$0 Birth Cost: How I Paid Nothing to Give Birth in the U.S.
And So Can You!
Two years ago, when I was pregnant with my son, I was a broke graduate student. I had a huge debt and constantly worried about the cost of giving birth. Every mommy friend I know complained about the enormous hospital bills they received only AFTER their deliveries. There is almost no cost estimation, no payment guarantee, and no financial assurance. The uncertainty was killing me. So, I became obsessed with researching how to lower the cost of giving birth in the U.S.
My obsession paid off.
I ended up paying nothing to deliver my son. Zero dollars. Not even a penny!
My $0 hospital bill included all OB/GYN visits, pre-birth testings, and natural birth with an epidural in a large hospital. It also covered 3 days in the recovery room for me and another 3 days in the NICU for my son. All that for free!
Over the years, I have used my knowledge and experience to help many mothers to minimize their hospital delivery bills. Together, we successfully made it in different states and with people of different income brackets. So, I’m confident that my strategies work in many situations-not just my own.
In this post, I will tell you exactly how I did it (step-by-step) and what you can do to lower your birth cost or to pay nothing at all!
The Issues of Delivery Costs in the U.S.
Before learning how to slash those hospital bills, we need to understand issues associated with giving birth in the U.S.
Giving birth in the U.S. can be very expensive. An average cost of having a baby is $10,808, which can be increased to $30,000 when factoring the cost during pregnancy and after delivery. Even with insurance, the average new parents still pay more than $4,500 for their delivery.
But the worst thing is hospitals don’t tell you how much. You only know when you receive the bills, often weeks or months after giving birth. And good luck with asking the hospitals for an estimate upfront, it rarely works. (Watch this Vox video to see a parent’s journey to find out the cost of giving birth).
This is because the U.S. healthcare system has been structured in a way that benefits many private sectors (e.g., hospitals, insurance companies, and testing labs). Every playing agent needs to pocket something in the transaction. As a result, the initial cost of a medical service tends to be inflated significantly, which hurts low-income workers without insurance the most.
Giving birth in such a complicated, profit-driven healthcare system can be stressful and frustrating. You may end up paying much more than the medical service costs. It is really heartbreaking to see new parents get into so much medical debt after giving birth. Who would want to have babies born from, and into debt?
However, the good news is all of these are preventable. With the right strategies, you can totally avoid overpaying for your delivery and save tens of thousands of dollars.
How to Pay Nothing (or Much Less) to Give Birth in the U.S.
So, how to crack this broken system? Below is my step-by-step guide with pro tips. These steps can be taken sequentially or simultaneously, depending on your situation.
Step 1: Contact your insurance
If you have any insurance, contact them as soon as you’re pregnant. You need to figure out the maximum out-of-pocket/co-pay amounts you are expected to pay for pregnancy and birth-related services. This includes all OB/GYN visits, pre-birth testings, ultrasounds, delivery, recovery, and healthcare coverage for your newborn. Don’t bother calling your hospital’s billing office for these cost estimates; they are not as helpful as your insurance agency.
In my case, I called and was quoted a maximum of $1,200 co-payment for my delivery, which wasn’t too bad. However, my insurance refused to pay for early generic testings because I wasn’t classified as “high risk”. Moreover, my insurance only covered the 25-week ultrasound. Any additional ultrasounds I wanted to do, I would have to pay out-of-pocket. Regardless, these are helpful information that provides me a better view of my future medical expenses. I would recommend you to do the same. A simple phone call can save you a lot of money and headache later on in the process.
Pro tip: Before ending the call with your insurance representative, ask s/he to email you a summary of your conversation. That way, you’ll have everything in writing. Alternatively, you can email your insurance to gather the same information.
Step 2: Ask About the Cost BEFORE Agreeing to Any Services
You know the nervous feeling when you first come to the doctor’s office, especially if this is your first pregnancy. Within minutes, you are bombarded with so many elective, early preventative tests. “Do I need to do this genetic test to figure out the possibility of my baby having Down syndrome?”, “Should I take this blood test to make sure about my baby’s gender?”, “Must I do another ultrasound to confirm my baby’s development?” — so many questions come to your mind. And friends, this is where many future moms make their deadly financial mistakes! They are so nervous that they take every elective testing offered, which later serves them enormous medical bills. Don’t fall into the trap of unnecessary testings!
In fact, before agreeing to any tests or services, ask your provider the following questions: (1) Is it truly necessary for my specific case? and (2) How much will it cost me? Depending on their policies, some providers can straightforwardly answer your second question or direct you to the financial office. In either case, always double-check the information. I have a friend whose doctor said one of her elective tests would cost $80, but she ended up with a $500 bill. You don’t want that to happen to you.
Pro tips: Always double-check the information. If possible, have them in writing. Only agree to tests and services if they are necessary and you know for sure about their costs.
Step 3: Negotiate! Negotiate! Negotiate!
Because medical costs are highly inflated, their “true” values are likely much lower than the amount you are billed for. Therefore, don’t be afraid to negotiate to lower your hospital bills down to their real values. This means when you receive a bill that appears to be high, don’t pay for it right away. Instead, you should talk to someone at the billing or financial departments to discuss the cost first. This negotiation can happen either before or after you receive a medical service.
The topic of hospital bill negotiation is hard to cover in a single blog post. However, it can be as simple as making a brief phone call or in-person meeting, in which you explain to the person in charge your situation and ask if there is any way you can have a discount. The worst thing they can say is “no”, but the best thing they may say is “yes”. You’ll never know and it never hurts to ask.
Many people have found success with hospital bill negotiations, myself included. This is because many U.S. hospitals are aware of the inflated costs of their services, they are totally capable of lowering your bills.
One of my best friends’ insurance didn’t cover ultrasound. She was told by her provider to pay $750 if she wanted an ultrasound in her 25-week checkup. After hearing that, she literally went down the hall and knocked on the financial department’s door. She said: “I am a full-time student and underinsured, I can’t afford to pay $750 out-of-pocket for an ultrasound”. The official quickly responded: “We can give you a 75% discount. That means with taxes, you would pay about $200. Would you be okay with that?” Just like that, within less than 5 minutes, she saved $550! It truly never hurts to ask.
Step 4: Apply for Medical Assistance
The best thing to guarantee a $0 co-payment on your medical bill is having medical assistance (Medicaid). Medicaid is a public assistance program that provides health insurance for low-income Americans and qualified individuals living in the U.S. Before you brush this option off, thinking that your income may not be qualified or you had been denied for Medicaid in the past, I urge you to reconsider.
First, you might not be qualified for Medicaid before but you may be qualified now since you’re pregnant. Pregnancy is one of Medicaid’s first priorities. Second, your income might not be considered low before but it may be now if your unborn baby is included in the household income estimation. Third, each state, county assistant office, caseworker… has different ways to determine your qualification; it’s all case-by-case basis and not as clear cut as it seems. Therefore, it is always good to check with your county assistant office to find out your possibility of getting Medicaid.
I personally know many expected parents who were qualified for Medicaid but didn’t apply for it. They didn’t want to go through the application process (submitting financial documents, proof of pregnancy, medical bills…). As a result, they ended up with a mountain of medical debt after giving birth. True, it may take some time (and some pain) to go through the Medicaid application process. However, the financial outcomes (if you get approved) is totally worth it.
Pro tips: From my experience, sometimes it helps to meet your caseworker in-person. In-person meetings provide you a good opportunity to present your case and explain why you really need Medicaid, which can help the result be in your favor.
Step 5: Look into Your Hospital’s Financial Assistance Program
If you are denied for Medicaid, look into your hospital’s financial assistance program. Many hospitals offer programs that support uninsured or underinsured patients. In fact, if possible, CHOOSE the hospital that has a good financial assistance program for your delivery. The income limits to qualify for hospitals’ financial assistance programs are often higher than that of Medicaid. So you may have a higher chance to be accepted for these local, hospital-based programs. Once you are accepted, your unpaid medical bills will be forgiven or reduced significantly.
In my case, I hadn’t known about such a program until I received the first hospital bill in the mail. The bill came with a sheet of paper mentioning a financial assistance program and instructions to apply. According to the instruction, patients need to apply for Medicaid first (since both programs support low-income individuals). If patients were denied by Medicaid, they would be considered for the hospital’s financial assistance program.
I was accepted for Medicaid. However, because my Medicaid only back paid 3 months of medical expenses prior to the acceptance date, I had some older bills that weren’t covered. Therefore, I wrote a letter to my hospital’s financial assistance program, asking them to consider my uncovered bills. Fortunately, they accepted my application. All my older hospital bills were erased. You see, again, it never hurts to ask!
With that, I confidently arrived at the delivery room with my regular insurance, Medicaid, AND the hospital’s financial assistance. That’s the most financial assurance you can get!
Pro tips: Search on the hospitals’ websites or call their financial offices to find out information about financial assistance programs. Ask local mommy groups for advice on high-quality, affordable hospitals before committing to one.
Step 6: Keep Track of All Bills and Receipts
Either you are qualified for medical and financial assistance or not, always keep track of your medical bills and receipts. Call immediately if you suspect any problem with your bills. Trust me, I have done data analytics for hospitals, they bill their patients wrong ALL THE TIME. I know how tired new parents can be, but you need to on top of your bills. Don’t let the hospital rob you!
After my delivery, I continued receiving many hospital bills, despite being told that my services would be fully covered So, I called the hospital to fix it. And I did it every time! Amid all the excuses (“some errors in our billing system,” “your information was entered incorrectly,” “the bill has not been updated,” etc.), I couldn’t help but wonder what would happen if I didn’t follow up and pay all bills in full without asking. Will the hospital refund me? I doubt it.
Pro tip: Ask for all the bills to be sent both digitally via email/online portal and physically via postal mail. Although I love the environment and hate paperwork, I find having paper bills easier to organize and follow up. After paying off all of your bills, don’t forget to call the hospital to make sure all of your charges are clear.
I hope you find this post helpful in heading you in the right direction to minimize your delivery cost. I know for me, avoiding giving birth costs helped tremendously in our debt-free journey. I’m forever grateful for it. Good luck with your pregnancy. You got this, mama!
Originally published at https://theessentialcash.com on May 15, 2020.
