The Cost of Bringing Up Baby
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According to the Health Insurance Association of America, the average bill for doctors' fees and hospital charges runs around $6,400 for a normal delivery and roughly $10,600 for a cesarean section -- and that's not even counting prenatal doctor's visits or such common (but costly) tests as ultrasound and amniocentesis. If you're among the 75 percent of privately insured Americans who belong to a managed-care plan, and your obstetrician is a member of the plan's network of doctors, breathe a deep sigh of relief right now. Besides the standard $5 to $15 copayment due at your prenatal visits, you probably won't have to shell out another dime. Most managed-care plans cover virtually all medical costs associated with pregnancy and delivery. "Maternity is one of the things managed care does best," says Erin Carlson, a librarian with the American Association of Health Plans, in Washington, DC.
If you've signed up with an out-of-network doctor or are enrolled in a traditional indemnity plan, prepare for your pocket to be pinched. Yes, you'll likely be reimbursed for the lion's share of your expenses (typically 80 percent of your obstetrician's fees and 100 percent of the cost of your hospital stay). But whereas insurance companies ordinarily pay these bills after you deliver the baby, many obstetricians want their money up front or on a pay-as-you-go basis.
If your practitioner is among them, you may be able to negotiate more wallet-friendly terms by simply asking the doctor to accept the difference between what she charges and what your insurance will reimburse, rather than the full amount. You can then work out a reasonable payment plan with your physician's billing office.
But while you obviously don't want your out-of-pocket costs to be any higher than necessary, don't choose your medical plan on price alone. "During open-enrollment season, many people simply go with the lowest-cost option," says Barry Barnett, a principal with Kwasha Lipton, a benefits consulting firm. "Then they spend the next year cursing the constraints put on them."
If you're opting for managed care, for instance, find out whether you're comfortable with the obstetricians and pediatricians in the network and if the hospital where you want to deliver is part of the plan as well. No matter what kind of insurance you have, you'll also need to find out whether tests such as ultrasound and amniocentesis are covered and how long a hospital stay will be covered. Go with the plan that's most likely to allow you to have the pregnancy and childbirth experience you want, even if it costs a bit more.