North Carolina Babies

Cost of having a baby minus maternity coverage:

I finally got all the numbers sorted out and just wanted to share. I'm sure there's prob some really good reason for me to not post this, but I would have loved to see something like it when I was just going in, so I'm posting anyway! I hope it helps somebody out.

The final verdict: my out-of-pocket delivery was, in fact, cheaper than purchasing the optional maternity rider through my private insurance carrier!!!

I'm winding up paying...(drumroll please)...

GRAND TOTAL: $6,788.40

The breakdown:

Prenatal care (13 appts + one utrasound + delivery doc): $3,140.80

Brief hospital stay for bleeding: $483.04 

Hospital delivery: $2,760.88

Baby's hospital charges: $403.68

*please note that my actual bills were 20% more than each of these, but a 20% discount is offered for self-pay patients at my doc, and for prompt payment at the hospital. Also note that I'm not positive that I'm not missing some lab bills somewhere. I expected to see lab bills but never did. Maybe my insurance covered them? 

 

AND....if I would have purchased maternity coverage, I would have paid:

GRAND TOTAL: at least $8,009.75

Adding maternity to my policy would cost a little over $200/month. I have $60 copays for specialists, a $3500 deductible, and 50% coinsurance. (We are self-employed and have private insurance coverage.) That's:

Copays for 13 visits: $780

Maternity Premiums for 16 months: $3,200 (from when I started coverage in Sept '08 thru the end of this year)

Deductible: $3,500

Coinsurance on remainder of hospital bill: $529.75 

 

PLEASE NOTE: If you're thinking about going this route, your bills might be higher. I did not do any of the optional prenatal screenings or tests, had only one ultrasound, had a very healthy pregnancy, and did not receive an epidural or any medicines in the hospital (besides a shot of lidocaine for stitches and a little oxytocin just after delivery). 

Then again, if any serious complication had arisen, my regular insurance policy would have kicked in--they're required to cover serious complications. 

Also, of course, every doc and every hospital has different fees. And they can be a total pain in the ass to self-pay patients. Just wanted to share my experience, though! I've decided to keep on riding without maternity coverage. If you do the same, just don't be shy about asking for every discount you can get--it works!

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Re: Cost of having a baby minus maternity coverage:

  • I am so glad it worked out so well for you.  Insurance is just a game anyways.  You get it for the "Just in case situations" and hope that you'll never have a "Just in case" issue. 
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  • Good job on figuring all of this out!

    Yeah, my DH's BCBSNC group insurance through his work royally sucks.  We are paying close to $5,500 out of pocket for Caylee's delivery b/c of the $2,500 deductible and 70% maternity coverage.  And that doesn't even take it to account how much they deduct out of his paycheck bi-weekly.  Ugggghhhhhhhhhhhhhhhhhhhhhhhhhh. 


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  • Thanks for sharing!  What I've learned: having a baby is expensive!
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  • Interesting....I only had 1 copay not one every visit...so to me it looks like its about even. I'm glad it worked out for you though.
  • I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different. My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.
  • imagetoadslove:
    Interesting....I only had 1 copay not one every visit...so to me it looks like its about even. I'm glad it worked out for you though.

    Oh! Maybe that would have been the case -- didn't know it worked that way. Either way, I'm just pumped I didn't lose money by not getting the coverage. 

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  • imageECUPirate04:
    I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different.My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.

    Absolutely agree that I was way lucky to have such an easy pregnancy and delivery, with or without maternity coverage. But have to also point out again that if there had been a serious complication or emergency c/s, it wouldn't have mattered whether I had purchased the maternity rider anyway, as my regular insurance policy would kick in in those situations.

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  • imagenark:

    imageECUPirate04:
    I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different.My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.

    Absolutely agree that I was way lucky to have such an easy pregnancy and delivery, with or without maternity coverage. But have to also point out again that if there had been a serious complication or emergency c/s, it wouldn't have mattered whether I had purchased the maternity rider anyway, as my regular insurance policy would kick in in those situations.

    I'll have to agree with you on this one because only you know your insurance policy but I'm just about 99% sure you insurance would not have paid for an emergency c/s or any kind of c/s for that matter.

  • imageECUPirate04:
    imagenark:

    imageECUPirate04:
    I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different.My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.

    Absolutely agree that I was way lucky to have such an easy pregnancy and delivery, with or without maternity coverage. But have to also point out again that if there had been a serious complication or emergency c/s, it wouldn't have mattered whether I had purchased the maternity rider anyway, as my regular insurance policy would kick in in those situations.

    I'll have to agree with you on this one because only you know your insurance policy but I'm just about 99% sure you insurance would not have paid for an emergency c/s or any kind of c/s for that matter.

    Yep. It's in my policy. They'd cover it (well, 50% coinsurance after deductible) if it were an emergency. Or if it were non-emergency (like if she were breech), my package with the OB would have been $1,000 more. (That part's in my contract with them.) 

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  • imagenark:
    imageECUPirate04:
    imagenark:

    imageECUPirate04:
    I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different.My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.

    Absolutely agree that I was way lucky to have such an easy pregnancy and delivery, with or without maternity coverage. But have to also point out again that if there had been a serious complication or emergency c/s, it wouldn't have mattered whether I had purchased the maternity rider anyway, as my regular insurance policy would kick in in those situations.

    I'll have to agree with you on this one because only you know your insurance policy but I'm just about 99% sure you insurance would not have paid for an emergency c/s or any kind of c/s for that matter.

    Yep. It's in my policy. They'd cover it (well, 50% coinsurance after deductible) if it were an emergency. Or if it were non-emergency (like if she were breech), my package with the OB would have been $1,000 more. (That part's in my contract with them.) 

    Interesting.  Well as you already said you were lucky.  My c/s was 15k.  50% of that would have doubled your oop.

  • imagenark:
    imageECUPirate04:
    imagenark:

    imageECUPirate04:
    I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different.My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.

    Absolutely agree that I was way lucky to have such an easy pregnancy and delivery, with or without maternity coverage. But have to also point out again that if there had been a serious complication or emergency c/s, it wouldn't have mattered whether I had purchased the maternity rider anyway, as my regular insurance policy would kick in in those situations.

    I'll have to agree with you on this one because only you know your insurance policy but I'm just about 99% sure you insurance would not have paid for an emergency c/s or any kind of c/s for that matter.

    Yep. It's in my policy. They'd cover it (well, 50% coinsurance after deductible) if it were an emergency. Or if it were non-emergency (like if she were breech), my package with the OB would have been $1,000 more. (That part's in my contract with them.) 

    Interesting.  Well as you already said you were lucky.  My c/s was 15k.  50% of that would have doubled your oop.

  • imagenark:
    imageECUPirate04:
    imagenark:

    imageECUPirate04:
    I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different.My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.

    Absolutely agree that I was way lucky to have such an easy pregnancy and delivery, with or without maternity coverage. But have to also point out again that if there had been a serious complication or emergency c/s, it wouldn't have mattered whether I had purchased the maternity rider anyway, as my regular insurance policy would kick in in those situations.

    I'll have to agree with you on this one because only you know your insurance policy but I'm just about 99% sure you insurance would not have paid for an emergency c/s or any kind of c/s for that matter.

    Yep. It's in my policy. They'd cover it (well, 50% coinsurance after deductible) if it were an emergency. Or if it were non-emergency (like if she were breech), my package with the OB would have been $1,000 more. (That part's in my contract with them.) 

    Interesting.  Well as you already said you were lucky.  My c/s was 15k.  50% of that would have doubled your oop.

  • imageECUPirate04:
    imagenark:
    imageECUPirate04:
    imagenark:

    imageECUPirate04:
    I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different.My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.

    Absolutely agree that I was way lucky to have such an easy pregnancy and delivery, with or without maternity coverage. But have to also point out again that if there had been a serious complication or emergency c/s, it wouldn't have mattered whether I had purchased the maternity rider anyway, as my regular insurance policy would kick in in those situations.

    I'll have to agree with you on this one because only you know your insurance policy but I'm just about 99% sure you insurance would not have paid for an emergency c/s or any kind of c/s for that matter.

    Yep. It's in my policy. They'd cover it (well, 50% coinsurance after deductible) if it were an emergency. Or if it were non-emergency (like if she were breech), my package with the OB would have been $1,000 more. (That part's in my contract with them.) 

    Interesting.  Well as you already said you were lucky.  My c/s was 15k.  50% of that would have doubled your oop.

    Absolutely.

    My only point really is that I wouldn't have paid less because of buying the maternity rider. Complications would have cost me the same either way. 

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  • Woo-hoo!  Glad that you did your homework on that!

  • imageECUPirate04:

    Interesting.  Well as you already said you were lucky.  My c/s was 15k.  50% of that would have doubled your oop.

    I don't know how much of it was "luck", as much as it was she read her policies, did her homework and asked lots of questions.  I guess, if she's lucky anywhere - it's that it was written into her policy that these serious complications would be covered.  And in that case, again, its not luck, it's just the policy.

    Again, Way to go Nark for working your way through the tangles of Insurance!

  • I'm glad it worked out well for you and I'm glad you posted this! 

    When we lived in Austin we both had private insurance too.  I researched this to try and figure my possible out of pocket costs without maternity coverage.  My premiums with maternity were going to be $450/month yet only pay 60%.  My insurance policy also would have covered me for an emergency c/s even without maternity coverage.  But DH ended up changing jobs so we got coverage (including maternity) through his work. 

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  • imageECUPirate04:
    I'm going to be the lone dissenter on this one. You are very lucky to be writing this post. If there had been one serious complication and/or a c/s delivery this post would be completely different. My bills pre insurance were over 50k. Hopefully you will be just as lucky next time around.

    I'm in with Pirate on this one (I read all the other stuff below, but felt it was to much to quote).  If I had no insurance and no other assistance of any kind DS would have been just over $86K.  I've spent a lot of time pouring over EOBs and statements from all the different doctors and specialist - it is insane what kind of bill you rack up with complications.  It was $800 just to walk into the MFM office - that wasn't even for the u/s, blood, and urine they did weekly, that was just for 20 min. visit.  This is just part of the reason it's so hard to decide on trying for number 2.

  • imagesurfnsandbride:

    I'm in with Pirate on this one (I read all the other stuff below, but felt it was to much to quote).  If I had no insurance and no other assistance of any kind DS would have been just over $86K.  I've spent a lot of time pouring over EOBs and statements from all the different doctors and specialist - it is insane what kind of bill you rack up with complications.  It was $800 just to walk into the MFM office - that wasn't even for the u/s, blood, and urine they did weekly, that was just for 20 min. visit.  This is just part of the reason it's so hard to decide on trying for number 2.

    I totally understand how both of you could feel this way.

    FWIW, this wasn't meant IN ANY WAY to be a bragging post about an easy pregnancy. I understand that the numbers I have up there are really low compared to the numbers a lot of other women see, and I am extremely grateful for that.

    But if I, say, had enough complications to bring my bill up to $50,000, I'd still probably have to pay...

    EDITED: ...my out-of-pocket maximum. With or without the maternity rider. (Though without the rider, I may have to still pay some fees to the doc for prenatal care, which should come out around the same as the cost of all those maternity rider premiums.)

    I know that's kind of confusing, but that's the whole point: I think women of child-bearing age who have to purchase private insurance coverage are under-informed and sort of tricked into believing that they HAVE to have the maternity rider or they'll be screwed if they get pregnant. Or that they'd be being irresponsible or putting themselves or the baby at risk by not buying it. From my experience and research, that just isn't generally the case. 

    To me, it seems that if you purchased the maternity rider "just in case," and paid the premiums for a couple of years before actually getting pregnant, that could be a good wad of dough down the drain ON TOP of whatever the pregnancy wound up costing you.

    My intention was to share this info (and to hopefully get it out there on the search engines) for other self-employed women out there who are making decisions about their private insurance carriers...or who have just gotten pregnant without maternity coverage and are freaking out. I hope they'll see this and do more homework on their policies before making their decision. When I first began doing my research on this, I couldn't find much to go on. 

    OK. I'm off my soapbox now.   :) 

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  • I'm stepping off my soapbox after this post too but I have to say I think your information is off base in regards to your post above. 

    Most insurance policies if not all have a max out of pocket which is not even close to 50k so if you had been in a different situation I have a hard time believing you would still have been better off without insurance.  Without insurance you would have owed the 50k but with insurance it would have been significantly less like maybe 4k depending on your policy.

    Also, even though you negotiated a deal with your doctors office I will go out on a limb and say the amounts you were able to negotiate were not even close to being what the insurance companies are able to negotiate.

    For example, if my hospital bills $1,000 for a procedure insurance says we are only paying $50.  They may have still charged you $500.

    Like you said you just posted this because you were excited but the fact that you are trying to make it informational for others just doesn't make any sense to me seeing as how you got extremely lucky you are thousands in debt for medical bills now due to unforeseen complications.

     

  • Pirate -

    My doctor told me that if a patient doesn't have insurance, their office will give the patient 40% insurance discount.  He also said, that his affiliated hospital does the same.

    I imagine that a lot of practices do this.

  • imageECUPirate04:

    I'm stepping off my soapbox after this post too but I have to say I think your information is off base in regards to your post above. 

    Most insurance policies if not all have a max out of pocket which is not even close to 50k so if you had been in a different situation I have a hard time believing you would still have been better off without insurance.  Without insurance you would have owed the 50k but with insurance it would have been significantly less like maybe 4k depending on your policy.

    Also, even though you negotiated a deal with your doctors office I will go out on a limb and say the amounts you were able to negotiate were not even close to being what the insurance companies are able to negotiate.

    For example, if my hospital bills $1,000 for a procedure insurance says we are only paying $50.  They may have still charged you $500.

    Like you said you just posted this because you were excited but the fact that you are trying to make it informational for others just doesn't make any sense to me seeing as how you got extremely lucky you are thousands in debt for medical bills now due to unforeseen complications.

     

    Well, you're right that I wouldn't pay $50K if I only had to pay my out-of-pocket max. In EITHER situation. 

    Once again: Since my insurance would cover complications, I would have the exact SAME coverage, with or without the maternity rider.

    I'm not telling people to have a baby without medical insurance, I'm saying to do your homework before deciding on the maternity rider.

     

    ETA: sheesh! see how confusing that maternity rider is to people? THAT is my point. 

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  • FWIW, Nark, I'm really glad you posted this. I give you so much credit for all the legwork you did to research and advocate for yourself in all of this. I mean, I know you just gave birth, but I'm gonna go out there and say you have some big balls ;)

    It's a confusing system... I'm impressed! 

  • Thanks McJ   :)

     

    And finally, if anyone is reading this and wants to do more homework, here's a link to Blue Cross maternity rider info in North Carolina. It pretty much says what I said, but I don't think many people see this unless they really search for it...or understand it unless they really start doing some math.

    https://www.bcbsnc.com/assets/plans/public/pdfs/Maternity_Rider.pdf 

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