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Friday
May072010

Maternity Care Costs

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I created a separate journal on the site for images of maternity care costs. Based on the response from the last post, I think this could be an interesting way to see what maternity care costs around the world in images.

http://www.theunnecesarean.com/maternity-care-costs

 

Got a scanner or a decent camera?

 

1. Scan a statement* of how much was charged for your birth, prenatal care, etc.

2. Remove personal information.

3. Send to unnecesarean (at) gmail (dot) com with the subject “MATERNITY CARE COSTS.”

or

Send via e-mail (also with subject line “MATERNITY CARE COSTS”) and attached image or link to a cost comparison of maternity services.

 

I’ll post them as I receive them. Don’t forget the subject line or my inbox might eat your e-mail.

 

*Edit: Explanation of Benefit from providers, itemized statements or whatever you think would be interesting to share is welcome. 

 

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Reader Comments (11)

What was charged is irrelevant. Billed charges are always inflated for the very few patients for whom services are reimbursed at a percent of billed charges. Hospitals and obstetricians are almost always reimbursed with a case rate for maternity services.

I think what you want here are EOBs, not statements. What you would look for is the allowable amount.

May 7, 2010 | Unregistered CommenterJennifer

I'm mostly curious about what is being charged, whether or not it's being reimbursed.

I'll change that so it's clear. Thanks.

May 7, 2010 | Registered CommenterJill

But it really doesn't mean anything. I negotiate managed care contracts for a provider and billed charges are meaningless to me except for the very few patients from whom we will be paid based on charges. A hospital will bill for every service, medication, etc that's provided but since they are paid on a case rate basis for maternity, it's completely irrelevant.

Billed charges are absolutely meaningless. They are not based on costs. They are not based on contracted rates with payors. They are basically set as high as possible to maximize reimbursement for those very few patients with indemnity insurance.

When I review statements, I may look for what services were actually provided. That's relevant when I'm analyzing a rate proposal. But I pay no attention to the billed amounts.

May 7, 2010 | Unregistered CommenterJennifer

I want to see the behind the scenes stuff. It's obvious when I look at my benefit statements from insurance that the billing is inflated and I think it would be interested to see the value assigned to each item, even (or maybe especially) if Jennifer is saying that it's phony.

May 7, 2010 | Unregistered CommenterLynn

@Lynn, with maternity services, you can't see the value assigned to each item because it's almost always reimbursed under a global rate. To be clear, I'm not saying that it's "phony," just irrelevant. Also a hospital must "cost-shift" to patients with commercial insurance to make up for losses on un-insured, under-insured and government patients.

May 7, 2010 | Unregistered CommenterJennifer

Jennifer is correct. The costs charged are irrelevant, mostly. Private insurance is billed higher to take the brunt of the uninsured. Government insurance will decrease reimbursements if a hospital is not charging enough, based on what other comparable hospitals are charging (ever read "Catch 22"?). It is not really a matter of being "phony" or hospitals trying to grift patients. These crazy, outrageous charges are mostly due to the gigantic, unorganized, inefficient, fee for service system that is American Health Care.
One important topic that I have yet seen addressed in maternal health blogs (*hint to Jill, I have stopped blogging so you need to address this :)!), hospitals often lose money, or at best do not make money on delivering babies. Running an L&D unit comes with huge overhead and liability, and limited revenue. Many struggling hospitals will close their maternity services first in an effort to be solvent, but invariably the entire hospital will eventually close. One reason (and a very valid and ethical reason) that hospitals keep a maternity unit is because they know women primarily make the health care decisions for their entire family. Giving birth is usually the first introduction a woman has to the hospital system. If the experience is good, they theory is they will be loyal to that hospital and refer their family for care throughout the lifespan.
*So I wonder, is this theory valid? If you had a good experience giving birth at a hospital, would it make you more prone to visit this hospital for your entire family's health care needs? Conversely, if you had a bad experience,would you jump ship and go elsewhere? As a health care provider, your answers interest me greatly.*
(Jill, since I do not blog anymore, I will be occasionally hijacking your blog when I see fit. The price you must pay for being awesome).

May 7, 2010 | Unregistered CommenterReality Rounds

The billed amount isn't necessarily irrelevant for the patient. Whenever I've had charges for care that insurance chooses not to pay for, the billed amount is what they come after me for.

May 8, 2010 | Unregistered CommenterJenna

I offer to review hospital charges with my patients. I am fascinated by incorrect and redundant billing. I have saved patients as much as $1100 in hospital charges on one normal delivery. I know what the codes and names mean and it still is difficult to understand some of this stuff. That said I have a question. Jill, what the hell did you do to hack Tuteur off so much? She is in a rant about something.

May 8, 2010 | Unregistered CommenterOb

Jenna, if you see a provider who is contracted with your insurance company, you should not be balanced billed. Balance billing is when a patient is billed for the difference between billed charges and what the insurance company paid. If you are seen by a participating provider, you should only be responsible for your cost-share, e.g. 20% for an 80/20 plan. Your out of pocket should go towards your coinsurance max and once that is met, you should have no out of pocket costs. The key is that you are seen by a provider who is participating in your network.

If you are out of network, some payors have tried to shift greater costs to patients by applying what is called "usual and customary" payments. For example, the billed amount is $1,000 and the insurance company pays a U&C rate of $200. Because you are out of network, you can be balanced billed and will be responsible for the difference ($800). This practice has been challenged by many patient advocates and there was a huge settlement last year between the Attorney General of the state of New York and several of the largest insurance companies over the mis-use of U&Cs.

To summarize, if you are in network, you shouldn't ever be balanced billed. If you are balanced billed, take it up with your provider and if they refuse to rectify the situation complain to the insurance company. A contracted provider is contractually obligated not to balance bill members.

If you are seen by a non-contracted provider, then you can be balance billed. If the amount you are billed is excessive, then you can appeal what was paid by your insurance company. You should also attempt to work out an arrangement with the provider. Most providers do not like to go after patients for amounts not paid by insurance because we believe that money is noncollectable. Most providers will substantially discount bills for un-insured and under-insured patients.

The key to reducing your out of pocket costs is to see providers who are in your network.

May 8, 2010 | Unregistered CommenterJennifer

I think the word "irrelevant" is throwing people off. Irrelevant in terms of not being the true cost of the procedure? Yes. Irrelevant as in uninteresting or not worth learning about? No.

Jennifer, I'm loving your comments.

RR, so it's official? Clearly you'll need to post here if you ever get the itch to blog. (Oh please please please).

Ob, I'll e-mail you a funny story.

FYI, the cost project might end up being the most boring thing ever. I figure we can see what gets sent in and take it from there.

May 8, 2010 | Registered CommenterJill
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