Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.
At a prenatal class in March, she was told about epidural anesthesia
and was given the option of using a birthing tub during labor. To each
offer, she had one gnawing question: “How much is that going to cost?”
Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance,
her current policy does not cover maternity care. So the couple had to
approach the nine months that led to the birth of their daughter in May
like an extended shopping trip though the American health care bazaar,
sorting through an array of maternity services that most often have no
clear price and — with no insurer to haggle on their behalf — trying to
negotiate discounts from hospitals and doctors.
When she became pregnant, Ms. Martin called her local hospital inquiring
about the price of maternity care; the finance office at first said it
did not know, and then gave her a range of $4,000 to $45,000. “It was
unreal,” Ms. Martin said. “I was like, How could you not know this?
You’re a hospital.”
Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound,
arguing that she had already paid a radiologist $256 to read the scan,
which took only 20 minutes of a technician’s time using a machine that
had been bought years ago. She ended up paying $655. “I feel like I’m in
a used-car lot,” said Ms. Martin, a former art gallery manager who is
starting graduate school in the fall.
Paying Till It Hurts
Like Ms. Martin, plenty of other pregnant women are getting sticker
shock in the United States, where charges for delivery have about
tripled since 1996, according to an analysis done for The New York Times
by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.
And though maternity care costs far less in other developed countries
than it does in the United States, studies show that their citizens do
not have less access to care or to high-tech care during pregnancy than
Americans.
“It’s not primarily that we get a different bundle of services when we
have a baby,” said Gerard Anderson, an economist at the Johns Hopkins
School of Public Health who studies international health costs. “It’s
that we pay individually for each service and pay more for the services
we receive.”
Those payment incentives for providers also mean that American women
with normal pregnancies tend to get more of everything, necessary or
not, from blood tests to ultrasound scans, said Katy Kozhimannil, a
professor at the University of Minnesota School of Public Health who
studies the cost of women’s health care.
Financially, they suffer the consequences. In 2011, 62 percent of women
in the United States covered by private plans that were not obtained
through an employer lacked maternity coverage,
like Ms. Martin. But even many women with coverage are feeling the
pinch as insurers demand higher co-payments and deductibles and exclude
many pregnancy-related services.
From 2004 to 2010, the prices that insurers paid for childbirth — one of
the most universal medical encounters — rose 49 percent for vaginal
births and 41 percent for Caesarean sections in the United States, with
average out-of-pocket costs rising fourfold, according to a recent report
by Truven that was commissioned by three health care groups. The
average total price charged for pregnancy and newborn care was about
$30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.
Women with insurance pay out of pocket an average of $3,400, according to a survey by Childbirth Connection,
one of the groups behind the maternity costs report. Two decades ago,
women typically paid nothing other than a small fee if they opted for a
private hospital room or television.
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