I've been combing through the data and something jumped out at me: While there's a wide variation in the bills that new parents paid, several of you paid very little for your labor and delivery.
Two moms I spoke with paid just $250 for their entire birth. That cost was written into their plan, so they knew what their bill would be before they ever got pregnant.
What's the secret, you ask? No, they're not giving birth in bargain basement hospitals. Rather, they get their health insurance through an HMO, a health maintenance organization. And setting a fixed price for childbirth is standard practice among HMOs.
HMO vs. PPO
I've only had insurance coverage through a Preferred Provider Organization, or PPO, so these relatively low bills surprised me. But they didn't surprise Gerald Kominski, director of the UCLA Center for Health Policy Research.
He says these bills are a result of how these different types of plans are structured:
- People in HMO plans have a narrower network of doctors and hospitals to choose from. This is one way that the plans keep out-of-pocket costs lower for consumers.
- People in PPO plans have a broader network of doctors and facilities to choose from, but they pay for this level of choice: They're responsible for a greater share of medical expenses.
When people choose an HMO, they're "accepting restriction and limited choice of provider, in exchange for the safety of knowing how much it's going to cost me," says Shana Charles, an assistant professor at California State University, Fullerton.
Charles has intimate knowledge of that trade-off: She gave birth to two children while covered by a Kaiser HMO. She says that in exchange for an affordable childbirth bill, she and other Kaiser members give up things like:
- The opportunity to give birth at other area hospitals with great reputations, like UCLA and Cedars-Sinai;
- The convenience of giving birth at a facility near home. Kaiser members can only go to Kaiser hospitals.
That leads to another thing that Charles says she and other women might give up: The chance to get 3-D ultrasounds. Charles says that while they are very cool, Kaiser deemed them to be medically unnecessary.
Besides the certainty regarding cost, another positive aspect of giving birth through an HMO is that "the HMO is not motivated to order unnecessary tests because there is no financial incentive for them to order more tests for women than are necessary," says Claire Brindis, professor of pediatrics and obstetrics at UC San Francisco. "But at the same time, the HMO is under reporting guidelines that really focus on the quality of care that is being provided through that hospital."
'I didn't regret the birth experience'
I was curious to know whether the PriceCheck participants who gave birth while covered by an HMO thought they’d made the right choice. Did they think they’d compromised quality or convenience in exchange for an affordable bill?
Erin Senge, 34, was enrolled in Kaiser through her job for her first two pregnancies. At that time, she says she paid monthly premiums of $46; in exchange, she knew she'd be charged a $250 hospital admittance fee when she gave birth.
Looking back, she admits that she felt locked into having a hospital birth. She says she wanted a more natural experience - like a birthing center or the help of a doula – but "the Kaiser insurance wouldn't cover anything that was outside of its scope of care."
During the birth itself, she recalls that she wanted fewer medical interventions. She didn't want routine fetal heart monitoring, because she was worried it would require her to be stuck in a hospital bed. But she was monitored the whole time for both births.
Still, "in the end, I didn't regret the birth experience that I had," Senge says. "I wouldn't have wanted to go into debt just to have those other experiences."
Lara Ratzlaff, 36, has an Anthem Blue Cross HMO plan through her husband's employer. She and her husband pay $334 to cover themselves and their two children. Ratzlaff also knew that her entire birthing experience – being admitted, labor and delivery, her hospital stay and any anesthesia – would cost $250.
For Ratzlaff, that low cost came with some mandatory homework.
Under her plan, she says, she has to carefully choose a primary care provider, which would in turn place her in a medical group with particular specialists and facilities. She realized that she had to leave a primary care doctor she really liked, and choose a new one, to give birth under the supervision of a specific obstetrician who would perform a VBAC – a vaginal birth after cesarean – at the facility the OB preferred.
"That part was a little stressful because you had to do it before you had been diagnosed as pregnant," Ratzlaff says. "Once you're diagnosed as pregnant, you're stuck in the group that you're in, because they're taking on the risk and cost of the pregnancy."
Overall, "I was happy with my care the whole way through – I liked my OB, I was really happy with the hospital," she says. Ratzlaff notes that her insurance also wouldn't cover a doula, so she paid for that service out of pocket.
If you're pregnant and have a PPO plan, it's important to ensure that all the care you receive during your delivery is from in-network providers; "that's the best protection you have against getting hit with a surprise bill," Kominski of UCLA says.
HMO patients, he adds, "don't need to worry about these things."
But as always, cost is just one element of the health care experience. For others, the freedom to have more choice in selecting doctors, specialists, facilities and procedures is worth the price tag.