Cost of pregnancy?

[lehresman]

Hi all,

I'm relatively new to this forum, but have been in the process of taking control of my personal finances for quite a while. I'm well on the way to freedom from debt. I should have everything but my mortgage paid off by December, possibly sooner. I've had a budget for years and am doing well at spending less than I make.

My wife and I are hoping to start having children soon. I'm not a big fan of health insurance, and I know this is probably a sticky subject. We both have our own HSA's, her deductible is $5000 (we buy her insurance on our own) and mine is $2000 (provided with my job). We're both in excellent health. She's only been to the doctor once in her life, and the same with me. So we have high deductible insurance "just in case." but I can't justify paying out a ton of cash for an insurance plan I'm most likely not going to use. I put that money into our HSA.

Now to my actual question. How much does pregnancy cost, and what is actually necessary? I've heard it can cost anywhere from $3,000 to $10,000 depending on where you go and what you do all during the pregnancy. We are open to alternatives to birth at the hospital -- birthing centers or a midwife (but I don't think midwifes are allowed in NC). We will be paying for this out of pocket since we don't have maternity coverage, but we do have savings to cover it and we have planned for this. What are our options? What have you all done and what worked for you? I want to spend as little as possible, but of course my wife's health and well-being is my main concern.

Thanks for your input!

[AmbitiousSaver]

It really varies.

My first pregnancy was completely uncomplicated along with my 2nd... so for that, my doctor would only charge around $2500 for a completely non-complicated normal delivery

My third pregnancy was also uncomplicated BUT my son was born with sepsis and had to be sent in an ambulance to the children's hospital. He was there for 2 weeks and thankfully DH is military and we never had to pay a cent for that $20K stay on top of the $2500 the insurance paid for my delivery.

My fourth which just happened in January was my first complicated pregnancy. I had the normal delivery for $2500, plus in my third trimester I had to have NST tests which were $115/each for 2x a week... then I had 3-4 high level u/s which the insurance billed out between $500-$1500 per u/s. I got so tired of doctor's appointments I just wanted my baby born so they could leave me alone.

This last pregnancy was the most costly... but my son's care after birth was the most expensive.

On top of that you have to figure maternity leave. I work from home and did not take short-term disability, so I accrued as much PTO as I could (3 weeks) worth... and then went back to work after that since I couldn't afford to, but thankfully I don't have to pay childcare.

I think it is great you guys have saved for this. It definitely helps you to be more prepared.

[sweeps]

In my experience, $10,000 is a more realistic number than $3,000. Unless you're doing something unusual (home birth, etc.), I would expect to blow through your deductible in the year you have a child.

[plumpossum]

It does vary quite a bit...

The actual pregnancy check ups for me ran around $100 each visit for ten visits (and that is after what my insurance covered). I had two ultrasounds which were medically necessary, thus covered by insurance, but the doctor said any non-medically necessary ultrasounds are $300 (not the 3D or 4D kind). Tests and other screenings are also an additional cost, and depending on your personal beliefs and your wife's age, could get quite costly.

I wound up being overdue, and incredibly uncomfortable. My mother has a condition which renders her incapable of having contractions and going into labor (some kind of hormone doesn't react the way it should) and had cesareans with my brother and I when we were 3.5 and 2 weeks overdue. With her medical history, my doctor had a similar concern for me when I was very, very large, engaged, and dilated, but nothing was happening. I had my membranes stripped in the doctor's office, my water broke at home, I got to the hospital, and still wasn't really in labor. Because my water had broken, I had 24 hours to deliver the baby, and spent the next 14 hours on a pitocin drip trying to make labor happen.

I eventually birthed with the assistance of an epidural (thanks to Pitocin and its double peak contractions). And while my son's cord was wrapped, it was still a pretty textbook delivery.

Because I went into labor in the evening, and gave birth in the early morning, I didn't meet the cut off point to be released within 24 hours (I'm not really sure how else to explain that). My son failed the first few hearing tests, and that was another setback. Overall I was in the hospital for three days and three nights.

AFTER insurance I paid $1500 for the epidural and $2500 for the hospital stay. The total on the bills was something like $8000 or so.

I had a pretty uncomplicated pregnancy and childbirth, didn't have any additional tests done or excessive ultrasounds, and still wound up spending quite a bit of money.

Other things to think about are maternity clothing, missing work for check ups (if she does not have paid sick leave), and classes. I didn't take any birthing classes, but if you go the all natural route, it's a good idea to take classes to learn about pain management and delivery techniques. There's also expenses immediately post delivery. If your wife intends to breastfeed, usually a hospital or midwife will want to set you up with a lactation consultant, and while breastfeeding is cheaper in the long run, it's pretty expensive at first to get pumps and special clothing and whatnot. Plus, in the first few months, your baby would be visiting a doctor every few weeks for well baby checkups. And that's just if they're healthy, even common newborn problems require tons of visits (jaundice, eczema, bowel problems, etc.)

And as another poster stated, think about maternity leave. I have what's considered an excellent benefits package for the area I live and work in, and had to use my own vacation leave for my six week maternity leave. I only had enough to cover 4 weeks, so two weeks were unpaid leave. And daycare costs are another issue, many daycares don't like to take newborns, and if they do, it's at an exorbitant price (going rate downtown here is $250+/week, suburban is about $180-$200/week), and there's usually a wait list.

[FrugalFish]

Boy, that's a tough situation. I personally would not be comfortable having a baby without some kind of insurance plan in place. Insurance is for the unexpected, you know. What if, heaven forbid, the baby has complications and requires a long stay? Can you really afford that? That can run hundreds of thousands of dollars.

I can tell you this about my own DD who was born 2 years ago. I am very healthy, and she is very healthy. She was full term + 1 day. (That's a trait from DH's family- being a day late and a buck short.) My prenatal visits were covered 100% by my HMO, as were all the tests. I don't know how much that would have run, but certainly not cheap. I had to have 2 ultrasounds at outside facilities. While I didn't pay for those, I did get the EOB and each was just shy of $500.

The actual birth was probably about as easy as childbirth can be and it the final cost of birth + hospital stay was $17,000, not including the $2000 for an epidural- which would have been worth every penny even if I had to pay for it . This bill did not include newborn care, but my HMO negotiates with the hospital to include newborn care in with mother's care as a packaged deal. My DD developed very mild jaundice and they wanted to be safe and treat her; they tried to bill us $1700 for that, the HMO told them to go fly a kite.

So for my simple and straightforward birth, it was more than $20,000, not including routine prenatal visits. My HMO paid 100% thank goodness.

An option for you might be a birthing center, but what happens if you go to a birthing center and are then directed to a hospital because of complications? What if she needs a C-section? I have no idea how much the costs can run on something that gets more complicated and requires a hospital. Even the healthiest mother in the world can't be assured that her baby won't be breech.

I don't mean to sound discouraging, but unless you have a pretty spectacular amount of money in savings (maybe you do), I would be cautious about having a baby without maternity insurance. Some private companies do offer maternity plans. If you can afford to pay cash for a baby, maybe a better use of your money would be to buy maternity insurance and hold off until it kicks in. The peace of mind alone would be worth it to me. Some states offer maternity plans, so that might be worth looking into- they would rather a woman have some kind of coverage to guarantee dr. visits, a safe birth, and a healthy baby that will not be a drain on the public system.

Good luck.

[noppenbd]

If you are paying cash, you should be able to negotiate upfront with the hospital. They should be jumping over each other to get your business. Make sure you get the prices in writing.

Complications present a different story and I would make sure that those would be covered under your wife's HDHP. I'm sure there are plenty of completely normal pregnancies, but there are also many many stories of complications which did not cause any long term problems but just cost a lot of money. For instance our daughter spent her first week in the NICU and that ended up costing $20K or so. I would imagine a preemie would cost much more than that. Also check whether you have to pay coinsurance (some plans require 20% after deductible), which can be very costly. There is usually a max out-of-pocket per year per person. You could end up paying 2x the max out-of-pocket if the baby requires a NICU stay. I would spend some time getting very familiar with the details of your wife's plan.

[sweeps]

Originally Posted by noppenbd

If you are paying cash, you should be able to negotiate upfront with the hospital. They should be jumping over each other to get your business. Make sure you get the prices in writing.

Not disagreeing, just curious. Has anyone actually tried this? I just don't see how this would play out. Who in the hospital do you approach for this? What about the doctors and specialists that get involved but are not directly affiliated with the hospital? Also it seems they would be reluctant to put these figures in writing since there's no telling how a delivery will play out.

[lehresman]

FrugalFish, we do have insurance.. we just pay for the first $5000 and are covered 100% after that. That's why we were able to get such a great rate ($88/month). The other quotes we got for normal health insurance for my wife were in the range of $300/month, not including maternity coverage which was an extra $150. We still paying about that much per month, except we are putting it in an HSA instead of just paying it to the insurance company. Thus, we have a sizable savings built up. That seemed like a better option for us. The money is still in our control, and we're covered in case of major medical expenses.

[noppenbd]

Originally Posted by sweeps

Not disagreeing, just curious. Has anyone actually tried this? I just don't see how this would play out. Who in the hospital do you approach for this? What about the doctors and specialists that get involved but are not directly affiliated with the hospital? Also it seems they would be reluctant to put these figures in writing since there's no telling how a delivery will play out.

I don't know the details of how to go about it, since we were fully insured when my wife was pregnant. However, I point you to this story:

ABC News: Learn How to Negotiate Your Medical Bills

I would love to read the original Smartmoney story if anyone can find it. I would imagine the upfront negotiations would only cover expected costs for a normal delivery (anesthesiologist for epidural, OB doing normal delivery, postnatal standard care, etc).

[jIM_Ohio]

My wife just gave birth. The bill is not in, but her pregancy we are estimating at 50k-100k. She was admitted to hospital at week 20 and gave birth at week 28.

We have twins, that does not increase the cost of the pregancy, but now we have two kids in two different ICUs (one had complications so was transferred to a surgical hospital).

Twin A is in week 8 at a level 3 NICU. I am sure his bill will come out to 150k or 200k for around a 10-12 week stay.

Twin B spent 6 weeks in same level 3 NICU. Guessing that stay will cost 100k. He is now in a different level 3 NICU which is probably going to cost 100-200k for an 8 week stay.

Obviously my numbers will scare you, that is why we have insurance. All that money each of you pays to Aetna helps fund our boys. Thank you.

[noppenbd]

I found the original Smartmoney article, which has a lot more detail and some weblinks for investigating costs state-by-state:

Under the Knife: Cutting Medical Bills (SmartMoney Magazine) at SmartMoney.com

For instance, healthgrades.com will give you a customized report for your region or even individual hospitals for $7.95.

[stressedmama]

I just had my second son a little less then a year ago. Thankfully we didn't have any complications this time around and just the birth alone (hospital stay/doctor bill) cost about $12K.

Remember if you have kids, you will have prenatal visits, prenatal vitamins, blood work, glucose testing, and usually 2 ultrasounds (for a completely uncomplicated pregnancy). I checked and mine ran about $2500. Any complications, and these costs will skyrocket.

Then you must think about all the pediatrician visits you will have right after birth, immunizations, etc. Plus if your wife has post pardum, you will have additional doctor visits and potentially meds to pay for. There are so many unknowns when it comes to having children even if both parents are young and healthy.

[LivingAlmostLarge]

So how does the HDHP work when you have complications like Jim? I have a friend who had something similar happen but everyone I know has regualr insurance.

[lehresman]

Originally Posted by LivingAlmostLarge

So how does the HDHP work when you have complications like Jim? I have a friend who had something similar happen but everyone I know has regualr insurance.

That's a great question and honestly I don't know. I'll contact my health care provider and ask -- that's a good thing to know. I'll post what I find out.

[noppenbd]

I think it depends on the plan. Usually there is a deductible per person and then there can also be a (higher) yearly max out-of-pocket per plan. The second number is if you have coinsurance, since you will continue to pay a percentage even after the deductible is met. For instance you may have a $1700 deductible per person with 20% coinsurance. You would pay all costs up to $1700 (per person) and then pay 20% of everything after that up to the yearly max OOP (which may be $4K for all family members covered). Above the OOP it should be 100% coverage. In addition, some policies charge extra for maternity coverage, so if that is the case and you did not purchase that, then the above may not apply. IMO I would not own a HDHP without maternity coverage if pregnancy was a possibility.

[PrincessPerky]

I wouldn't want to deliver without a 'back up insurance' just in case..paying out of pocket for maternity care is feasable if you know where to look (and are willing to fudge rules) but ... I rpolly wouldn't do this for my first.

I have three kids, I have excellent maternity history and 'easy deliveries' (no delivery is truly easy, just some are uncomplicated). So this time around to go without any of the fancy modern medicine and trust that 4th time things will work out is ok with me.

If I had wanted the full modern medical workup paid out of pocket would be a minimum of 10K. For a healthy normal pregnancy..... any complications would be extra even simple things like excema (I always get excema when pregnant, now that I know what it is I don't worry the rash is a sign of pregnancy complication, no need to pay a derm to look at it..but for a first time mom.....)

In short even though I am going with a home birth, midwife assisted, I do not recommend any first time mom do so.

[tripods68]

Wow! I'm still amazed how many people spend on medical cost just to have a baby. But Because we belong to HMO plan employer covered plan, we paid ZERO cost when we had our first child 4 years ago. When we had our daughter 2 years ago, our cost was $250.00 hospitalization. That's it. But all our medical insurance coverages is through my wife employer and I get monthly stipend on top of my base salary; for not electing my employer's health covered plan. Our monthly health care cost is $210 for family of four. The rest is paid by her employer.

[noppenbd]

Originally Posted by tripods68

Wow! I'm still amazed how many people spend on medical cost just to have a baby. But Because we belong to HMO plan employer covered plan, we paid ZERO cost when we had our first child 4 years ago. When we had our daughter 2 years ago, our cost was $250.00 hospitalization. That's it. But all our medical insurance coverages is through my wife employer and I get monthly stipend on top of my base salary; for not electing my employer's health covered plan. Our monthly health care cost is $210 for family of four. The rest is paid by her employer.

Just to clarify, in our case even though the NICU stay cost around $20K, and my wife's delivery was in the $8-11K range, we paid zero out-of-pocket. We have a great insurance plan through DW's employer, costing about $210 a month for family coverage.

[sweeps]

Originally Posted by LivingAlmostLarge

So how does the HDHP work when you have complications like Jim? I have a friend who had something similar happen but everyone I know has regualr insurance.

I just joined an HDHP, and this is what would happen in my case: You would pay 100%* for services until you hit your deductible. Then you would be covered 100%.

Ideally you would have funded an HSA along with the HDHP. You can tap the HSA for all the charges leading up to the deductible, but you don't have to. You can leave the money in the HSA if you prefer.

* Note that you only pay the amount that the provider has negotiated with the insurance company. So a service that might be $200 for someone without insurance might be $120 for someone with insurance.

[stressedmama]

To clarify for myself, I only paid $10 out of pocket for all prenatal care, birth/doctor, post delivery, and pediatrican visits. I'm in a pretty comprehensive HMO plan thankfully. As long as I stay in network, everything is covered.