High Costs after Routine, Healthy Birth? How to Investigate Hospital Charges


By now, most Americans know that hospitals and other medical providers make billing mistakes and include hidden fees. Depending on the type of insurance you have, you may rarely question a bill if the majority is paid for you. Some families, even with robust insurance coverage, experience unexpected high hospital bills after childbirth, even with a routine and healthy birth.

In a recent investigation, NPR found that questionable billing hospital billing practices are often to blame for these costs. What they found will make you want to take a second (and third look) at your hospital bill, and possibly make a few phone calls.

In their “Bill of the Month” segment, NPR talked with a family from Fort Collins, CO, who received an unusually high hospital bill after the birth of their second son, which was a routine, non-emergency birth. At the same hospital and with the same insurance just four years earlier for a very similar birth, they paid only $30 out of pocket. This time, their bill amounted to $3,609.09. After an investigation, NPR found that the hospital upcoded their visit to a “Level 5” emergency services use because they first went to the emergency room. Here’s the kicker: this family only entered through the emergency room (as instructed due to Covid policies), but went straight to labor and delivery without so much as the use of a wheelchair! Even if this family had received emergency department labor triage services (checking dilation, IV antibiotics, etc.), those are all considered routine, non-emergency procedures. 

NPR found that in recent years, hospitals have begun billing what are known as “OB-ED” charges for anyone using hospital services during pregnancy as a way to collect additional revenue, even if the procedures were not performed in the emergency department.

If you find yourself in a similar situation after receiving your hospital childbirth bill, it’s worth looking very closely at your bill. NPR advises taking the following steps for avoiding unexpected charges and disputing charges:

1. Call your hospital in advance of your birth to ask if they charge OB-ED fees and how it will affect your bill. Ask your hospital how much your birth is expected to cost. Document your call and get the name of who you spoke with. 

2. Call your insurance in advance of our birth to find out how much your birth is expected to cost. Document your call and get the name of who you spoke with. 

3. If, during your labor and birth, you need an ER encounter, look at your bill to see how it was coded. It will be coded from Level 1 to 5. If your visit was misrepresented, call your hospital to dispute the charge. Ask, “Was my bill upcoded?” NPR links to a helpful chart for the description of each level. Be prepared to make several phone calls. 

4. Remain calm, confident, and steadfast. It may take you many calls and hours on the phone, but you can win and get a charge removed. Document all calls and details. Gather as much information and data as you can to back up your dispute.


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