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Hello. I've noticed that some members here have a good understanding of medical insurance and billing, so decided to ask here. My search for "newborn" and "delivery" in Finance did not answer my question.
Is it customary, that the mom and baby be considered (and billed as) separate inpatients when the delivery is in a hospital, even if baby does not require any surgery or complicated procedures outside the realm of a normal delivery? Typically, would Baby be billed inpatient room charges even if Baby stayed in mom's room?

Background:
I recently became a dad. My insurance covers pregnancy and delivery costs, and also "newborn care" (defined as "all physician services provided to a baby during the motherís hospitalization"). There is a per-day copay for inpatient stay, which (quite understandably) was charged for the Mom's stay in the hospital. It was a normal delivery. Baby was born healthy, but needed to be kept under the infrared lamp a few times, until body temperature was stable. The infrared lamps were in the NICU, and baby was shuttled there and back to mom's room a few times.
After discharge from hospital, the hospital bill arrived for the patient (Mom), and I could see it included the customary copay, the coinsurance, and the not-so-surprising "padding" items, for e.g. a $100 charge for a disposable that WalMart sells for $2.50. All in all, about $14,800 billed for Mom (before the $6.5k of adjustments for prenegotiated discounts that the insurance company gets from the hospital).
A few weeks later a different bill arrived for Baby, and seemed to assess $1100/day of "inpatient room charges" for Baby. Hence the question in bold above.

Thank you for weighing in.

Member Summary
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When my daughter was born in December, we received 3 bills also. Facilities were $4,800, mom was $3,500 and baby was $1... (more)

Rick0822 (Nov. 04, 2010 @ 4:52p) |

It was probably for the pediatrician's visit to the hospital.

geo123 (Nov. 04, 2010 @ 4:55p) |

I was charged a seperate copay for my newborn as well. This was United healthcare. I called CS and they confirmed that i... (more)

ymtang (Nov. 24, 2010 @ 1:56p) |

per gatzdon: When requesting an itemized bill, you need to specifically request that it include the ICD and CPT codes. This makes it much easier for you to google the real diagnostic and procedure code to see what they really billed for.

The ICD codes help you figure out if there were any unnecessary procedures
performed. If a procedure was performed, but was unwarranted (in other
words the ICD code does not describe a symptom/condition/situation that occurred), then you are also justified in disputing the charge for the procedure.
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Newborn will typically have their own physician's and room charge (nursery). Insurance negotiated rates should also apply to these charges. Of course you can argue that the baby was not in the nursery.

When our baby was born a little while back and we were transfered to the hospital immediately following delivery (long story but mom wanted a water birth but had some complications that required surgery) we were charged ~$800 for the baby. We only stayed at the hospital for ~14hrs (also a long story) so 1100/day seems believable especially with visits to the ICU mixed in there.

Yes, it's what purely money-motivated hospital scum do. Disgusting isn't it?

When my daughter was born they started billing her insurance (because we're responsible people and actually ensured she'd be insured) the second she was born. My wife's care hit our $10,000 deductible then they started billing my newborn daughter as if her presence in the hospital was somehow not related to my wife giving birth.

Our health care system is so outrageously broken I can't even laugh about it any more

We just had the exact same experience. We were at the hospital a total of 20 hrs. and my wife had no meds of any kind and no procedures other than them catching the baby, wiping her off, crimping the cord for me to cut, and giving a vaccination. We first received a bill for about $6,800 and were blown away. It turns out that was just for the "hospital facilities." A few days later another bill showed up for $4,500 more, which was even more astonishing. It turns out that was just for the care of the mother. A few days later, yet another bill arrives for over $1,000. This was for care of the baby. They literally only touched the baby twice for a total of a few seconds. Once to catch her and wipe her off and once to give her a vaccination. It's no skin off our nose since we have excellent insurance, but it is just absolutely insane.

They don't break much of the bill down, either, so you can't really call them out on anything in particular. Items such as delivery fee and infant care are hundreds or thousands of dollars with no detail as to how they come up with that amount.

Yes they bill they as two different patients . Three if you have twins. They are different people and get billed as such.

kcjeffery said: It's no skin off our nose since we have excellent insurance, but it is just absolutely insane.


There-in lies the problem. It's skin off ALL our noses, these outrageously bloated bills are the reason why our insurance premiums are so high. The "I don't care, I'm not paying the bill" attitude is short sighted in the extreme. Not singling you out, it's the prevalent attitude.

If we the people stood up and said "Stop! We're not paying $100 for a hospital provided diaper ever again." (etc) the overcharging would stop tomorrow. But apparently we like it...

If you question any of it, call the billing department and request an itemized bill. I did with our daughters birth. Everything seemed correct, including the $10 ibuprofen and all that overpriced stuff.

We were also billed seperately, which is fun with 2 deductibles.

Thank you, folks, for the answers. Sure appreciate the knowledge you bring to the table here.

ganda said: kcjeffery said: It's no skin off our nose since we have excellent insurance, but it is just absolutely insane.


There-in lies the problem. It's skin off ALL our noses, these outrageously bloated bills are the reason why our insurance premiums are so high. The "I don't care, I'm not paying the bill" attitude is short sighted in the extreme. Not singling you out, it's the prevalent attitude.

If we the people stood up and said "Stop! We're not paying $100 for a hospital provided diaper ever again." (etc) the overcharging would stop tomorrow. But apparently we like it...


We initially thought they had to have charged for something they didn't do. We couldn't wait to get the itemized bill so we could call them on it, but like I said, they just state vague things like delivery fee and charge over $4,000 for it. How do you dispute that? They technically delivered a baby.

And even things as obvious as a $100 diaper, how are you going to dispute that? Are you going to bring in the one from Wal-Mart, hand it to them, and request a refund? If someone has useful ideas, I hope they share them. I would jump all over them if they charged for something they didn't do, but if they just charge too much what can you do?

Apparently that "bill" (more like a notification) is a summary of what the MSRP is but the amount actually paid by the insurance is not nearly as high. Our baby is just over 3 weeks old now so we went through the same thing and it came up during a discussion with my brother who routinely audits these things on behalf of the state.

For the person who said they only stayed for 14-20 hrs, how'd you do that?!?! We had a routine birth but enjoyed every bit of the 3 days we were there. It was especially since for me (dad) since we were in a double room with no one else in that second bed so I made it mine for those few days.

Yes, it's what purely money-motivated hospital scum do. Disgusting isn't it?

If this is the case, we should then be able to assume that the hospital is profiting an obscene amount of money.

Is this the case?

Medical bills are a complete disaster - where else would you pay $10000 and not understand what you were buying? The insurance companies make it even more difficult as they send you these summary bills that lump everything into generic categories like "DIAGNOSTICS FEES". Billing makes you feel like a pain for asking for detailed bills, and questioning things.

WillyWah said: Apparently that "bill" (more like a notification) is a summary of what the MSRP is but the amount actually paid by the insurance is not nearly as high. Our baby is just over 3 weeks old now so we went through the same thing and it came up during a discussion with my brother who routinely audits these things on behalf of the state.

For the person who said they only stayed for 14-20 hrs, how'd you do that?!?! We had a routine birth but enjoyed every bit of the 3 days we were there. It was especially since for me (dad) since we were in a double room with no one else in that second bed so I made it mine for those few days.


My wife was fortunate enough to not need an epidural, episiotomy, cesarian, etc. that would lay her up for days or weeks. She really didn't want to spend another night in the crappy hospital bed and eat the crappy hospital food and I didn't even have a bed. I would have had to sleep on a hard bench if we stayed there. We were far more comfortable back home, so we left after 20 hr.

They made a big deal that we needed to come in to the pediatrician the next day to have the baby checked for jaundice. When we went in, however, she said it was too early to check for that and the hospital shouldn't have sent us in so soon. We were still charged $250 for the visit, though, and had to come back two days later to check again and pay another $200+. It's such a racket.

One other note is that the insurance paid 80-90% of MSRP of the bills, as well. I always heard they got such a great pre-negotiated discount, but this wasn't the case either.

InsuranceExpert said: Yes, it's what purely money-motivated hospital scum do. Disgusting isn't it?

If this is the case, we should then be able to assume that the hospital is profiting an obscene amount of money.

Is this the case?


Apparently so, judging by the extravagant lobbies, artworks and fountains at my local hospital. You know, the stuff that's so vital to the quality of the health care provided...

It really depends on your plan. Many managed care plans have it negotiated to consider the baby (babies) as part of the mother's coverage for the first 30 days, and they may bundle the billing or the total charge (aside from any complication needing special care) including pre-negotiated costs.

If you have a traditional indemnity plans or a PPO plan, then things may get more interesting as listed on the above responses. Some plans require you to add your baby within a certain amount of time to get such items covered.

Rasheed

ganda said: InsuranceExpert said: Yes, it's what purely money-motivated hospital scum do. Disgusting isn't it?

If this is the case, we should then be able to assume that the hospital is profiting an obscene amount of money.

Is this the case?


Apparently so, judging by the extravagant lobbies, artworks and fountains at my local hospital. You know, the stuff that's so vital to the quality of the health care provided...


Is the cost there different than the cost at a hospital without that?

When requesting an itemized bill, you need to specifically request that it
include the ICD and CPT codes. This makes it much easier for you to google
the real diagnostic and procedure code to see what they really billed for.

The ICD codes help you figure out if there were any unnecessary procedures
performed. If a procedure was performed, but was unwarranted (in other
words the ICD code does not describe a symptom/condition/situation that occurred),
then you are also justified in disputing the charge for the procedure.

If they don't provide it, start filing written complaints with everyone
involved.

Speaking of cost, is "cost" what someone charges or what someone pays?

OP I have recently devlivered a baby, unfortunately it was Cesarean . Hospital billed me and child seperately . I was billed 18,658 ( insurance adjusted 17847) (4 days hosp stay)and the baby was charged 11,203 (insurance adj 10,789 ). The doctors and anesthesia charges are seperate from the hospital charges

I had a baby in July. Aside from the pediatric fees, there was one charge for the baby, billed by the hospital. On my EOB it was labeled "MEDICAL ADMISSION" with a total of $1500 ($1400 allowed by insurance). This was from a c-section delivery early Saturday morning, and we checked out Monday around noon, so that charge should be for 3 days. That makes it less than half the cost/day you were billed.

For my wife's charges (including all costs from hospital, doctor, anesthesiologist, etc, but not counting the baby's stay or pediatric exam costs) was billed at $22.2k, and insurance allowed $10.4k.

It seems Kaiser get's this right. For both my babies under Kaiser, the baby and the mom counted the same. With Kaiser, the baby gets it's own insurance (for free) for one month under the mother. The charge was something like $200 per day.

all these people complaining about how much their hospital bill came to, a bunch of other threads about how people are going to "negotiate" their bill...it's just silly...this isn't "dr. quinn medicine woman" and you're not going to barter five chickens for a delivery...if there was the tiniest thing wrong with mother or baby you'd want every doctor and every high-tech medical gadget in the state on the spot stat...21st century medical care is expensive...it's especially expensive in the u.s. because for whatever reason we are incapable of adopting a health care system like every other first world country

3 kids and none billed separately.

I think this depends on the insurance company/plan. I called up Aetna about this and they informed me that once baby takes that first breath, they become separately covered and subject to deductible/coinsurance (this is a PPO/POS plan)

WillyWah said: Apparently that "bill" (more like a notification) is a summary of what the MSRP is but the amount actually paid by the insurance is not nearly as high. Our baby is just over 3 weeks old now so we went through the same thing and it came up during a discussion with my brother who routinely audits these things on behalf of the state.

For the person who said they only stayed for 14-20 hrs, how'd you do that?!?! We had a routine birth but enjoyed every bit of the 3 days we were there. It was especially since for me (dad) since we were in a double room with no one else in that second bed so I made it mine for those few days.


Our hospital experience wasn't all that good. After the surgery (and 36hrs of labor) we had random hospital staff in our room waking my wife and I up every 30 to 45 mins for random things like lecturing us on the importance of car seats, why we shouldn't shake our baby, some kind of RFID tracking bracelet for mom/baby and a half dozen other things (not that any of it was inherently bad it was just very in a manner that was inconsiderate ). After 13 or 14 hours of that garbage we decided that it was in our best interest to go home where we could actually rest even though the doctor wanted us to stay at least 2 days. There was just no way we were going to be able to make it through all of that.

To be entirely honest I'm not sure how people can happily stay in the hospital for 3 days after the birth. It was really a miserable experience for us.

rikerseye said: all these people complaining about how much their hospital bill came to, a bunch of other threads about how people are going to "negotiate" their bill...it's just silly...this isn't "dr. quinn medicine woman" and you're not going to barter five chickens for a delivery...if there was the tiniest thing wrong with mother or baby you'd want every doctor and every high-tech medical gadget in the state on the spot stat...21st century medical care is expensive...it's especially expensive in the u.s. because for whatever reason we are incapable of adopting a health care system like every other first world country

Yes, you have to pay for their expertise and their equipment, even if they don't have to use it. I think a lot of it is also paying for all the patients that don't pay, either because the can't or don't want to. Everything is so expensive that you either have insurance and don't care how much it is, or you don't have insurance and don't pay because the cost is so outrageous.

After seeing an itemized bill for my first, I took everything for the baby with me and insisted they take back all the "supplies" and got it in writing- I even took water, nipples, etc. and tylenol for me, colace, etc. It took me a month to get a credit for the "epidural" they charge me for that I didn't have! That/s a big reason why babies 3 and 4 were born at home- few hundred dollars as a gift to a lay midwife, bada bing bada boom!

I seems that you folks don't know that hospital charges are FIXED by the Federal Government (Social Security Admin.). The Hospital in a given area can only charge a set amount --- the insurance companies then negotiate with the hospital to discount that rate. Social Security has a set discount that they take, and the insurance companies ussually wind up within 5-10% of that.

pdxmale said: I seems that you folks don't know that hospital charges are FIXED by the Federal Government (Social Security Admin.). The Hospital in a given area can only charge a set amount --- the insurance companies then negotiate with the hospital to discount that rate. Social Security has a set discount that they take, and the insurance companies ussually wind up within 5-10% of that.

We don't know about hospital charges being FIXED by the Federal Government because that is a false statement.

What OP is saying is what I thought was normal. There was a thread on FWF a while back about some guy who forgot to add his new kid to his insurance within the first 30 days. The kid spent some time in the NICU, and having gone too long to add the kid to the insurance the guy had to pay for the $30,000 bill. So this supports the idea the kid is treated separately.
I have had several friends with high-deductible plans tell me that they basically paid two deductibles (one for the mom and one for the kid).
Edit to add: It basically makes sense to have mom vs kid charges. I mean what if the baby was stillborn? Then the hospital wouldn't charge as much, because there wouldn't be any need to run tests on the baby, weight it, give it shots, etc. Twins means double the work, and likely would result in more charges than if you have one baby.

ganda said: If we the people stood up and said "Stop! We're not paying $100 for a hospital provided diaper ever again." (etc) the overcharging would stop tomorrow. But apparently we like it...Diapers are easy. But do we have the courage to say no to those expensive tests like MRIs the doctors suggest we do just to be sure? After all, it is not the patient who went to med school and have $400K student loan balance.

If you are not familiar, look up "supply sensitive care" at the "dartmouth atlas of health care".

ganda said: If we the people stood up and said "Stop! We're not paying $100 for a hospital provided diaper ever again." (etc) the overcharging would stop tomorrow. But apparently we like it...

you're being unreasonable...have you ever arranged catering for a business meeting?...ever look at what they're charging you for a twelve pack of soda?...it's like twenty or thirty bucks...there's a markup because of the cost of the labor that delivers it to you...and labor in a hospital is 10x more expensive than people who work minimum wage for caterers...there's really nothing particularly extraordinary going on here

pdxmale said: I seems that you folks don't know that hospital charges are FIXED by the Federal Government (Social Security Admin.). The Hospital in a given area can only charge a set amount --- the insurance companies then negotiate with the hospital to discount that rate. Social Security has a set discount that they take, and the insurance companies ussually wind up within 5-10% of that.

Not even close to accurate.how bout you google something first before you spew this inaccurate garbage on the board?

Also, just FYI: icd9 codes are for a diagnosis, not a procedure. Cpt codes are for a procedure. The way to check your bill is make sure the cpt codes (procedures performed) are for accurate diagnoses, being the icd9 codes.

nycll said: ganda said: If we the people stood up and said "Stop! We're not paying $100 for a hospital provided diaper ever again." (etc) the overcharging would stop tomorrow. But apparently we like it...Diapers are easy. But do we have the courage to say no to those expensive tests like MRIs the doctors suggest we do just to be sure? After all, it is not the patient who went to med school and have $400K student loan balance.

If you are not familiar, look up "supply sensitive care" at the "dartmouth atlas of health care".


I wish people who are perfectly fine would stop demanding every test under the sun. Or they are good to go home but decide to stay in the hospital another day. This sword cuts two ways, my friend. And god forbid you say no to a test and 6 mos later someone comes back with something terrible. Think they'll still be so understanding then about cost containment then, or you think they'll be lawyering up?

By the way, the only one making money on your MRI scan is the guy reading it, the radiologist. Who is not the one who orders the test. Antikickback laws in healthcare are far more stringent than in most other businesses ... So get your facts straight.

gatzdon said: When requesting an itemized bill, you need to specifically request that it
include the ICD and CPT codes. This makes it much easier for you to google
the real diagnostic and procedure code to see what they really billed for.

The ICD codes help you figure out if there were any unnecessary procedures
performed. If a procedure was performed, but was unwarranted (in other
words the ICD code does not describe a symptom/condition/situation that occurred),
then you are also justified in disputing the charge for the procedure.

If they don't provide it, start filing written complaints with everyone
involved.

SUBSCRIBED!!!

rikerseye said: ganda said: If we the people stood up and said "Stop! We're not paying $100 for a hospital provided diaper ever again." (etc) the overcharging would stop tomorrow. But apparently we like it...

you're being unreasonable...have you ever arranged catering for a business meeting?...ever look at what they're charging you for a twelve pack of soda?...it's like twenty or thirty bucks...there's a markup because of the cost of the labor that delivers it to you...and labor in a hospital is 10x more expensive than people who work minimum wage for caterers...there's really nothing particularly extraordinary going on here

You, like a lot of people, are missing the point. We understand there are costs, lots of costs, that the $100 diaper isn't really for the diaper but for something else. Currently, the way healthcare in the U.S and actually most elsewhere is handled, instead of being upfront with the cost of things and itemizing them as such, they instead makeup for these costs by raising the prices for other things. The idea is that by evening out the costs, overall it comes out to what it should cost and therefore everything is alright and no one is being ripped off. (Think cost of compensated care making up for uncompensated care). However, there is a problem with doing things like this.. It allows for "gaming" of the system. You see, when you have govt. run programs, this happens. When you get sloppy with your accounting and billing, things slip through and then the problem gets bigger and bigger, allowing for more things to go unnoticed before it becomes so bad that you don't even know anymore what is a legitimate charge and what isn't which eventually leads to the implosion of the whole system and finally you get exposed for what you are and what you've been doing.

Insurance companies, doctors, hospitals, governments need to be forthright and articulate about what they're charging for, how much they're charging for and why it's necessary. This will never happen until the consumer becomes more involved in the process which at this point is not the case at all.

It is accurate --- my wife is a VP of a hospital and all costs pivit off of what ss/medicare payments are ---- and they are fixed. END OF STORY

I think part of the issue with with medical billing stems from a misunderstanding regarding how patients are billed. The CPT codes yield a certain charge, regardless of the amount of work involved. I get paid the same amount for a non-complex cataract surgery whether it takes me 10 minutes or 45 minutes because it all gets billed under 66984. SO if your kid hit the NICU for 10 minutes or 10 hours, it probably gets billed under the same code. I'm not saying I like it, but that's how all billing is set up.

Regarding you question of separate charges for mother and child, that has been the case with my three kids. The recent birth of my daughter had bills for my wife and the kiddo. Sucks, but I think that's normal for billing.

Skipping 36 Messages...
I was charged a seperate copay for my newborn as well. This was United healthcare. I called CS and they confirmed that it's their policy to have seperate hospitalization copays for the newborn and mother.



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