Stella
Apo Osae-Cwum and her husband did everything by the book. They went to a
hospital covered by insurance, saw an obstetrician in their plan, but
when her three sons – triplets – were born prematurely, bills started
rolling in.
The hospital charged her family $877,000 in total.
“When
the bills started coming, to be very honest, I was an emotional wreck,”
said Apo Osae-Cwum. “And this is in the midst of trying to take care of
three babies who were premature.”
America is the most expensive
nation in the world to give birth. When things go wrong – from
pre-eclampsia to premature birth – costs can quickly spiral into the
hundreds of thousands of dollars. While the data is limited, experts in
medical debt say the costs of childbirth factor into thousands of family
bankruptcies in America each year.
It’s nearly impossible to put a
price tag on giving birth in America, since costs vary dramatically by
state and hospital. But one 2013 study by the advocacy group Childbirth
Connection found that, on average, hospitals charged $32,093 for an
uncomplicated birth and newborn care, and $51,125 for a standard
caesarean section and newborn care. Insurance typically covers a large
chunk of those costs, but families are still often on the hook for
thousands of dollars.
Another estimate from the International
Federation of Health Plans put average charges for normal birth in the
US at $10,808 in 2015, but that estimate excludes newborn care and other
related medical services. That is quintuple the IFHP estimate for
another industrialised nation, Spain, where it costs $1,950 to deliver a
child, and the cost is covered by the government.
Even the luxurious
accommodations provided to the Duchess of Cambridge for the birth of
the royal family’s daughter Princess Charlotte – believed to have cost
up to $18,000 – were cheaper than many average births in America.
Despite
these high costs, the US consistently ranks poorly in health outcomes
for mothers and infants. The US rate of infant mortality is 6.1 for
every 1,000 live births, higher than Slovakia and Hungary, and nearly
three times the rate of Japan and Finland. The US also has the worst
rate of maternal mortality in the developed world. That means America is
simultaneously the most expensive and one of the riskiest
industrialised nations in which to have children.
American families
rarely shoulder the full costs of childbirth on their own – but still
pay far more than in other industrialised nations. Nearly half of
American mothers are covered by Medicaid, a programme available to low
income households that covers nearly all birth costs. But people with
private insurance still regularly pay thousands of dollars in co-pays,
deductibles and partially reimbursed services when they give birth.
Childbirth Connection put the average out of pocket childbirth costs for
mothers with insurance at $3,400 in 2013.
In Apo Osae-Cwum’s case, private insurance covered most of the $877,000 bill, but her family was responsible for $51,000.
Apo
Osae-Cwum was the victim of what is called “surprise billing”. In these
cases, patients have no way of knowing whether an ambulance company,
emergency room physician, anesthesiologist – or, in her case, a half
dozen neonatologists – are members of the patient’s insurance plan.
Even
though Apo Osae-Cwum went to a hospital covered by her insurance, none
of the neonatologists who attended to her sons were “in-network”.
Therefore the insurance reimbursed far less of their bills.
There are
few studies that estimate the number of families who go bankrupt from
this type of unexpected expense. One of the best estimates is now
outdated – conducted 10 years ago. But one of the authors of that
research, Dr Steffie Woolhandler, estimates as many as 56,000 families
each year still go bankrupt from adding a new family member through
birth or adoption.
“Why any society should let anyone be bankrupted
by medical bills is beyond me, frankly,” said Woolhandler. “It just
doesn’t happen in other western democracies.”
Since Woolhandler
conducted that research in 2007, 20mn Americans gained health insurance
through the Affordable Care Act health reform law, and consumer
protections were added for pregnant women. But Republicans and the Trump
administration have pledged to repeal these consumer protections.
“People
face a double whammy when they’re faced with a medical condition,” said
Woolhandler. Bankruptcy is often, “the combined effect of medical bills
and the need to take time off work”.
There is no nationwide law that provides paid family leave in the US, meaning most families forego income to have a child.
And
although childbirth is one of the most common hospital procedures in
the nation, prices are completely opaque. That means Americans don’t
know how much a birth will cost in advance.
Dr Renee Hsia, an
emergency department physician at the University of California San
Francisco and a health policy expert likened the experience to buying a
car, but not knowing whether the dealership sells Fords or Lamborghinis.
“You don’t know, are you going to have a complication that is a lot
more expensive? And is it going to be financially ruinous?”
According
to Hsia’s 2013 study, a “California woman could be charged as little as
$3,296 or as much as $37,227 for a normal delivery, and $8,312 to
$70,908 for a caesarean section, depending on which hospital she was
admitted to.”
Apo Osae-Cwum and her family only found relief after a
professional medical billing advocate agreed to take their case. Medical
Cost Advocate in New Jersey, where Derek Fitteron is CEO, negotiated
with doctors to lower the charges to $1,300.
“This is why people are
scared to go to the doctor, why they go bankrupt, and why they forego
other things to get care from their kids,” said Hsia. “I find it
heartbreaking when patients say… ‘How much does this cost?’”
According to a 2013 study, in America, on average, hospitals charge $32,093 for an uncomplicated birth and newborn care.