Baby's first bill
May 3, 2018 6:09 AM Subscribe
The costs of delivering a baby in the US can be eye-watering, but did you know that babies are billed, too? Hospitals are routinely charging babies for nursery stays and baby care, separately from mom and dad's insurance.
“It seemed weird to me too until I realized the newborn is (of course) another human being,” he wrote in an email, “receiving their own distinct services, so the hospital treats them as a separate patient.” Usually, he says, the baby’s charges were applied to the new mother’s policy. Which is what happens most of the time. States have individual rules about how long an infant must be covered under a mother’s policy. ACA plans usually kick in immediately, and most private insurers are required to cover a child for the hospital stay during a normal birth, even if the bills are filed under separate names."
The billing practice itself isn't weird (how else will you know that blood count is on the babe, not you? And my pedi always bills in my child's name), what 's weird is that no one during the entire pregnancy or prenatal hospital tour or billing verification process mentions it...even as they're yammering on for the millionth time about visiting hours and what you can/can't bring with you. And then it takes 3 yrs for billing to catch up with collections. Oh America, how great thou art!
posted by beaning at 6:22 AM on May 3, 2018 [4 favorites]
The billing practice itself isn't weird (how else will you know that blood count is on the babe, not you? And my pedi always bills in my child's name), what 's weird is that no one during the entire pregnancy or prenatal hospital tour or billing verification process mentions it...even as they're yammering on for the millionth time about visiting hours and what you can/can't bring with you. And then it takes 3 yrs for billing to catch up with collections. Oh America, how great thou art!
posted by beaning at 6:22 AM on May 3, 2018 [4 favorites]
There's nothing that capitalism cannot ruin.
posted by Fizz at 6:23 AM on May 3, 2018 [17 favorites]
posted by Fizz at 6:23 AM on May 3, 2018 [17 favorites]
This is a thing that comes up from time to time for Canadians: There will be a news story about a woman who travelled to the US while pregnant, bought travel health insurance, and then racked up a gigantic bill because the travel insurance didn't cover the baby once it was born. Here's one where the woman was billed almost a million dollars for what would have been free if it had happened in Canada.
posted by If only I had a penguin... at 6:48 AM on May 3, 2018 [6 favorites]
posted by If only I had a penguin... at 6:48 AM on May 3, 2018 [6 favorites]
Meanwhile, jerks like bezos pay no tax and have so much money they have to publicly wangst about it. You make me so sad sometimes, America. I hope you can get your shit together someday.
posted by mrjohnmuller at 6:54 AM on May 3, 2018 [11 favorites]
posted by mrjohnmuller at 6:54 AM on May 3, 2018 [11 favorites]
On my list this is under Reasons Why I Love The US And Its People But Could Never Live There Item 3.
posted by GallonOfAlan at 7:07 AM on May 3, 2018 [4 favorites]
posted by GallonOfAlan at 7:07 AM on May 3, 2018 [4 favorites]
One father I spoke to sent me a $200 bill for the time his newborn apparently chose an out-of-network provider while his wife, exhausted after labor, was sound asleep.
One of the most maddening things about American healthcare is the people who defend this bullshit in the name of "patient choice." The plans are complex enough, but even if you understand them, surprise! Your baby saw someone out of network or the hospital you went to in an emergency was covered but not the anesthesiologist. I had surgery recently and I've finally gotten the last bill ($200 for the hospital stay and $20 for basically every doctor I saw, but all pretty reasonable), but until I got them I had no confidence that I wasn't going to get some surprise $5,000 bill from a doctor who I never agreed to see.
posted by Bulgaroktonos at 7:07 AM on May 3, 2018 [20 favorites]
One of the most maddening things about American healthcare is the people who defend this bullshit in the name of "patient choice." The plans are complex enough, but even if you understand them, surprise! Your baby saw someone out of network or the hospital you went to in an emergency was covered but not the anesthesiologist. I had surgery recently and I've finally gotten the last bill ($200 for the hospital stay and $20 for basically every doctor I saw, but all pretty reasonable), but until I got them I had no confidence that I wasn't going to get some surprise $5,000 bill from a doctor who I never agreed to see.
posted by Bulgaroktonos at 7:07 AM on May 3, 2018 [20 favorites]
God I know this reeks of privilege, but I left America and I am never going back.
posted by Literaryhero at 7:09 AM on May 3, 2018 [14 favorites]
posted by Literaryhero at 7:09 AM on May 3, 2018 [14 favorites]
I'm not sure what it would have cost in the US, but our first baby was born in a nice private hospital in Malaysia and cost about 1,000usd (without insurance) and we had the option to use a public hospital and pay almost nothing. My following two kids were born in Korea and cost negative money, meaning the government not only subsidized the births, but also gives us a stipend every month. In both cases the follow up visits and vaccinations and such were free or close enough to free that I don't remember.
posted by Literaryhero at 7:26 AM on May 3, 2018 [5 favorites]
posted by Literaryhero at 7:26 AM on May 3, 2018 [5 favorites]
One father I spoke to sent me a $200 bill for the time his newborn apparently chose an out-of-network provider while his wife, exhausted after labor, was sound asleep.
This sort of stuff happens all the time, baby or not. If you want a weirdly specific hobby-horse to badger your state legislatures about, there are states (mine is one) that have made it illegal to charge out-of-network prices for providers in situations where the person with the insurance can't reasonably be expected to be able to choose an in-network provider. My insurance tried to bill me for an out-of-network doctor who was working at an in-network emergency room when I rocked up with a concussion and broken nose after a fall. I wrote them a terse letter letting them know that in the Commonwealth of Pennsylvania, this is not legal. They paid the provider in full.
posted by soren_lorensen at 7:34 AM on May 3, 2018 [31 favorites]
This sort of stuff happens all the time, baby or not. If you want a weirdly specific hobby-horse to badger your state legislatures about, there are states (mine is one) that have made it illegal to charge out-of-network prices for providers in situations where the person with the insurance can't reasonably be expected to be able to choose an in-network provider. My insurance tried to bill me for an out-of-network doctor who was working at an in-network emergency room when I rocked up with a concussion and broken nose after a fall. I wrote them a terse letter letting them know that in the Commonwealth of Pennsylvania, this is not legal. They paid the provider in full.
posted by soren_lorensen at 7:34 AM on May 3, 2018 [31 favorites]
Oh yeah, this is totally a thing. I'm in the middle of trying to get $3500 of charges for my son to be billed to insurance first instead of just to him. Like beaning says, is not crazy to put some of the charges in the baby's name instead of mine, but why on earth would the hospital assume that a family with insurance for the mother wouldn't have it for the baby, never mind that my insurance says the baby is covered under me until I leave the hospital. Definitely the one thing every new parent has time and the mental energy for is multiple phone calls to multiple parties sorting out complicated medical billing messes. Hopefully this gets resolved soon before the original bill gets sent to collecting cause it's not like the hospital has stopped sending me notices about it while they're submitting the claim to my insurance.
posted by carolr at 7:36 AM on May 3, 2018 [2 favorites]
posted by carolr at 7:36 AM on May 3, 2018 [2 favorites]
Instead of single-payer healthcare, y'all got baby-payer healthcare.
posted by clawsoon at 7:40 AM on May 3, 2018 [10 favorites]
posted by clawsoon at 7:40 AM on May 3, 2018 [10 favorites]
", I had to prove that my kids didn't have an income. My kids were... an infant, a 2 year old, and a 3 year old at the time."
My favorite thing is when one of my kids goes to the ER and insurance sends me a worker's comp verification form for on-the-job injuries where I have to explain where my child is employed and, if he is not, why not, because the insurer really wants to get that ER money back from whatever industrial accident my children suffered at the sweatshop.
I also liked when they sent me a pre-approval form letter saying I now had "permission to proceed with NORMAL VAGINAL BIRTH" (all caps in the letter where they fill in the procedure) and I was like, "dude, I'm pretty sure that proceeds whether you give permission or not." (Joke's on them, I had a C-section.)
I guess we were lucky in that our ob/gyn explained baby billing to us, our hospital explained baby billing to us, our benefits administrator explained baby billing to us, and our insurer sent us a letter when they got my ob/gyn's prenatal care bill explaining how to register the baby when it arrived, and when we called walked us through the process. The insurer even told us that due to the billing cycle of our specific hospital vs. the social security number issuance process, we could expect to get a couple sky-high bills from the hospital we were using saying the baby wasn't covered, but that when the baby's SSN came through all the bills would go back for reprocessing and we'd get new bills with the proper co-pay on them, and that as long as we'd properly notified the insurer (as we did, and they send a confirmation letter), to ignore the first set of incorrect bills from the hospital.
We did have a couple minor baby-billing bobbles, but our benefits administrator was able to sort them out easily, apparently that's pretty common and they have a lot of practice.
We had a different insurer for our third, and they were glorious (as health insurers go) -- I got a call from them one day saying, "Hi, this is So-and-so with $Insurance. I just wanted to let you know that you're going to receive an incorrect bill in two or three days for $Child; we noticed it was unusual and when I checked in to it, I saw that your doctor used an incorrect billing code. We contacted them to have that corrected and they're submitting a new bill, but it'll take a couple weeks to process and their billing office had already put the incorrect bill in the mail. So don't pay the bill for $600 when it comes in a couple days! The correct bill should arrive in about two weeks, given the billing cycle."
posted by Eyebrows McGee at 7:55 AM on May 3, 2018 [13 favorites]
My favorite thing is when one of my kids goes to the ER and insurance sends me a worker's comp verification form for on-the-job injuries where I have to explain where my child is employed and, if he is not, why not, because the insurer really wants to get that ER money back from whatever industrial accident my children suffered at the sweatshop.
I also liked when they sent me a pre-approval form letter saying I now had "permission to proceed with NORMAL VAGINAL BIRTH" (all caps in the letter where they fill in the procedure) and I was like, "dude, I'm pretty sure that proceeds whether you give permission or not." (Joke's on them, I had a C-section.)
I guess we were lucky in that our ob/gyn explained baby billing to us, our hospital explained baby billing to us, our benefits administrator explained baby billing to us, and our insurer sent us a letter when they got my ob/gyn's prenatal care bill explaining how to register the baby when it arrived, and when we called walked us through the process. The insurer even told us that due to the billing cycle of our specific hospital vs. the social security number issuance process, we could expect to get a couple sky-high bills from the hospital we were using saying the baby wasn't covered, but that when the baby's SSN came through all the bills would go back for reprocessing and we'd get new bills with the proper co-pay on them, and that as long as we'd properly notified the insurer (as we did, and they send a confirmation letter), to ignore the first set of incorrect bills from the hospital.
We did have a couple minor baby-billing bobbles, but our benefits administrator was able to sort them out easily, apparently that's pretty common and they have a lot of practice.
We had a different insurer for our third, and they were glorious (as health insurers go) -- I got a call from them one day saying, "Hi, this is So-and-so with $Insurance. I just wanted to let you know that you're going to receive an incorrect bill in two or three days for $Child; we noticed it was unusual and when I checked in to it, I saw that your doctor used an incorrect billing code. We contacted them to have that corrected and they're submitting a new bill, but it'll take a couple weeks to process and their billing office had already put the incorrect bill in the mail. So don't pay the bill for $600 when it comes in a couple days! The correct bill should arrive in about two weeks, given the billing cycle."
posted by Eyebrows McGee at 7:55 AM on May 3, 2018 [13 favorites]
Pardon my ignorance, but how could this practice possibly hold up in court? A minor being involuntarily bound to an unknowable contract? Where can the consent come from?
Where else in the world do they attempt this sort of skulduggery?
posted by the letter at 7:58 AM on May 3, 2018 [8 favorites]
Where else in the world do they attempt this sort of skulduggery?
posted by the letter at 7:58 AM on May 3, 2018 [8 favorites]
of course they're billed, babies need to learn responsibility, otherwise they would just suck from the teat.
posted by zippy at 8:32 AM on May 3, 2018 [20 favorites]
posted by zippy at 8:32 AM on May 3, 2018 [20 favorites]
Again, however: the American people have shown that they specifically desire this state of affairs. Indeed, situations like this are sufficiently motivating to a slice of the citizenry that you can be elected largely on the grounds that you promise to make healthcare suck.
posted by aramaic at 8:34 AM on May 3, 2018 [7 favorites]
posted by aramaic at 8:34 AM on May 3, 2018 [7 favorites]
...when I spoke to women who were uninsured and pregnant, many of them blamed the unexpected bills on themselves.In these few words you find everything you need to know as to why the US healthcare industry continues to run amok over the bodies of patients, without a care or pause. Americans are exceedingly well-trained to blame themselves for everything a business entity might inflict on them.
posted by Thorzdad at 8:40 AM on May 3, 2018 [24 favorites]
The cost of having a baby here is insane and the lack of transparency is insane and the out-of-network thing is insane and insurance is insane generally, but I guess I don't see why you'd think it could work any other way as far as the actual billing goes. The baby is billed for procedures done to it because billing follows the procedure and diagnosis codes attached to it, which are attached to the baby, because the baby is the patient. I also work with a lot of babies that are removed from their mothers at birth and so I think it's weird to assume that the infant is always automatically tied to mom.
posted by Lutoslawski at 8:44 AM on May 3, 2018
posted by Lutoslawski at 8:44 AM on May 3, 2018
conservative christian america: a baby is a person from conception except for insurance purposes and then it's from birth.
posted by zippy at 8:57 AM on May 3, 2018 [17 favorites]
posted by zippy at 8:57 AM on May 3, 2018 [17 favorites]
"When I moved a few years ago and qualified for state-based ACA insurance, I had to prove that my kids didn't have an income.
My kids were... an infant, a 2 year old, and a 3 year old at the time."
Well, it seems silly now in this weird lull we're having where infants and children for some reason aren't expected to work, but presumably with the coming decades, children will need to get jobs before Kindergarten to help keep their families afloat. Sorry future children, no more free rides.
posted by GoblinHoney at 9:19 AM on May 3, 2018 [4 favorites]
My kids were... an infant, a 2 year old, and a 3 year old at the time."
Well, it seems silly now in this weird lull we're having where infants and children for some reason aren't expected to work, but presumably with the coming decades, children will need to get jobs before Kindergarten to help keep their families afloat. Sorry future children, no more free rides.
posted by GoblinHoney at 9:19 AM on May 3, 2018 [4 favorites]
conservative christian america: a baby is a person from conception except for insurance purposes and then it's from birth.
Not sure what you're trying to say here? Medical procedures during pregnancy are typically performed on the mother, not the baby, except for in-utero operations I suppose.
posted by windykites at 9:23 AM on May 3, 2018
Not sure what you're trying to say here? Medical procedures during pregnancy are typically performed on the mother, not the baby, except for in-utero operations I suppose.
posted by windykites at 9:23 AM on May 3, 2018
i'm saying that we (societally in the US, not necessarily you and I) define personhood one way when it benefits a religious interest, and another when it benefits a capitalist one.
posted by zippy at 9:30 AM on May 3, 2018 [9 favorites]
posted by zippy at 9:30 AM on May 3, 2018 [9 favorites]
When I moved a few years ago and qualified for state-based ACA insurance, I had to prove that my kids didn't have an income.
My kids were... an infant, a 2 year old, and a 3 year old at the time.
I wish I could count the number of times some government agency wanted me to prove a negative.
posted by Miss Cellania at 9:36 AM on May 3, 2018 [3 favorites]
My kids were... an infant, a 2 year old, and a 3 year old at the time.
I wish I could count the number of times some government agency wanted me to prove a negative.
posted by Miss Cellania at 9:36 AM on May 3, 2018 [3 favorites]
Well here’s my Canadian story. (Ontario)
With my first child, I was still lying in my own gore and being monitored to see whether I would need a blood transfusion when a poor, poor young male staff person was sent in with a clipboard and booties so he wouldn’t track said gore anywhere for me to sign, and add a baby name to, to assign my daughter a health care number.
I will admit that was bizarre as experiences go. For my next two kids we did it calmly a few hrs after delivery but for her it was clear she was going to need her own card. She had been resuscitated and was clearly going to need a lot of care. She was transferred via space pod incubator and ambulance to Top NICU Hospital (Sick Kids) about 10 hrs later, received $600k-ish worth of treatment (estimate from an American neonatologist relative, we don’t see those numbers.) I was discharged 24 hrs after that to join her there.
It all cost us the price of hospital parking, since we had a car.
posted by warriorqueen at 10:01 AM on May 3, 2018 [12 favorites]
With my first child, I was still lying in my own gore and being monitored to see whether I would need a blood transfusion when a poor, poor young male staff person was sent in with a clipboard and booties so he wouldn’t track said gore anywhere for me to sign, and add a baby name to, to assign my daughter a health care number.
I will admit that was bizarre as experiences go. For my next two kids we did it calmly a few hrs after delivery but for her it was clear she was going to need her own card. She had been resuscitated and was clearly going to need a lot of care. She was transferred via space pod incubator and ambulance to Top NICU Hospital (Sick Kids) about 10 hrs later, received $600k-ish worth of treatment (estimate from an American neonatologist relative, we don’t see those numbers.) I was discharged 24 hrs after that to join her there.
It all cost us the price of hospital parking, since we had a car.
posted by warriorqueen at 10:01 AM on May 3, 2018 [12 favorites]
While the concept of in network and out of network has some degree of validity, it's clearly been turned into an extended exercise in gotcha with the express purpose of turning patients into victims of mugging via insurance policy.
There's really only one reasonable fix at this point, admit that the concept has been utterly and completely debased and what value it once had is long gone and pass a law mandating that all insurance is in network for all medical practitioners.
I've got a friend who is facing medical bills in the multiple hundreds of thousands of dollar range because she and her daughter were involved in an automobile accident in a rural area hundreds of miles from their homes and both were unconscious when they were medivacced out by helicopter to a regional hospital. Neither the medivac nor the hospital were in network for them. Even if they'd been conscious what should they have done? Refused airlift to a hospital and bled out while they called an Uber to drive them 6+ hours back to their hometown and a hospital in their insurance network?
The entire thing is horrifying.
the letter Pardon my ignorance, but how could this practice possibly hold up in court? A minor being involuntarily bound to an unknowable contract?
In the USA children as young as five are instructed to represent themselves at immigration court to save the government the cost of providing them with an attorney.
America has some really, truly, horribly, evil aspects.
posted by sotonohito at 10:23 AM on May 3, 2018 [20 favorites]
There's really only one reasonable fix at this point, admit that the concept has been utterly and completely debased and what value it once had is long gone and pass a law mandating that all insurance is in network for all medical practitioners.
I've got a friend who is facing medical bills in the multiple hundreds of thousands of dollar range because she and her daughter were involved in an automobile accident in a rural area hundreds of miles from their homes and both were unconscious when they were medivacced out by helicopter to a regional hospital. Neither the medivac nor the hospital were in network for them. Even if they'd been conscious what should they have done? Refused airlift to a hospital and bled out while they called an Uber to drive them 6+ hours back to their hometown and a hospital in their insurance network?
The entire thing is horrifying.
the letter Pardon my ignorance, but how could this practice possibly hold up in court? A minor being involuntarily bound to an unknowable contract?
In the USA children as young as five are instructed to represent themselves at immigration court to save the government the cost of providing them with an attorney.
America has some really, truly, horribly, evil aspects.
posted by sotonohito at 10:23 AM on May 3, 2018 [20 favorites]
Couldn't the newborn declare bankruptcy over the debt and be over it before he starts start the first grade?
posted by cosmic.osmo at 10:34 AM on May 3, 2018 [10 favorites]
posted by cosmic.osmo at 10:34 AM on May 3, 2018 [10 favorites]
I guess we were lucky in that our ob/gyn explained baby billing to us, our hospital explained baby billing to us, our benefits administrator explained baby billing to us, and our insurer sent us a letter when they got my ob/gyn's prenatal care bill explaining how to register the baby when it arrived, and when we called walked us through the process etc. etc.
It seems like the whole system has you all gaslit out the wazoo if this sounds lucky.
I remember seeing commercials for health insurance plans talking about how friendly/helpful their CSRs etc. were and how you could call a hotline for this or that and whatever and thinking "If I have any contact at all with my insurer direct or indirect (i.e. a doctor/hospital etc. brings up insurance) then they're doing something wrong." I don't want to hear that your CSRs are friendly or that everything was explained clearly or anything else. I don't want to call you or have you call me. I don't want to ever get any mail from you. Don't send me emails. Don't send my pamphlets. I don't ever want to go to your web site. Your job is to pay for my healthcare and be completely invisible while doing it.
If you need multiple to walk through your health insurance process with you, that means your health insurance system sucks, not that you're lucky.
I had a high-risk pregnancy involving multiple-specialists and a high-risk-specializing OB. I had a planned c-section. I walked into the hospital at the schedule time. They put a hospital bracelet on my wrist. I hunched over for the anesthesia, lied down, and they handed me a baby. Two days later I took my baby home. Nobody ever mentioned insurance and I didn't pay a penny (not even parking because I don't have a car). If I had spent any portion of my ob visits or hospital time talking about insurance, I would have felt put-out that anyone was bothering me with that crap, not lucky, that's for sure.
posted by If only I had a penguin... at 10:39 AM on May 3, 2018 [13 favorites]
It seems like the whole system has you all gaslit out the wazoo if this sounds lucky.
I remember seeing commercials for health insurance plans talking about how friendly/helpful their CSRs etc. were and how you could call a hotline for this or that and whatever and thinking "If I have any contact at all with my insurer direct or indirect (i.e. a doctor/hospital etc. brings up insurance) then they're doing something wrong." I don't want to hear that your CSRs are friendly or that everything was explained clearly or anything else. I don't want to call you or have you call me. I don't want to ever get any mail from you. Don't send me emails. Don't send my pamphlets. I don't ever want to go to your web site. Your job is to pay for my healthcare and be completely invisible while doing it.
If you need multiple to walk through your health insurance process with you, that means your health insurance system sucks, not that you're lucky.
I had a high-risk pregnancy involving multiple-specialists and a high-risk-specializing OB. I had a planned c-section. I walked into the hospital at the schedule time. They put a hospital bracelet on my wrist. I hunched over for the anesthesia, lied down, and they handed me a baby. Two days later I took my baby home. Nobody ever mentioned insurance and I didn't pay a penny (not even parking because I don't have a car). If I had spent any portion of my ob visits or hospital time talking about insurance, I would have felt put-out that anyone was bothering me with that crap, not lucky, that's for sure.
posted by If only I had a penguin... at 10:39 AM on May 3, 2018 [13 favorites]
> This is a thing that comes up from time to time for Canadians:
As a Canadian I react to these stories the same way I'd react to a horror movie, or maybe one of Roman Polanski's early films like Rosemary's Baby or The Tenant.
posted by The Card Cheat at 11:01 AM on May 3, 2018 [9 favorites]
As a Canadian I react to these stories the same way I'd react to a horror movie, or maybe one of Roman Polanski's early films like Rosemary's Baby or The Tenant.
posted by The Card Cheat at 11:01 AM on May 3, 2018 [9 favorites]
If you Canadians and other non-US-ians could stop pouring salt in our wounds, that'd be great. You know we can't afford the co-pay to get that treated.
posted by amanda at 11:04 AM on May 3, 2018 [17 favorites]
posted by amanda at 11:04 AM on May 3, 2018 [17 favorites]
I live in the US. I have 2 sisters. One just had a baby who had health complications and it was known in advance he would need special care immediately after birth. My other sister works in insurance and knows how it works.
Before my pregnant sister went to the hospital, my insurance sister was giving her information about what exactly to say and what questions to ask to make sure everything was billed properly. She came to the hospital to visit after the baby was born and again spent time advising the new mother about what to do to make sure everything was on the up-and-up.
It should have been just a celebration of new life, but instead we had to talk about a bunch of technical information so that my sister wasn't suddenly on the hook for 6 figures.
posted by Emmy Rae at 11:17 AM on May 3, 2018 [7 favorites]
Before my pregnant sister went to the hospital, my insurance sister was giving her information about what exactly to say and what questions to ask to make sure everything was billed properly. She came to the hospital to visit after the baby was born and again spent time advising the new mother about what to do to make sure everything was on the up-and-up.
It should have been just a celebration of new life, but instead we had to talk about a bunch of technical information so that my sister wasn't suddenly on the hook for 6 figures.
posted by Emmy Rae at 11:17 AM on May 3, 2018 [7 favorites]
"My kids were... an infant, a 2 year old, and a 3 year old at the time."
See, if you were part of the 1%, you would be paying your children from the time of conception at least a 6 figure CEO wage. They would probably have their own
subsidiary corporations at birth.
posted by BlueHorse at 11:39 AM on May 3, 2018
See, if you were part of the 1%, you would be paying your children from the time of conception at least a 6 figure CEO wage. They would probably have their own
subsidiary corporations at birth.
posted by BlueHorse at 11:39 AM on May 3, 2018
When my kiddo was born in November 2016, the cost billed to our insurer under her name was $39k. $36k of that alone was "accommodations," for 2 nights in tub next to me. (I too was billed $36k for accommodations, separately.) We do live in NYC, but seriously, even at city prices $18,000 as the going rate for a night in a plastic tub on top of a dresser seems a little high.
(To clarify: We did not actually pay that amount; that's what the hospital said the stay cost. There WAS some ridiculous crap with our insurer where they first said our responsibility was $31k, but that got straightened out ... eventually. Although we were still getting bills for that stay, like, 7 months post-birth.)
posted by alleycat01 at 12:02 PM on May 3, 2018 [3 favorites]
(To clarify: We did not actually pay that amount; that's what the hospital said the stay cost. There WAS some ridiculous crap with our insurer where they first said our responsibility was $31k, but that got straightened out ... eventually. Although we were still getting bills for that stay, like, 7 months post-birth.)
posted by alleycat01 at 12:02 PM on May 3, 2018 [3 favorites]
Pardon my ignorance, but how could this practice possibly hold up in court? A minor being involuntarily bound to an unknowable contract? Where can the consent come from?
The patient and "guarantor" are 2 separate things. THe patient is who was treated. THE guarantor is who is responsible for payment. For minors the guarantor is typically a parent or guardian. This would thus be their debt, not the baby's. Adults are usually their own guarantor and thus responsible for whatever their insurance doesn't pay with a few exceptions (like if someone legally took over your financial life and medical decision making i guess but i've never seen it). IF its a workman's comp issue or auto accident or a prisoner being brought in for care then the "guarantor" is still the adult, but rather than their health insurance it goes through whatever applicable liability insurance first.
posted by WeekendJen at 12:16 PM on May 3, 2018 [1 favorite]
The patient and "guarantor" are 2 separate things. THe patient is who was treated. THE guarantor is who is responsible for payment. For minors the guarantor is typically a parent or guardian. This would thus be their debt, not the baby's. Adults are usually their own guarantor and thus responsible for whatever their insurance doesn't pay with a few exceptions (like if someone legally took over your financial life and medical decision making i guess but i've never seen it). IF its a workman's comp issue or auto accident or a prisoner being brought in for care then the "guarantor" is still the adult, but rather than their health insurance it goes through whatever applicable liability insurance first.
posted by WeekendJen at 12:16 PM on May 3, 2018 [1 favorite]
I got the option to prepay the baby hospital expenses, and they set up a billing schedule at our first doctor pregnancy visit. How kind of them!
posted by The_Vegetables at 12:27 PM on May 3, 2018
posted by The_Vegetables at 12:27 PM on May 3, 2018
This is like Original Debt. How fitting.
posted by Sphinx at 12:57 PM on May 3, 2018 [5 favorites]
posted by Sphinx at 12:57 PM on May 3, 2018 [5 favorites]
odinsdream: "When I moved a few years ago and qualified for state-based ACA insurance, I had to prove that my kids didn't have an income.
My kids were... an infant, a 2 year old, and a 3 year old at the time."
I'm sure there are 2 nd 3 years old with significant incomes. Here in Canada we had to get our daughter a SIN at around age 3 in order to open her tax free education plan because the plan generates income in her name just like any other investment.
posted by Mitheral at 1:06 PM on May 3, 2018
My kids were... an infant, a 2 year old, and a 3 year old at the time."
I'm sure there are 2 nd 3 years old with significant incomes. Here in Canada we had to get our daughter a SIN at around age 3 in order to open her tax free education plan because the plan generates income in her name just like any other investment.
posted by Mitheral at 1:06 PM on May 3, 2018
I just had a baby here in New Zealand. I saw a midwife frequently throughout my pregnancy. I had multiple scans. At the very end my blood pressure jumped up so I was induced. It failed and I was sent home with close monitoring. Then I was induced again - successfully. I had multiple doctors and midwives see me in hospital. I used multiple medicatins. I stayed in hospital one night then went home (I’m a nurse and boy did I not want to stay in hospital longer than the absolute minimum). My midwife visited me at home every day for the first two weeks to monitor my blood pressure and to check on bubs. Then she started seeing me every 4-5 days until 6 weeks post partum. Now I take bubs to a well-child nurse for periodic checkups. These will continue until she’s 5 years old. This also comes with a free 24 hour healthline I can ring if I have weird 2am questions. She’s also been getting visits to the doc for checkups and immunizations. The doc wanted to double check her for hip dysplasia so she had an xray a couple weeks back. I also attended antenatal educational courses during my pregnancy. And I will attend well child courses on things like baby reflexes and starting solids in the near future.
All of this cost almost nothing. I made no phone calls other than to make appointments. I never saw a bill. I never talked to an administrator. The largest total cost was hospital parking. I also paid for one scan - it was thirty dollars. I was put on iron supplements during my pregnancy- it was six dollars.
America do better. What the fuck is the point of having all that money if you can’t use it for anything worth having? Healthcare in America is fucking bonkers. It’s like people there speak martian. I grew up there and I have no idea how I ever thought that state of affairs was normal. Oh wait I do know - I grew up poor and so had no insurance and so almost never interacted with the health system apart from absolute emergencies. Fucking hell man.
posted by supercrayon at 3:05 PM on May 3, 2018 [10 favorites]
All of this cost almost nothing. I made no phone calls other than to make appointments. I never saw a bill. I never talked to an administrator. The largest total cost was hospital parking. I also paid for one scan - it was thirty dollars. I was put on iron supplements during my pregnancy- it was six dollars.
America do better. What the fuck is the point of having all that money if you can’t use it for anything worth having? Healthcare in America is fucking bonkers. It’s like people there speak martian. I grew up there and I have no idea how I ever thought that state of affairs was normal. Oh wait I do know - I grew up poor and so had no insurance and so almost never interacted with the health system apart from absolute emergencies. Fucking hell man.
posted by supercrayon at 3:05 PM on May 3, 2018 [10 favorites]
When Kid Ruki was born, the mister had to spend hours of his life disputing my hospital bill because, you see, according to United Health, Womens' & Infants Hospital is an in-network provider, but Womens' and Infants Hospital is not.
posted by Ruki at 3:41 PM on May 3, 2018 [2 favorites]
posted by Ruki at 3:41 PM on May 3, 2018 [2 favorites]
Supercrayon, that matches my experience very closely, with the addition of a last minute emergency caesarean. I was walking out of the hospital with a new baby and I remember thinking 'wait a minute - shouldn't I pay someone something?'
NZ spends a little more than a third as much on health, per person, as the United States.
posted by Sebmojo at 4:43 PM on May 3, 2018 [1 favorite]
NZ spends a little more than a third as much on health, per person, as the United States.
posted by Sebmojo at 4:43 PM on May 3, 2018 [1 favorite]
This happened to us! In fact, the author of this piece reached out to me and asked me about my birth some time ago, and this was my number 1 complaint/surprise. It's total bullshit.
Luckily for us, our little baby qualified for Medicaid, which ended up covering literally everything that was billed to her, unlike my private health insurance which still left thousands for us to cover. Because my full-time, 60 hour week job requiring a doctorate degree that I use every day apparently still put us in a low enough income bracket for my dependant to be Medicaid eligible. Lol.
And what a joy it has been. Medicaid for All, Y'all. It is the best.
posted by likeatoaster at 5:08 PM on May 3, 2018 [3 favorites]
Luckily for us, our little baby qualified for Medicaid, which ended up covering literally everything that was billed to her, unlike my private health insurance which still left thousands for us to cover. Because my full-time, 60 hour week job requiring a doctorate degree that I use every day apparently still put us in a low enough income bracket for my dependant to be Medicaid eligible. Lol.
And what a joy it has been. Medicaid for All, Y'all. It is the best.
posted by likeatoaster at 5:08 PM on May 3, 2018 [3 favorites]
When our baby was born with a small heart defect and needed to see a pediatric cardiologist, there was a brief moment of very serious panic when we were initially told she wasn't covered by our insurance and potentially on the hook for untold $$$. Turns out that wasn't true; there was just a 30-day enrollment window for new births, and because she was only 11 days old she hadn't been put into the system yet (even though we had carefully registered her the same day of her grand entrance). Had it not been for the blessedly level-headed receptionist who corrected all the records after she saw us clutching our very tiny baby looking completely terrified, sleep-deprived, and blindsided, I have no idea how quickly we would have been able to resolve this. Healthcare in the US is insane.
posted by Diagonalize at 8:12 PM on May 3, 2018
posted by Diagonalize at 8:12 PM on May 3, 2018
The baby is billed for procedures done to it because billing follows the procedure and diagnosis codes attached to it, which are attached to the baby, because the baby is the patient.Yeah, that's crazy. You might not think it's crazy, but it is. The idea that a child can receive a bill for things that happen in the first days and weeks of its life is rediculous, no matter how much you've contorted your thinking to believe it's totally reasonable.
General rule of thumb: If the child can't talk yet, the bill needs to be in someone else's name.
America do better. What the fuck is the point of having all that money if you can’t use it for anything worth having? Healthcare in America is fucking bonkers. It’s like people there speak martian. I grew up there and I have no idea how I ever thought that state of affairs was normal.This is the correct response once you've gotten a little distance.
posted by krisjohn at 8:14 PM on May 3, 2018 [6 favorites]
When my twins were born six-weeks premature, they were billed almost $200k for their NICU stay, in addition to the ~$25k emergency c-section. My wife and I were both self-employed, and wouldn't have been able to afford insurance without the ACA. With a "silver" Obamacare plan, though, we paid less than $2k for the prenatal and postnatal care together.
posted by bradf at 8:19 PM on May 3, 2018 [2 favorites]
posted by bradf at 8:19 PM on May 3, 2018 [2 favorites]
i'm saying that we (societally in the US, not necessarily you and I) define personhood one way when it benefits a religious interest, and another when it benefits a capitalist one.
There are many examples that I could understand this sentiment being applied to, but I don't see how this is one of them. If anything, personhood beginning at conception, and a newborn being an independant entity to its parents to be billed seperately, are totally consistent views. Not mutually exclusive like you seemed to suggest.
posted by windykites at 8:34 PM on May 3, 2018
There are many examples that I could understand this sentiment being applied to, but I don't see how this is one of them. If anything, personhood beginning at conception, and a newborn being an independant entity to its parents to be billed seperately, are totally consistent views. Not mutually exclusive like you seemed to suggest.
posted by windykites at 8:34 PM on May 3, 2018
Well, if personhood begins at conception, then pre-natal care should be billed to the prospective infant as well, not just starting after birth. That's the inconsistency.
posted by Karmakaze at 10:11 AM on May 4, 2018
posted by Karmakaze at 10:11 AM on May 4, 2018
pre-natal care should be billed to the prospective infant
That doesn't follow. Pre-natal care is care applied to the pregnant mother, unless it's e.g. an in-utero operation on the unborn baby. It's not typically a procedure on the baby.
posted by windykites at 10:57 AM on May 4, 2018
That doesn't follow. Pre-natal care is care applied to the pregnant mother, unless it's e.g. an in-utero operation on the unborn baby. It's not typically a procedure on the baby.
posted by windykites at 10:57 AM on May 4, 2018
Yeah, that's crazy. You might not think it's crazy, but it is. The idea that a child can receive a bill for things that happen in the first days and weeks of its life is rediculous, no matter how much you've contorted your thinking to believe it's totally reasonable.
Again, it is not at all crazy, because the child is a patient. Do you not think the child is a separate person from the mother? With separate medical issues? Like I said, this is a separate issue from the insane health care prices and insurance practices in this country, but it is crazy to think that a child should have its healthcare tied to anyone but themselves because that child is its own person.
You probably don't work in healthcare and don't understand how this works, which is okay, most people don't. It works like this: Your baby is born. Your baby has a number of procedures done to it, even if it is a healthy child. Why on earth would those procedures be listed under the mother's (or anyone else's, who do you think it ought to be listed under?) healthcare record? If you are a provider and need to know the medical history of some child, you have to be able to access that child's medical history. Not only does that make sense, but any other way would be a huge HIPPA violation. If your child ended up in foster care, any other way of doing things would result in unattainable medical information. An H&P note starts the medical record of a person, and all subsequent notes are recorded under that patient to follow them for the rest of their life. Their bloodspot screen. Their hearing screen. Their apgar scores. Their discharge from the hospital. In difficult cases, all of their other newborn procedures. The record of care is attached to that person and this is appropriate. You don't list procedures done to a dependent under any other person's care. That would be a crazy way to track medical care and it would have disastrous results, as well as being hugely unethical.
Billing someone for care provided to a different person is a terrible and unethical idea, and would lead to way more problems than we already have.
I see a lot of kids who don't go home with their birth mothers. If billing were assessed to their birth mothers 1) we'd lose their medical records necessary to appropriately inform foster parents and to inform their healthcare for the rest of their lives; 2) would saddle their birth mothers with their infant's bills which would devastate them even more; 3) it would make no sense.
Most health insurance policies in this country take all of this into account.
Healthcare is super broken in this country, but this is not the problem.
posted by Lutoslawski at 8:08 PM on May 4, 2018 [2 favorites]
Again, it is not at all crazy, because the child is a patient. Do you not think the child is a separate person from the mother? With separate medical issues? Like I said, this is a separate issue from the insane health care prices and insurance practices in this country, but it is crazy to think that a child should have its healthcare tied to anyone but themselves because that child is its own person.
You probably don't work in healthcare and don't understand how this works, which is okay, most people don't. It works like this: Your baby is born. Your baby has a number of procedures done to it, even if it is a healthy child. Why on earth would those procedures be listed under the mother's (or anyone else's, who do you think it ought to be listed under?) healthcare record? If you are a provider and need to know the medical history of some child, you have to be able to access that child's medical history. Not only does that make sense, but any other way would be a huge HIPPA violation. If your child ended up in foster care, any other way of doing things would result in unattainable medical information. An H&P note starts the medical record of a person, and all subsequent notes are recorded under that patient to follow them for the rest of their life. Their bloodspot screen. Their hearing screen. Their apgar scores. Their discharge from the hospital. In difficult cases, all of their other newborn procedures. The record of care is attached to that person and this is appropriate. You don't list procedures done to a dependent under any other person's care. That would be a crazy way to track medical care and it would have disastrous results, as well as being hugely unethical.
Billing someone for care provided to a different person is a terrible and unethical idea, and would lead to way more problems than we already have.
I see a lot of kids who don't go home with their birth mothers. If billing were assessed to their birth mothers 1) we'd lose their medical records necessary to appropriately inform foster parents and to inform their healthcare for the rest of their lives; 2) would saddle their birth mothers with their infant's bills which would devastate them even more; 3) it would make no sense.
Most health insurance policies in this country take all of this into account.
Healthcare is super broken in this country, but this is not the problem.
posted by Lutoslawski at 8:08 PM on May 4, 2018 [2 favorites]
If anyone is going to get a bill for healthcare (which I agree with everyone, no one should) then every individual person has to have their own records, insurance number, and codes for the services they individually received. I didn't spend the night in the NICU, my baby did. It would look pretty weird if I had a bunch of codes in my record indicating that I was given x ml of formula and received y heelsticks. I didn't.
I have been lucky to have good insurance and I never saw a single bill for my prenatal care or delivery. But as soon as my kid was out, he had his own insurance number by dint of being my dependent and me having just changed to a family health care plan (I had 30 days after the birth to finalize this and get a copy of his birth certificate to my insurer--I had a binder full of various papers to be signed by various doctors and sent to various people to do various things that meant I got paid while on maternity leave and I didn't get billed for having an uninsured dependent). It's not like when he goes to the doctor he gets shit mailed to him in his name expecting him to pay his copay out of his little kindergarten bank account. He's my minor dependent, I'm the primary insured, it all comes to me and I am the financially responsible party. I'm the name on the billing statement, but he's the patient. A lot of shit does not make sense in our health care system, but this makes complete sense to me.
posted by soren_lorensen at 8:37 PM on May 4, 2018 [2 favorites]
I have been lucky to have good insurance and I never saw a single bill for my prenatal care or delivery. But as soon as my kid was out, he had his own insurance number by dint of being my dependent and me having just changed to a family health care plan (I had 30 days after the birth to finalize this and get a copy of his birth certificate to my insurer--I had a binder full of various papers to be signed by various doctors and sent to various people to do various things that meant I got paid while on maternity leave and I didn't get billed for having an uninsured dependent). It's not like when he goes to the doctor he gets shit mailed to him in his name expecting him to pay his copay out of his little kindergarten bank account. He's my minor dependent, I'm the primary insured, it all comes to me and I am the financially responsible party. I'm the name on the billing statement, but he's the patient. A lot of shit does not make sense in our health care system, but this makes complete sense to me.
posted by soren_lorensen at 8:37 PM on May 4, 2018 [2 favorites]
For those who are saying this system makes sense, I would like to ask: who gets billed in the edge cases and why? When the infant is partially delivered, for example, and something goes wrong, or before the umbilical cord is cut, what happens? Do they get to double-bill for cutting the cord? What logic is there to billing codes in these circumstances, beyond common law/profit motive? At what can anyone raised outside of this baffling system grasp to gain this insight? Most of the rest of the world appears to have this problem solved without need for this byzantine overlay to protect patient health records.
A further example of this is how the building also gets paid, typically via separate invoice. In this case, the facility gets its money twice, too, doesn't it, because of the introduction of a new person? Does the author of the article mention receiving this separate bill for the infant that is standard operating procedure in the US? Perhaps they'll get it some months down the line, and we'll get a follow-up!
I appreciate the discourse, it's informative of the narrative of how health systems operate in at least one place that could afford a universal system and opts not to, and to the methods employed to limit that coverage. Billing codes and health records need not be cemented together.
posted by the letter at 6:49 PM on May 5, 2018
A further example of this is how the building also gets paid, typically via separate invoice. In this case, the facility gets its money twice, too, doesn't it, because of the introduction of a new person? Does the author of the article mention receiving this separate bill for the infant that is standard operating procedure in the US? Perhaps they'll get it some months down the line, and we'll get a follow-up!
I appreciate the discourse, it's informative of the narrative of how health systems operate in at least one place that could afford a universal system and opts not to, and to the methods employed to limit that coverage. Billing codes and health records need not be cemented together.
posted by the letter at 6:49 PM on May 5, 2018
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posted by thelonius at 6:19 AM on May 3, 2018 [1 favorite]