Medical
Turns out it's advisable to get medical care to grow and birth a baby. I had 14 pre-baby checkups with my OB for baby #1 (and 2 post-baby visits), and the same for baby #2. Then there are dozens of blood/urine tests, a few ultrasounds, and a several day (if you're lucky) stay at the hospital.
Then, once the baby is born, there are well visits - we had 7 well visits (typically covered 100% by insurance) and one sick visit in baby #1's first year (and 0 sick visits for baby #2). We also paid additional insurance premiums to add him to our health insurance plan.
Prenatal vitamins and birthing/breastfeeding classes are also recommended.
All of that stuff costs $$. How much? Due to the complicated nature of insurance, it's really quite hard to estimate, even from one uncomplicated pregnancy to the next.
Overall, we spent money in these categories (out of pocket):
| Category | Baby #1 | Baby #2 | Average |
|---|---|---|---|
| Medical Services for Mom | $1,739 | $3,832 | $2,785 |
| Medical Services for Baby | $394 | $319 | $357 |
| Insurance Premiums | $1,040 | $0 | $520 |
| Vitamins | $125 | $37 | $81 |
| Classes | $115 | $0 | $58 |
| Misc | $14 | $11 | $13 |
| Total | $3,427 | $4,199 | $3,813 |
Disclaimer
Obviously, this varies a lot across regions, circumstances (C-section? Epidural? Twins?), and health insurances, so this is just a snapshot of what we paid for "having the baby", as well as the baby's medical needs in his first year. Note that this doesn't include over the counter items like Tylenol and saline spray (covered in the Baby Gear article), but would include prescription drugs if necessary.
Here are some details for our insurance:
| Baby | Deductible (Individual) | Deductible (Family) | Copay after Deductible | In-network out-of-pocket max (individual / family) |
|---|---|---|---|---|
| #1 (Aug 2019) | $1,350 | $2,700 | 10% | $2,600 / $5,200 |
| #2 (Aug 2021) | $1,400 | $2,800 | 10% | $2,600 / $5,200 |
We pay 10% of our costs over the deductible, up to an out-of-pocket max of $2,800/$5,600 - assuming in-network. Note that baby #1 was on my husband's insurance in the year that baby #2 came, so both pregnancies occurred on an individual plan and converted to family once baby came for the rest of the year.
Medical Services
Most of the expenses of having a baby come from seeing doctors and performing tests that they order, as well as care in the hospital. I gave birth in a hospital - obviously this would differ with a home birth. These expenses can be divided into 2 categories:
- Care for mom
- Care for baby
Care for mom
I have medical bills from two babies, born 2 years apart in Aug 2019 and Aug 2021. The cost after insurance discounts differs a little bit (~$19,900 for baby #1 and ~$13,000 for baby #2), as did our cost: $1,740 for baby #1 and $3,832 for baby #2.
An overview (all numbers include cost after insurance discounts, but are not our actual cost because insurance paid for quite a bit):
| Category | Cost | Notes |
|---|---|---|
| Pre-birth expenses (bloodwork, ultrasounds, vitamins) | $500-1,000 | Covered by insurance but we ended up paying some until we hit our deductible. I had 2 ultrasounds per baby and a bunch of blood work (a lot was covered as preventative so not subject to deductible but not all). Note that if your pregnancy doesn't take place within a single calendar year, this is probably all you'll need to pay in the first calendar year. The biggest variable here is the cell-free fetal DNA test (see more in this section). |
| OB Care (Regular Visits + Delivery) | $3,200-$3,500 | This is typically billed +/- a day or two of baby's birthday, even though you've been going to the doctor for ~9 months. Typically, the first visit (there's a baby in there, yay!) is billed separately, but every other visit is lumped into this number. |
| Hospital (for Mom) | $7,300 - $11,000 | This varied between babies because of the length of stay (2 nights vs. 3 nights) as well as whether I got an epidural ($1,200 more). Note that because we checked into the hospital the day before baby was born, this was charged to the "mom only" insurance plan, not the "mom + child(ren)" plan. |
Following is the nitty gritty of every expense billed for each baby.
Baby #1 - Born Aug 2019
| Item | Billed | Insurance Discount | Cost after Insurance Discounts | Insurance Paid | Our Cost | Notes |
|---|---|---|---|---|---|---|
| 8 week ultrasound | $196.00 | $0.00 | $196.00 | $0.00 | $196.00 | Baby has a heartbeat! But looks like a gummy bear... |
| Blood and other tests | $1,679.00 | $1,580.11 | $98.89 | $57.07 | $53.58 | Pap smear, CBC, antibody tests, blood typing, etc. |
| Blood and other tests | $857.11 | $719.07 | $138.04 | $117.78 | $20.26 | STD testing, etc. |
| Cell-free fetal DNA tests | $8,246.42 | $4,050.00 | $4,196.42 | $1,472.58 | $99.00 | See rant below. We were billed $2,727.42 but paid $99. |
| Blood test | $76.00 | $57.34 | $18.66 | $18.66 | $0.00 | Alpha-fetoprotein test |
| 20 week ultrasound | $226.00 | $0.00 | $226.00 | $226.00 | $0.00 | So fun to see baby moving around and actually looking like a baby |
| OB Care (First OB) | $735.00 | $13.19 | $721.81 | $721.81 | $0.00 | We switched OB practices mid-pregnancy, so this is the cost of the doctor visits, but not delivery. |
| Blood test | $275.00 | $261.41 | $13.59 | $13.59 | $0.00 | Gestational diabetes |
| OB Care (Second OB) | $1,350.00 | $147.16 | $1,202.84 | $1,202.84 | $0.00 | We switched OB practices mid-pregnancy, so this is the cost of the doctor visits from Jun-Aug, but not delivery. |
| Urine test | $72.00 | $57.41 | $14.59 | $14.59 | $0.00 | |
| Urine test | $72.00 | $66.91 | $5.09 | $5.09 | $0.00 | |
| TDAP vaccine | $140.00 | $55.92 | $84.08 | $84.58 | $0.00 | Covered 100% preventative |
| Hospital stay | $16,901.70 | $6,659.70 | $10,242.00 | $10,242.00 | $0.00 | We had already hit our OOP max due to cell-free fetal DNA test bill (see rant below). 3 days in the hospital. |
| Epidural at hospital | $7,770.00 | $6,570.00 | $1,200.00 | $1,200.00 | $0.00 | |
| OB Care - Delivery | $2,400.00 | $849.79 | $1,550.21 | $180.19 | $1,370.02 | Cost of OB services during delivery |
| Total | $40,996 | $21,088 | $19,908 | $15,557 | $1,739 |
Cell-free fetal DNA tests
There is a blood test that is often done in the late 1st trimester/early 2nd trimester, called cell-free fetal DNA or NIPT (non-invasive prenatal testing). It screens for certain chromosomal abnormalities in the baby, like Down's syndrome, trisomy 13, and trisomy 18 (and the baby's sex, since they're in there looking at the genes anyway). We had two different OBs, who both recommended getting the (optional) test, even though neither pregnancy was high risk. They stated it would help give the proper care/expectations if anything was abnormal, but said we could opt-out if we wanted.
Given that it's an optional, potentially expensive test, we tried to weigh the cost with the benefits of having the additional information. Naturally, I reached out to my insurance company, who said that it might be covered, but that they would need the doctor's office to call and answer a few questions to confirm. We asked the doctor's office to do so, but they said they don't do that for this test, and said something like "90+% of people don't ever see a bill, and the ones that do pay <$200, and if yours is more, call this represenative and they'll reduce it for you".
This was an incredibly dissatisfying answer. Is it covered, or not? How much will it cost? Is it in or out of network? This should be completely answerable - the test is straightforward (blood draw and a standard panel of tests). There aren't variables like "well, when we tried to repair your heart 3 other things went wrong and we had to give you some extra blood and anesthesia and you needed to spend 3 extra days in the hospital so that costs more". None of that uncertainty applies here, and this is a test being recommended to hundreds of thousands of pregnant women each year.
It's not that we don't mind paying for the test - a small monetary trade-off for better care for our baby and peace of mind are certainly worthwhile. We decided to do the test, because the financial burden on our family if the billing was unfavorable was manageable. This is a luxury for us, but not all families. Still - being stuck with an unexpected $3,000 bill is not something we wished for. If we knew ahead of time that the test would be $3,000, we would not have done it.
The test was performed in Feb 2019. Our HSA account auto-populated some claims:
| Item | Billed | Insurance Discount | Insurance Paid | Our Cost |
|---|---|---|---|---|
| Automated RBC Count | $12.42 | $0 | $0 | $12.42 |
| Hemoglobin Electrophoresis | $750 | $0 | $750 | $0 |
| Code 81420 | $7,500 | $4,050 | $722.58 | $2,727 |
It looks like it was out-of-network. The baby came in Aug 2019, and we received bills for the delivery and OB care, but nothing for the cell-free fetal DNA test 6 months prior. We thought, "great, we're part of the 90%".
Then, in October 2021, MORE THAN 2.5 YEARS after the test was performed, we received a bill in the mail from Progenity. It said "there is a balance due in the amount of $2,742.42", please go to this website to pay it.
Like all medical bills, it does not have a due date (WHY??? Bills should have due dates...) After logging in, it states that the insurance company made an adjustment and payment in March 2019 (a reasonable time to pay for a Feb 2019 bill), and that the remainder of ~$2,700 is now due (Oct 2021).
In my mom's group on Facebook, there is a thread with 6+ other women who got bills like this. Progenity also agreed to pay a settlement to Medicaid and the VA due to fradulent billing codes and illegal kickbacks to physicians, so there's definitely something fishy going on here.
I emailed my OBGYN who ordered the test, and they left me a voicemail to the effect of "don't worry about that bill; you don't have to pay it; they won't send it to collections". WHAT?!?!? I can't just ignore a $2,700 bill, can I? How is this a normal thing!!
So... I ignored the bill for a few months, but they sent another one. I called the OBGYN's office and the conversation went something like this:
- Me: I have this bill from Progenity and I have some questions. Someone from your office told me I don't have to pay it but they keep sending me bills.
- Receptionist: Oh, yeah, you have to pay that.
- Me: Oh, well it's $2,700 and it's from 3 years ago.
- Receptionist: Ohhhhhhh. Ummmm, you shouldn't have to pay more than the contracted rate.
- Me: I don't know what the contracted rate is <explains situation about being told we probably wouldn't get a bill>. Do you have a contact for them?
- Receptionist: Oh, we don't work with them anymore. But we did have a contracted rate for $199 or $249.
So... I login to my Progenity Bill Pay account to find the Dispute number, prepared to spend no more than $249. I steel myself to call (after finally remembering during business hours), and.... I wait on hold for 50 minutes after which they tell me to leave a voicemail and they'll call me back. I wait a week or two, but don't get a call back, so I tried to call again. This time, I talked to a lady named Sheila:
- Me: I got a bill for a service that was performed 3 years ago.
- Sheila: We stopped doing genetic testing last year. We did an audit and we realized we forgot to bill some people. This bill is for your unmet deductible and co-insurance. Because this bill is so late, we're willing to settle the account for $99.
- Me: Ummm okay? Can you put it in writing?
- Sheila: Pay the $99 today and we'll mail you a zero-balance statement in like a month.
- Me: Ummm okay?
Note: After 3 months, I checked the portal and it shows "Account Balance: $18,512.42. Please Pay: $0.00". I think that means we're good? I see the payment and an "administrative credit".
An interesting side-effect is that, due to this bill, the insurance company assumed I was paying a large amount of out-of-network costs (~$2,700), such that I hit my out-of-pocket max. Therefore, any in-network care between March and August, before my plan changed from an individual plan to a family plan (on baby's birthday), was completely free to me. The 10% coinsurance cost to me of these bills would have been $1,256, so doing this test "saved" a chunk of $$. After accounting for the $99 we paid Progenity, this whole billing fiasco saved us $1,157.
Baby #2 - Born Aug 2021
| Item | Billed | Insurance Discount | Cost after Insurance Discounts | Insurance Paid | Our Cost | Notes |
|---|---|---|---|---|---|---|
| Initial visit | $570.00 | $269.12 | $300.88 | $0 | $300.88 | |
| Pap smear and other tests | $1,560.00 | $1,355.33 | $204.67 | $0 | $204.67 | STD testing, etc. |
| Cell-free fetal DNA test | $1,100.00 | $455.00 | $645.00 | $0 | $645.00 | |
| Blood tests | $1,245.00 | $1,144.42 | $100.58 | $45.63 | $54.95 | Antibody tests, etc. Some of these tests were covered as 100% preventative care, and others weren't |
| 12 week ultrasound | $292.00 | $113.14 | $178.86 | $0 | $178.86 | |
| Blood test | $99.00 | $88.48 | $10.52 | $0 | $10.52 | Alpha-fetoprotein test |
| 20 week ultrasound | $315.00 | $107.95 | $207.05 | $181.74 | $25.31 | Hit our deductible here, so things are going to 10% instead of 100%. |
| Blood test | $59.00 | $50.35 | $8.65 | $8.65 | $0.00 | Gestational diabetes test |
| TDAP vaccine | $140.00 | $67.17 | $72.83 | $72.83 | $0.00 | Covered 100% preventative |
| Fibronectin test | $806.00 | $765.97 | $40.03 | $36.03 | $4.00 | Fetal fibronectin test (negative test indicates low probability of going into labor in the next 2 weeks). We did this for peace of mind on a trip to the mountains. |
| Urine test | $90.00 | $63.54 | $26.46 | $24.22 | $2.24 | |
| Hospital stay | $12,547.78 | $4,451.78 | $8,096.00 | $7,286.40 | $809.60 | 2 days |
| OB Care & Delivery | $3,500.00 | $350.17 | $3,149.83 | $1,574.85 | $1,574.98 | |
| Pelvic Floor Physical Therapy | $259.80 | $189.80 | $70 | $63 | $7 | Post-birth. Helped with diastastis recti, etc. |
| Pelvic Floor Physical Therapy | $203.50 | $133.50 | $70 | $63 | $7 | |
| Pelvic Floor Physical Therapy | $203.50 | $133.50 | $70 | $63 | $7 | |
| Total | $22,991 | $9,739 | $13,251 | $9,419 | $3,832 |
Comparisons between the two pregnancies
Baby 1 and Baby 2 came almost exactly 2 years apart. The pregnancies were basically the same (low-risk, uncomplicated, in-network, vaginal delivery of a single baby). A few interesting things:
| Baby 1 | Baby 2 | |
|---|---|---|
| Total cost after insurance discounts | $19,908 | $13,251 |
| Our cost | $1,739 | $3,832 |
Here is a breakdown of the "cost after insurance discounts", by specific categories:
| Baby #1 | Baby #2 | % Diff | |
|---|---|---|---|
| Blood/Urine Tests | $289 | $396 | 37% |
| Cell-Free DNA | $4,196 | $645 | -85% |
| Ultrasounds | $422 | $527 | 25% |
| Hospital Stay | $10,242 | $8,096 | -21% |
| Epidural | $1,200 | $0 | -100% |
| OB Care | $3,475 | $3,514 | -1% |
| Total | $19,824 | $13,178 | -34% |
Note that this excludes the TDAP vaccine, which is 100% covered as preventative under most insurance (which is why the numbers don't quite match the table above). If you remove the vastly different cell-free DNA blood test, you end up with this:
| Baby #1 | Baby #2 | % Diff | |
|---|---|---|---|
| Total | $15,628 | $12,533 | -20% |
Baby 1 still had a higher total cost, likely due to:
- A longer stay at the hospital (3 vs. 2 days)
- An epidural (baby #2 came so fast there wasn't time) - billed at $1,200 after discounts.
We paid less though, probably because:
- We met our OOP max early due to the large cell-free fetal DNA bill. Because we didn't end up paying most of that bill, this saved us $1,256 in billing differences based on our incorrect status as "already met out-of-pocket max".
- Baby #1 came after midnight, so technically the day after we arrived at the hospital. This resulted in all of mom's hospital costs being billed on the date we checked into the hospital at the free "you already met your out-of-pocket max and you're not on a family plan yet". This saved us $1,144.
These two factors account for $2,400 of savings, so our true cost would have likely been $4,139, which is ~7% more than the cost of $3,832 for baby #2.
Care for baby
Baby #1
| Item | Billed | Insurance Discount | Cost after Insurance Discounts | Insurance Paid | Our Cost | Notes |
|---|---|---|---|---|---|---|
| Hospital stay | $4,615.75 | $2,181.75 | $2,434.00 | $2,190.60 | $243 | 3 days |
| Pediatrician care at hospital | $754.00 | $319.20 | $434.80 | $391.32 | $43 | Includes circumcision (~$141 after discounts) |
| Heel prick | $12.50 | $0.00 | $12.50 | $0.00 | $12.50 | For routine newborn blood spot screening |
| Sick visit at pediatrician | $110.00 | $15.24 | $94.76 | $0.00 | $95 | Bronchiolitis |
| Total | $5,492 | $2,516 | $2,976 | $2,582 | $394 |
Preventative care
Baby's first year comes with lots of check-ups to ensure baby is developing properly, plus a bunch of vaccinations. These are all considered preventative care, covered by our insurance at 100%.
| Item | Billed | Insurance Discount | Cost after Insurance Discounts | Insurance Paid | Our Cost |
|---|---|---|---|---|---|
| 2 day well visit | $145 | $4.58 | $140 | $140.42 | $0 |
| 2 week well visit | $145 | $4.58 | $140 | $140.42 | $0 |
| 1 month well visit | $145 | $4.58 | $140 | $140.42 | $0 |
| 2 month well visit | $145 | $4.58 | $140 | $140.42 | $0 |
| 2 month vaccinations | $881 | $196.90 | $684 | $684.10 | $0 |
| 4 month well visit | $145 | $4.58 | $140 | $140.42 | $0 |
| 4 month vaccinations | $881 | $230.93 | $650 | $650.07 | $0 |
| 6 month well visit | $145 | $16.66 | $128 | $128.34 | $0 |
| 6 month vaccinations | $800 | $242.97 | $557 | $557.03 | $0 |
| 8 month well visit | $145 | $16.66 | $128 | $128.34 | $0 |
| Flu shot | $207 | $34.88 | $172 | $172.12 | $0 |
| Total | $3,784 | $762 | $3,022 | $3,022 | $0 |
Baby #2
Baby didn't need a sick visit before turning 1 (hooray!)
| Item | Billed | Insurance Discount | Cost after Insurance Discounts | Insurance Paid | Our Cost | Notes |
|---|---|---|---|---|---|---|
| Hospital stay | $4,706 | $1,862.78 | $2,843 | $2,558.47 | $284.28 | 2 days |
| Pediatrician care at hospital | $283 | $41.46 | $242 | $217.39 | $24.15 | |
| Hearing test | $486 | $426.81 | $59 | $53.27 | $5.92 | For routine hearing screening |
| Heel prick | $5 | $0.00 | $5 | $0 | $5 | For routine newborn blood spot screening |
| Total | $5,480 | $2,331 | $3,149 | $2,829 | $319 |
Baby #2's well visits and vaccinations were also completely covered ($0 cost for us). Over 2 years, the cost to insurance for an office visit rose from $140 to ~$145 (~3.5% increase).
Insurance Premiums
We are fortunate to have very good insurance. My employer covered my healthcare premiums while I was on maternity leave, so the first 4 months of having baby covered were free. For the remaining 8 months of baby #1's first year of life, we upgraded my husband's individual coverage to a family plan for an additional $130/month in premiums, for a total cost of $1,040.
My husband's insurance coverage improved in 2022: $0 premiums for dad + children. That, combined with my first 4.5 months of baby covered free by my employer (while I was on maternity leave), we paid $0 in premiums for baby #2.
Vitamins
Ensuring you give your baby a healthy environment to grow means avoiding some foods, but also popping some daily vitamins. MayoClinic has a good overview. Note that you can use an HSA/FSA to pay for prenatal vitamins.
| Item | Cost | Notes |
|---|---|---|
| Prenatal Vitamins | $89.12 | You're supposed to start taking these if you're trying to conceive, due to the importance of folic acid early in pregnancy. And prenatal vitamins = postnatal vitamins if you're breastfeeding (I did, for >1 year). I settled on these Nature Made ones from Costco. |
| Iron | $27.99 | I was anemic later in my pregnancy (this is fairly common), even though my prenatal vitamin contained iron. My OB recommended these Blood Builder ones to reduce side effects, since there are already plenty of unpleasant side effects during pregnancy anyway. |
| Vitamin D | $7.99 | Breastfed babies don't typically get enough Vitamin D, so supplementation is recommended. I frequently forgot to give some to the baby, so I supplemented my own diet as well. |
| Total | $125.10 |
My doctor actually "prescribed" a prenatal vitamin that was 100% covered with $0 copay by my insurance: Vitapearl. This would have reduced the $90 expense above to basically $0 (maybe 1 $20 bottle for pre-pregnancy use). However, shortly after I started taking these prenatal vitamins I got pretty bad headaches that could not be explained by anything else (and couldn't be treated with ibuprofen - probably my biggest pregnancy sacrifice). I stopped taking that brand of vitamins and the headaches went away. I'm still not sure why I reacted poorly to them (obviously if they gave everyone headaches, they would not be prescribed), but not having constant headaches is definitely worth $70 to me.
For baby #2, I didn't need iron, and had plenty of vitamin D left from baby #1, so I only spent $37, all on prenatal vitamins.
Birthing/Baby Classes
We took 2 classes at our hospital to help us prepare to be new parents. We're glad we took them for baby #1, but skipped them for baby #2.
| Item | Cost | Notes |
|---|---|---|
| Birthing class | $75 | 8 hour in-person class |
| Breastfeeding class | $40 | 2 hour in-person class |
| Total | $115 |
Misc
| Item | Cost | Notes |
|---|---|---|
| Pregnancy test | $4.50 | We bought a 2 pack of First Response tests for ~$9: $4.50 for baby #1, $4.50 for baby #2. I managed to be patient enough to use them until after I felt nauseous/hormonal enough to think I was pregnant (instead of taking them early in hopes of a positive test); otherwise, we may have gone through a few more packs. |
| Compression socks | $9.16 | My OB recommended wearing these while flying in my 2nd trimester and beyond. I vaguely recall they should reduce the risk of blood clots and also decrease uncomfortable swelling. |
| Total | $13.66 |
For baby #2, we used the other pregnancy test ($4.50) and I also bought a belly band ($6 after insurance).
Insurance Advice
This data should, in theory, help you calculate which insurance plan configuration will work best for your family, although if your pregnancy is more complicated (e.g., you need a C-section), it will likely cost more. There are too many insurance options out there to make a comprehensive calculator here, but you can calculate your total cost = premiums + min(deductible + your share of costs over deductible, out-of-pocket max) for the different options available to your family. Be sure to account for "family" plan thresholds vs. individual deductible/out-of-pocket max thresholds. If you can swing it, I recommend:
- Maxing out your HSA, if you have a HDHP (can adjust HSA contribution anytime). This gives you an automatic 10-50% discount on all baby expenses (discount dependent on your marginal tax rate and state tax rate).
- Putting at least $550 in your LPFSA (only at open enrollment), which you can roll over every year - typically available if you have a HDHP. If you don't, you should still put some $$ in an FSA based on your expected expenses. Note that you should be able to add $$ when you have a family change (aka baby's birthday), but can only use that on baby's birth date and later (which may be fine, if most bills are on baby's birthday or later).
Summary
The three most variable costs here depend on your insurance plan:
- Medical Care for Mom
- ~$16,500 after insurance discounts
- ~$2,800 out of pocket for us
- Medical Care for Baby
- ~$3,000 after insurance dicsounts
- ~$400 out of pocket for us
- Insurance Premiums for Baby's 1st Year
- ~$1,000 for us
- Luckily, future babies don't change the cost of our premium :)
These 3 categories accounted for $3,173 of the $3,427 we spent on baby #1, and $4,120 of the $4,172 on baby #2 (average: $3,650 of $3,813). Additionally, because we paid for all of this with HSA $$, we got a hefty discount compared to non-medical after-tax dollars (subject to your marginal tax rate).
You and your family know how much a $3,813 expense means for your budget. For us in 2021, ~$3,800 is about how much we spent on:
- Eating out: $150/month
- "Fun Things" (date nights, Netflix, sports leagues, alcohol): $100/month
- Travel: $600 (admittedly, a lower travel year with COVID and preganancy, but we still took 2 trips to visit family in Arizona, and one to the mountains)
Worth it :)