’s a huge unexpected expense! How about postnatal life? Did any financial stressors come up once you and the baby were home?

[00:08:28] Rebecca: Some of the things that were interesting to me came from the health insurance side of things. And I remember at the time I was paying $280 maximum per month, and then when I added on my daughter, the cost went up to $500 per month, I was like, oh, I’m adding a fully healthy newborn to my health insurance plan and my premiums double? Like, mmkay, like that’s a little interesting.

[00:08:48] And then we also went through a couple issues with health insurance companies as well, where we got started on a specific plan, set up things with her pediatrician, loved them. And then during the open enrollment process, we actually switched plans to get a better family deal and we were no longer able to see the pediatricians that we loved.

[00:09:05] And I think that’s something that gets overlooked. We focus a lot on cost, cost, cost. And yes, there are so many stressors, and fallacies that go along with that. But I think emotion does get involved as well. Like for us, like having to leave a pediatric office that we really loved and people that really treated our daughter like she was family, that was really hard on us.

[00:09:25] And I’m literally choosing to switch back to that plan specifically to get out of that network. And so, it’s gonna cost me more money, but like at the end of the day it’s a decision financially that we have to make in order to get the best care for my daughter possible.

[00:09:38] Allie: In your opinion as a practitioner and as a mother, what do you think is the reason patients aren’t fully educated on healthcare expenses?

[00:09:46] Rebecca: It sounds awful, but I think that health insurance companies prefer it that way. Lack of education usually leads to better results for them and better outcomes for them. And so, I think we now know how important patient education is. I think in general the world is changing to better educate mothers, or soon to be mothers, when it comes to this.

[00:10:04] But I think it’s happening very slowly from a health insurance standpoint, especially when we think about patients who have lower socioeconomic status or lower educational level. I mean, I can’t even tell you how long it takes me to train my staff on some of the terminology when it comes to health insurance and healthcare.

[00:10:19] I wish that everyone was sat down the second that they become pregnant or even beforehand, like maybe in a gynecology office. Maybe you’re not even considering getting pregnant for a long time, but you have one appointment a year that reminds you of what your maternal coverage is like through your health insurance plan.

[00:10:34] The number one thing I tell every person, every friend, family member, when they tell me that they’re pregnant is to just immediately look up your benefits and save whatever you need to save to get you there. So, that when you get that first medical bill you are not stressed. Because when you have a baby, there’s gonna be natural stressors that happen, and you just don’t have the time to worry about something like [Music] medical bills.

[00:10:57] Allie: Although Rebecca is familiar with medical billing and the intricacies of the healthcare system, her own experiences during pregnancy and the initial days of having a newborn show that even she had to confront financial surprises. She was able to stay informed and act as her own advocate, a privilege not every expectant mother has.

[00:11:17] The connection between mental health and financial stability during pregnancy in the postnatal period showed the clear need for comprehensive preparation. Fortunately, there are dedicated organizations and individuals who have devoted their lives to advocating for and supporting new parents throughout this process.

[00:11:35] Yuliya: My name is Yuliya Labko and I’m a certified nurse midwife and the policy director for March for Moms.

[00:11:42] Allie: March for Moms is a nonprofit organization whose goal is to align advocacy efforts of families and healthcare providers, along with industry and policy makers, to ensure that all families can grow with dignity. Since being established in 2017, their goal is to continue to raise awareness for the maternity healthcare crisis, and function with a coalition of other advocates in the family health care system.

[00:12:06] [Music Ends]

[00:12:06] Yuliya: Advocating for affordable care is really important because it goes back to really dignity, birth and growing our families is part of health care, which is a basic need. And if we have families who can’t afford care, who are burdened with bills that they may not even expect at times, and they get, it puts strain on families and moms during a time where we should really be helping them focus on themselves and their babies.

[00:12:34] So, really advocating on this specific piece of the system helps us ensure that families are taken care of all around and finances, now more than ever, of course, are tight for many people. So, advocating for this specific part of growing families is really important. You know, it’s a feedback loop, so we see effects of that downstream, later on for sure.

[00:13:04] Allie: How does March for Moms advocate for maternity care?

[00:13:08] Yuliya: So, we actually work within a coalition. inclusive of professional organizations for things like increased access to paid family leave, reproductive rights, raising awareness of and really working to decrease the maternal morbidity and mortality rate. And then we also work closely with our partners to address, um, maternal mental health and then racial disparities and, and care for families.

[00:13:33] So, March for Moms really tries to address the issues families might be going through, for example, in prenatal care, making sure they’re receiving equitable care in their appointments and ensuring that they have access to transportation to see a provider within their area that’s close by.

[00:13:54] We are experiencing lots of areas with maternity care deserts where people have to drive really far to see a provider, whether that’s an obstetrician or a midwife. So, we continuously work, with our partners to make sure funding is allocated and hospitals are able to stay open, so folks are able to go and access prenatal care.

[00:14:17] And then postpartum, big one, the maternal mental health has also declined along with perhaps almost every other group that, that we’ve talked about. And we’ve heard about, on the news, with mental health, for example, the maternal mental health hotline got rolled out through the federal government in this past six months, which has been a big feat, so we’ve worked really hard to send our support in terms of advocacy efforts and spreading the word to our followers to ensure that folks are aware that this is a resource.

[00:14:54] I currently work in a pretty large teaching system and in the past, I’ve also worked for a federally qualified health center and also for a private midwifery practice, and all three of these settings were in different states. So, I feel like I have a little bit of a glimpse into working with different healthcare systems and how they’re run. And patients consistently face financial struggles in all of these settings.

[00:15:21] I think sometimes it’s tempting to believe that people who have insurance or they’re fine and they’re covered, but the truth of the matter is that I’ve seen financial hardships in terms of not being able to afford copayments for appointments with a high risk doctor, ultrasounds, also surprise bills for every single patient population, folks who have Medicaid, who are uninsured, underinsured, or fully insured are all struggling. And each of those populations or groups may have a little bit of a different struggle, but the fact that is, that this issue permeates socioeconomic status, or health care coverage that you may have.

[00:16:07] And so, billing is a big part of what I do. I have to charge for the types of visits that I conduct. But even though I charge for the code type visit that I conducted, it may not always carry the same cost across all insurers, or reimbursement rather, but then I also cannot with certainty tell patients how much out of pocket they will have.

[00:16:30] Allie: Can you discuss the ethical dilemma of being able to afford pre- and post-natal care and the care of a newborn?

[00:16:37] Yuliya: When people make the choice to grow their families, that should be a life event that is covered and doesn’t produce burden for families, and I think many times it can, and it does. And the ethical dilemma is how is that really affecting people physically? A lot of the time that financial burdens, whether, and this is well documented across research, for virtually any human population, financial stress creates physical stress. So, to me, what is the ethics of providing care that also comes with some stress?

[00:17:18] So, I oftentimes provide some recommendations with a grain of salt. It’s hard to navigate it because you never know. My goal is always to prevent unnecessary charges and prevent surprises, because really the thought is, hey, I have insurance, why am I being charged?

[00:17:39] Some of it you are aware of, like deductibles, but a lot of times, actually, we get bills that we weren’t prepared for, and so there definitely is a way to begin, slowly to address that, even in the room one on one with a patient, that does not compromise their care in any way, shape or form, and you’re still providing the appropriate [Music] medical care.

[00:18:03] Allie: The way we care for folks during a normal life event, like a pregnancy, is a strong reflection on the state of our healthcare system as a whole. If we’re not taking care of people in an equitable and ethical way during a normal life event, how do we expect the healthcare system to have good and just coverage for an ailment that’s more out of the ordinary? If we’re not being clear about how billing works for pre and postnatal care, there’s little chance that someone who’s suffered a more unique diagnosis will have a good understanding of what they’re being billed for.

[00:18:33] [Music Ends]

[00:18:33] Yuliya: I think of the maternity health care system as a barometer for how we’re doing elsewhere. We use maternal mortality as a barometer for how well a society is doing. That’s a consistent measure across all countries to see how well a country is doing societally based on their maternity mortality rate.

[00:18:53] But I would like to take that a step further because I think how the coverage we provide for maternity care, and postpartum care, and newborn care, within all types of insurers and is inclusive of Medicaid and Medicare, is a big reflection on how we’re doing overall as a society with the healthcare system that we have.

[00:19:20] Allie: You mentioned to me that hospitals make little to no money on maternity care. Can you explain why this is, and what the purpose of charging such high bills for this care is?

[00:19:29] Yuliya: In general, maternity care is a bit different reimbursement than a lot of the things we encounter or illnesses we encounter in our healthcare system. Pregnancy is usually largely reimbursed as a global payment. So, we get a, a lump sum of money for someone’s pregnancy and delivery, whether they saw us 10 times, or they saw us 20 times. So, that’s number one.

[00:19:55] Number two is reimbursement for deliveries is different across different insurers. For example, Medicaid is the largest payer for births in the United States. Over 50 percent of all deliveries are reimbursed by Medicaid, and they reimburse at a lower rate than private insurers. So, there’s a disparity there in how much systems get paid. So, perhaps if you’re a hospital that serves largely a Medicaid population, you might not be getting as much revenue brought in.

[00:20:23] And so, when that happens, healthcare systems begin to lose money, and they operate as a business, which they are a business. A lot of times healthcare systems eliminate departments that aren’t making a lot of money, which many times is a maternity unit, and focus on more revenue generating procedures.

[00:20:44] So really, the second part of your question is what is the purpose of charging these, these bills? The short answer is that it helps insurers make money, but the big picture answer is I don’t have a good answer. The system of maternity care is not designed to generate revenue. Why are we putting this burden on, on moms and families with these bills? I don’t have a good answer. I wish I did.

[00:21:09] Allie: [Laughs]

[00:21:11] [Music]

[00:21:13] Allie: Rebecca and Yuliya both have experience working in medical facilities and can see the clear inequities of the cost of maternal care. The billing process can be both overwhelming and expensive. Two things you don’t need in the early stages of parenting. If you are insured, spend some time learning more about your insurance plan and what may or may not be covered throughout the pregnancy process. The good news is, if you can’t pay these bills up front, you do have other options.

[00:21:43] Ask the hospital about the possibility of setting up a customized payment plan. By breaking down the lump sum into smaller, more manageable installments, the financial burden becomes easier to bear. See if you can ask for discounted rates on your bills. You may qualify for a discounted rate, particularly if you’re uninsured or meet specific income requirements. While it may not entirely erase the amount owed, it can significantly reduce the financial burden.

[00:22:12] You may qualify for government sponsored health insurance programs based on your income level. If you meet the Medicaid or your state’s children’s health insurance program requirements in your state, your policy can provide retroactive coverage for medical expenses up to three months before the application date. You may also be eligible for state specific grants or financial assistance programs. Reach out to your hospital’s billing department for additional guidance.

[00:22:28] Across the nation, organizations like March for Moms are dedicated to advocating for the welfare of expecting and new mothers. Because mental health is so closely intertwined with our financial stability, it’s incredibly important to be well prepared when navigating this life transition.

[00:22:56] While financial education for expectant mothers is not commonplace in medical systems, we can empower ourselves by thoroughly understanding our insurance plans and creating a personalized financial strategy that best suits our individual needs. By taking these proactive steps, we can navigate the complexities of birthing costs with competence, ensuring a smoother and more secure transition into motherhood.

[00:23:22] We understand that a lot of people learn in different forms, so there will be a corresponding blog to this episode where we fully define the terms and also provide different tips and resources, whether they were mentioned today or in addition to that. So, check it out on empoweredus.org. We’ll link it in the show notes.

[00:23:40] Also, if you found this episode to be informative and impactful, please share it with anyone else that you think may need to learn about this. It may fill in some of the gaps of their knowledge.

[00:23:52] We at Empowered Us are committed to advocating for affordable healthcare for all. We look forward to continuing these conversations with patients and experts to both educate and create new solutions. Let’s keep pushing for change together. Take care and see you next time.

[00:24:13] [Music Ends]

Read Less