Billing Insurance for Hospital Birth

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By Jill

There are breakdowns of the cost of giving birth in U.S. hospitals all over the internet. This one is based on a small sample of maternity care patients in Maryland. Please read or skim the entire pdf if you want to put it in context. A short excerpt of the report is also pasted below.

Having given birth outside of the hospital system in a birth center where the medical billing and everything else was completely transparent, I still find myself doing a double-take at charts like this. The midwives billed insurance for about $5,500 total, which included everything. All prenatal visits, exams, blood draws, screenings, NSTs and AFIs, the birth, the 24 hour home visit, the three week postpartum visit, and the six week postpartum visit.

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The next step involved finding charges for each maternity care service. Fee schedules that insurers use to pay for services are proprietary and closely guarded. Instead, this analysis relies on a sample of claims for maternity care services for 106 women covered under one state high-risk pool, the Maryland Health Insurance Plan (MHIP). MHIP fee schedules for most providers are approximately 20 percent higher than those paid by Medicare. The MHIP payment level is thought to be generally consistent with that of other commercial insurers in Maryland. To estimate the cost of maternity care, median charges (those billed to and paid by MHIP) for each maternity care service were matched to each service and then summed. Researchers generated cost estimates for prenatal care, vaginal delivery, C-section delivery, and gestational diabetes care.

The most common model of health care financing is to reimburse providers for each service they perform, including diagnostic tests, office visits, and any other medically necessary care or service.

Obstetric care is an exception to this fee-for-service billing method. Most health insurance plans require costs of obstetric care after an initial consultation to be billed as part of one global fee encompassing prenatal care, delivery, and postpartum care.