Having a baby is about the ultimate “shoppable” health care experience, since you have roughly nine months to pick where to deliver.
As a health reporter, I have more experience with hospital prices than many people, so I thought I’d use my own situation of choosing where to have my baby as a demonstration of how to figure out what you might pay when you know you’ll need care.
For years, people who study the economics of health care have debated whether giving people more transparent information about prices will result in savings for the patient and the system as a whole.
Studies haven’t found significant changes in consumer behavior — a January poll found only about 17% of people feel they know what their care will cost before they get it — but the federal government and the state of Colorado have continued to pass laws to make it easier to find and compare prices.
While I’m searching for information about a birth, you can use these same basic steps for any planned hospital visit. This guidance doesn’t apply in emergency situations, though.
If you’re having severe chest pain, feel weak on one side of your body or are bleeding profusely, skip all this and get to the nearest emergency room. Federal and state laws should protect you from surprise bills, and as painful as fighting your insurance company after the fact may be, you don’t want to risk death by delaying care.
Step 1: Find out which hospitals are in-network
In my case, this was pretty easy. My workplace insurance is through Kaiser Permanente Colorado, which also owns the medical practice where I receive prenatal care, so my doctor knew which hospitals are in-network.
If your situation is different, you’ll most likely need to call your insurance company for this one. Asking the hospital if they take your plan won’t get you the answer you need — they might say they accept your insurance, but if you’ve gone out-of-network, you could be stuck with a significant bill.
Even if the hospital is in-network with your insurance, you might get a provider who isn’t. Unless you’re having a planned cesarean or induction, you have no way of knowing which obstetrician or anesthesiologist will be on call when labor starts. Colorado state law and the federal No Surprises Act both forbid billing patients at the higher out-of-network rate in those situations, provided they’ve gone to an in-network hospital. (They also don’t allow those higher bills for emergencies.)
Step 2: Find out likely costs
Basically every hospital is required to either display a list of prices for common “shoppable” services or to offer a price-estimating tool. The tools vary in how much personal information they ask for, and those that demand more tend to produce more accurate estimates.
In my case, the tools estimated a roughly $1,100 cost at Sky Ridge Medical Center in Lone Tree, or $1,700 at either Good Samaritan Hospital in Lafayette or Saint Joseph Hospital in Denver. The estimates were based on my insurance requiring me to pay one-fifth of my hospitalization cost.
You may be sick of calling your insurance company, but you should probably double-check your costs, because the estimate tools don’t make any promises.
You might also want to look up a few scenarios. Most people plan on an uncomplicated vaginal birth, but you might want to know what you could pay if you need a cesarean or have complications. Speaking of which…
Step 3: Figure out your worst-case scenario
If you’re the kind of person who wants to know the full range of what you could face, you’ll want to be familiar with your out-of-pocket maximum, which is what it sounds like: the ceiling of what you could spend on medical care in a given year. Most plans have a separate, higher out-of-pocket max if you go to an out-of-network hospital, though.
Most insurance companies will have a feature on their websites that allows you to see how much you’ve spent so far this year, and how that compares to your maximum spending. If yours doesn’t, you’ll have to call your insurer again to answer this one. (Sorry to be the bearer of bad news.)
In my case, I’m getting close to the out-of-pocket maximum because of some medical expenses at the start of the year, so the cost difference between my three options is minimal. If you have many thousands of dollars left to go until your max, though, you could have significantly different bills, particularly if you have complications.
Step 4: Consider non-financial priorities
You don’t have to complete this step, but not everything important translates into dollar amounts.
In my case, two of the three in-network hospitals would require a highway drive, which made them less appealing to me. I don’t relish time spent on Interstate 25 under any circumstances, and sitting in traffic while in labor sounds like an experience I’d rather avoid.
Your priorities may be different, though. Maybe you had a great previous experience, or a terrible one, at one of your hospital options. Maybe you place great value on the closest possible location. Maybe you want a religious hospital, or prefer to avoid one. Ultimately, only you can decide what matters most to you.
A final thought
Things can go wrong even if you’ve done everything right. Your best bet is to get any prices you were quoted or promises that all providers are in-network in writing. It doesn’t eliminate the chance of a billing error, but it would give you some ammunition to fight back.
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Originally Published: August 22, 2024 at 6:00 a.m.
