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First kid was no cost to us. My wife was on insurance with her employer. Long day, but no complications. I kept waiting for a bill that never came. Couldn't bel

First kid was no cost to us. My wife was on insurance with her employer. Long day, but no complications. I kept waiting for a bill that never came. Couldn't believe we didn't pay anything! By the time the second kid came around, we were self-insured on the healthcare.gov marketplace. We ended up paying $5000 out of pocket - $2k for the prenatal care and doctors' services, $3k for the delivery and stay at the hospital. We made a $1500 mistake. My wife had a really fast and normal delivery, but it was so fast that they didn't have time to administer an antibiotic that they otherwise would have. They wanted to monitor her for a day to look for an infection. We said okay, but if I had more closely read my policy I'd have learned that the policy had a $1500/day copay for labor and delivery. We'd have taken our chances and gone home had we known. Kid three is coming! And this year's marketplace plan says that we're on our own up to the individual deductible of $6950. That's a bronze plan that carries a $950/month premium for 4 people; financial assistance from the government drops that down to $700/month. So we pay $8400/year for the privilege of not paying more than $7000 for an individual ($14,000 for the family) on our plan. I don't think state-run healthcare is the only solution here (nor is it an inherently bad solution; I'm no libertarian), but I have to think that I'm living in the worst of all worlds here. I'm forced to buy an expensive product that I'm afraid to use, a product that costs more than the roof over my head per month but delivers a fraction of the value. It's expensive because it's violating basic principles of insurance, because the people who made the law are trying to implement universal healthcare in a system that's not built for that idea (at least not in the way it currently exists). If I lived in a more market-based system there'd be price transparency, presumably a better way to monitor outcomes, and a lot more say in what kind of policy I could get to better accommodate the needs of my family. Anyways, there are alternatives and means for assistance out there, and we're exploring them. But we like our doctors and our hospital; it's a shame that we have to look elsewhere. Not looking for sympathy, just adding a data point! My takeaway from that article was that maybe we should price out a trip to Spain sometime late in the third trimester :)

rsfern 9y ago
Have you and your wife considered using a birth center for #3 if there are no complications or high risk factors? My wife and I had our son at a midwife center in the US, and our prenatal, delivery, and postnatal care combined ran about $3k (of which our insurance covered about 2/3). The midwives were great, and overall I think it was a less stressful experience than the hospital might have been.
- Brendinooo 9y ago
  The most SEO-friendly one in the area that I found will run me about $6000, and I'm assuming I'd be on the hook for all of it if I read my plan correctly. Still in the early stages of research though. My wife is open to a birthing center, unlike my home-birth overtones which she summarily rejected :)
DoreenMichele 9y ago
I can't imagine dealing with such bills for bringing a child into the world. I was a military wife when I had kids. It cost me a few dollars a day for a hospital stay. I think both births were around $20 out of pocket, give or take a few bucks. I was in the hospital three days the first time and two days the second and the price went up a bit in between the two births. but I have to think that I'm living in the worst of all worlds here. I worked in insurance for a time. I do think Obamacare is the worst of all worlds. Requiring universal insurance is a terrible way to try to arrange universal health coverage for the nation.
- seanmcdirmid 9y ago
  > Requiring universal insurance is a terrible way to try to arrange universal health coverage for the nation. The country where Obamacare was copied from, Switzerland, also outlawed group insurance so (a) you didn't get health insurance from work and (b) EVERYONE was in the same risk pool. The current situation, you have group policies that are actually affordable because...people with good jobs to provide it typically are lower health risks. Everyone else is stuck a shitty individual pool with lots of high risk individuals. As long as the group pools siphon off all of the low risk, Obamacare won't work.
  - morogop 9y ago
    Group policies are still very expensive by international standards. The markets were broken before Obamacare, and are just getting worse. It's vile.
    - seanmcdirmid 9y ago
      Swiss insurance policies cost around the same as group policies in the states if you are on COBRA. Salaries are also higher in Swiss though.
  - deleted 9y ago
    [deleted]
- freedomben 9y ago
jostmey 9y ago
My wife is a resident physician. She also went through the same experience of delivering a kid. Here's what I've learned: * Pricing is not transparent. When the hospital tells you how much the procedure will cost, they are not telling you about the anesthesiologists portion, or the room fee, ect. There will be surprise bills. Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures? * Doctors are in short supply. This is because becoming a doctor is impossibly hard. Why can't undergraduates enter straight into a medical school program? Doctor's are in the 30's when they complete training and are already halfway toward the retirement age * If things go badly during the delivery, you will be glad you are at a well equipped Hospital. A $5000 bill is a small price to pay to ensure the baby does not arrive brain damaged.
- maxxxxx 9y ago
  "Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?" that's the first thing that should happen. Especially the free market people should want it.
- threatofrain 9y ago
  I believe in the UK, hospitals are by law required to give you the fully itemized bill. Knowing transaction price up-front seems to be an obvious part of market health.
  - isostatic 9y ago
    There is no cost to the patient in the UK, nor is there any bill presented, so in that sense you're right.
    - DanBC 9y ago
      Private health care exists in the UK. Some people chose it. If you do chose it the hospital must tell you the price up front. https://www.legislation.gov.uk/uksi/2001/3968/regulation/7/made https://www.legislation.gov.uk/uksi/2001/3968/regulation/7/m... > Patients' guide > 7.—(1) The registered person shall produce a written guide to the establishment or agency (in these Regulations referred to as “the patients' guide”) which shall consist of— > (a)a summary of the statement of purpose; > (b)the terms and conditions in respect of services to be provided for patients, including as to the amount and method of payment of charges for all aspects of their treatment;
giarc 9y ago
Tough call there. The antibiotics were likely for Group B Streptococcus, meaning during prenatal screening she tested positive. I work in the field and we see some terrible outcomes from GBS (and other bacterial) infections such as blood stream infections, neonatal infections to hysterectomies and death. I've seen cases where moms have symptoms at home but they simply chalk them up to "what happens after giving birth". So whatever choice you make, tell your wife to listen to her body.
- Brendinooo 9y ago
  I think you're right. I say "we would have gone home" pretty flippantly; I have the benefit of hindsight where everything was fine, and presumably if we said that in a hospital we'd have gotten someone give me a spiel similar to yours, then we would have had to sweat the decision at that time. Maybe we'd have stayed anyways. > So whatever choice you make, tell your wife to listen to her body. Thank you for this.
maxerickson 9y ago
What sort of policy would you like to buy?
- maxerickson 9y ago
  My question is specifically about the phrase and a lot more say in what kind of policy I could get to better accommodate the needs of my family. I'm wondering where the other poster thinks they would save money vs insurance that covers things like child birth, hospitalization, emergency room visits, etc.
  - Brendinooo 9y ago
    I was looking at a co-op alternative for 2018 - Our family premium would have been about $650/month unsubsidized, and our max out-of-pocket would have been $2500. Pregnancy is a pre-existing condition though, and co-ops are still allowed to exclude for that, so it wasn't a viable choice for this year. Regardless, I was alluding to the fact that I have no control over my health insurance costs, unlike every other kind of insurance I purchase.
isostatic 9y ago
Those figures are shocking. To pay $8400 a year for the NHS you'd need to pay $46,000 in tax, which would be two salaries of about $70k. (Cost of bringing my children into the world was about £10 - the petrol, the parking, and I bought a chocolate bar and bottle of water at one point) Why does America stand for it?
- theaeolist 9y ago
  ... and people are up in arms in the UK over the fact that hospital parking is not free. Go figure.
- Brendinooo 9y ago
  Inertia, probably. Any gradual change adds to the bloat; any radical change is rejected out of fear, or maybe ideological concerns. Not picking a fight here, just curious: another person commented on my original post noting that when I said my first birth didn't cost us anything, that wasn't true - my wife's employer paid a fair amount for her insurance. Are your taxes broken out in the UK? Do you know how much you pay a year for healthcare?
  - rupertj 9y ago
    UK taxpayer here. We get sent an annual summary of the tax we paid and what it paid for. It looks like this: http://i.telegraph.co.uk/multimedia/archive/02871/taxtable1_2871685b.jpg http://i.telegraph.co.uk/multimedia/archive/02871/taxtable1_...
  - isostatic 9y ago
    For my family it's about £2800, or $3900. My wife doesn't pay tax, but I earn in the top decile. Probably a little more due to spending on vat and other indirect taxes (petrol tax etc), call it $4200. However my parents, gran, and my mother in law combined pay under $1000 a year between them. On the other hand a premiership footballer pays about $250,000 a year for health. Plus their own private health care costs of whatever. That's the price they pay for living in our society though, a society where people aren't afraid to go to the doctors to check out that mole, or rush to give birth because they can't afford an extra day in hospital.
adimitrov 9y ago
> We said okay, but if I had more closely read my policy I'd have learned that the policy had a $1500/day copay for labor and delivery. We'd have taken our chances and gone home had we known. What the bloody flying everliving fuck?? Does this not seem absolutely absurd to anybody else? You'd have risked a severe infection for the mother of your newborn child had you known there was a monetary cost attached to not risking it? This is patently ridiculous, and it is inhumane that people have to make such calculations. You go to the place with the people in white robes when you're sick. No ifs, no buts, no strings attached. This is how you keep a healthy, productive populace. No wonder the US, the largest economy in the world, ended up with a terrible infant mortality rate… https://www.cnbc.com/2018/01/08/us-has-worst-rate-of-child-mortality-among-20-rich-nations.html https://www.cnbc.com/2018/01/08/us-has-worst-rate-of-child-m... EDIT: from the article: > "Persistently high poverty rates, poor educational outcomes, and a relatively weak social safety net have made the US the most dangerous of wealthy nations for a child to be born into." … yeah. As a young person who's planning on having a family: I will go work in the US exactly never.
- watwut 9y ago
  Socialized medicine (e.g. one paid by state) also weights costs and risks. You just don't see it and don't have to make those decisions by yourself. You don't know how much for them 1500 wad nor how high the risk nor whether coming back from home was that much dangerous in case that bacteria happened.
  - theaeolist 9y ago
    That's nonsense. You do know, statistically.
    - watwut 9y ago
      Parent I responded to does not know. He is just horrified that couple would save on healthcare. If you live in system with socialized healthcare, you don't have to make these decisions. However, if you pay out of pocket then you do have to make those decisions personally. Else you will be taken for financial ride.
kodablah 9y ago
To add, I have almost identical numbers across the board w/ a delivery in 2017. My bronze plan is up to $1100/mo though and I get no assistance. > If I lived in a more market-based system [...] Unfortunately you can be vilified for saying this stuff in public. If you believe others, you are helping subsidize the poor and those with preconditions. In a market-based system you end up paying for what you need which, while it seems rational, is often considered amoral.
- Brendinooo 9y ago
  I think that's one of the biggest disconnects when it comes time to purchase. I'm being asked to purchase a product, but that product is being used with other goals in mind. In other words, I bought a bronze plan because it fit best with my family situation and my budget, but was I selfish doing so? Should I have purchased a gold plan and therefore put more money in the system which would hopefully help more people? I think there are a lot of potential solutions to the healthcare issue; either market-based or single-payer, if well-implemented, would be better than what we're doing now.
ThomPete 9y ago
My first son was born 10 weeks too early, we lived in Denmark at the time, cost 0. My second son was born in New York and we had good health care coverage costed us nothing. Right now we are on Cobra and we are fine. But once thats up we will have to find something else and I worry about the cost of that plan. One thing I have learned though is that it's normally possible to negotiate the price down quist substantially (more than 50% sometimes) especially because these days it's the hospitals themselves who need to do the collecting and they simply aren't prepared for that (patient cost sharing up 230% and deductibles up more that 60%) They just want some money.
sytelus 9y ago
Insurance through employer is not a “no cost to us”. Employer is taking a significant chunk out of your income and giving it to insurance company. Government has already made insurance “self-funded” through HSA as well. So first few thousands dollars are coming directly out of your pocket.
- Brendinooo 9y ago
  I understand that's objectively true. "There ain't no such thing as a free lunch", etc. Practically, it's hard to think like that. I don't know what her employer was paying the insurance company for premium subsidies or the care we received.
apercu 9y ago
Why Americans don't demand some sort of national health plan is beyond me. That's one of the key reasons I moved to Canada.

rsfern 9y ago

Have you and your wife considered using a birth center for #3 if there are no complications or high risk factors? My wife and I had our son at a midwife center in the US, and our prenatal, delivery, and postnatal care combined ran about $3k (of which our insurance covered about 2/3). The midwives were great, and overall I think it was a less stressful experience than the hospital might have been.

Brendinooo 9y ago
The most SEO-friendly one in the area that I found will run me about $6000, and I'm assuming I'd be on the hook for all of it if I read my plan correctly. Still in the early stages of research though. My wife is open to a birthing center, unlike my home-birth overtones which she summarily rejected :)

DoreenMichele 9y ago

I can't imagine dealing with such bills for bringing a child into the world. I was a military wife when I had kids. It cost me a few dollars a day for a hospital stay. I think both births were around $20 out of pocket, give or take a few bucks. I was in the hospital three days the first time and two days the second and the price went up a bit in between the two births. but I have to think that I'm living in the worst of all worlds here. I worked in insurance for a time. I do think Obamacare is the worst of all worlds. Requiring universal insurance is a terrible way to try to arrange universal health coverage for the nation.

seanmcdirmid 9y ago
> Requiring universal insurance is a terrible way to try to arrange universal health coverage for the nation. The country where Obamacare was copied from, Switzerland, also outlawed group insurance so (a) you didn't get health insurance from work and (b) EVERYONE was in the same risk pool. The current situation, you have group policies that are actually affordable because...people with good jobs to provide it typically are lower health risks. Everyone else is stuck a shitty individual pool with lots of high risk individuals. As long as the group pools siphon off all of the low risk, Obamacare won't work.
- morogop 9y ago
  Group policies are still very expensive by international standards. The markets were broken before Obamacare, and are just getting worse. It's vile.
  - seanmcdirmid 9y ago
    Swiss insurance policies cost around the same as group policies in the states if you are on COBRA. Salaries are also higher in Swiss though.
- deleted 9y ago
  [deleted]
freedomben 9y ago

jostmey 9y ago

My wife is a resident physician. She also went through the same experience of delivering a kid. Here's what I've learned: * Pricing is not transparent. When the hospital tells you how much the procedure will cost, they are not telling you about the anesthesiologists portion, or the room fee, ect. There will be surprise bills. Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures? * Doctors are in short supply. This is because becoming a doctor is impossibly hard. Why can't undergraduates enter straight into a medical school program? Doctor's are in the 30's when they complete training and are already halfway toward the retirement age * If things go badly during the delivery, you will be glad you are at a well equipped Hospital. A $5000 bill is a small price to pay to ensure the baby does not arrive brain damaged.

maxxxxx 9y ago
"Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?" that's the first thing that should happen. Especially the free market people should want it.
threatofrain 9y ago
I believe in the UK, hospitals are by law required to give you the fully itemized bill. Knowing transaction price up-front seems to be an obvious part of market health.
- isostatic 9y ago
  There is no cost to the patient in the UK, nor is there any bill presented, so in that sense you're right.
  - DanBC 9y ago
    Private health care exists in the UK. Some people chose it. If you do chose it the hospital must tell you the price up front. https://www.legislation.gov.uk/uksi/2001/3968/regulation/7/made https://www.legislation.gov.uk/uksi/2001/3968/regulation/7/m... > Patients' guide > 7.—(1) The registered person shall produce a written guide to the establishment or agency (in these Regulations referred to as “the patients' guide”) which shall consist of— > (a)a summary of the statement of purpose; > (b)the terms and conditions in respect of services to be provided for patients, including as to the amount and method of payment of charges for all aspects of their treatment;

giarc 9y ago

Tough call there. The antibiotics were likely for Group B Streptococcus, meaning during prenatal screening she tested positive. I work in the field and we see some terrible outcomes from GBS (and other bacterial) infections such as blood stream infections, neonatal infections to hysterectomies and death. I've seen cases where moms have symptoms at home but they simply chalk them up to "what happens after giving birth". So whatever choice you make, tell your wife to listen to her body.

Brendinooo 9y ago
I think you're right. I say "we would have gone home" pretty flippantly; I have the benefit of hindsight where everything was fine, and presumably if we said that in a hospital we'd have gotten someone give me a spiel similar to yours, then we would have had to sweat the decision at that time. Maybe we'd have stayed anyways. > So whatever choice you make, tell your wife to listen to her body. Thank you for this.

maxerickson 9y ago

What sort of policy would you like to buy?

maxerickson 9y ago
My question is specifically about the phrase and a lot more say in what kind of policy I could get to better accommodate the needs of my family. I'm wondering where the other poster thinks they would save money vs insurance that covers things like child birth, hospitalization, emergency room visits, etc.
- Brendinooo 9y ago
  I was looking at a co-op alternative for 2018 - Our family premium would have been about $650/month unsubsidized, and our max out-of-pocket would have been $2500. Pregnancy is a pre-existing condition though, and co-ops are still allowed to exclude for that, so it wasn't a viable choice for this year. Regardless, I was alluding to the fact that I have no control over my health insurance costs, unlike every other kind of insurance I purchase.

isostatic 9y ago

Those figures are shocking. To pay $8400 a year for the NHS you'd need to pay $46,000 in tax, which would be two salaries of about $70k. (Cost of bringing my children into the world was about £10 - the petrol, the parking, and I bought a chocolate bar and bottle of water at one point) Why does America stand for it?

theaeolist 9y ago
... and people are up in arms in the UK over the fact that hospital parking is not free. Go figure.
Brendinooo 9y ago
Inertia, probably. Any gradual change adds to the bloat; any radical change is rejected out of fear, or maybe ideological concerns. Not picking a fight here, just curious: another person commented on my original post noting that when I said my first birth didn't cost us anything, that wasn't true - my wife's employer paid a fair amount for her insurance. Are your taxes broken out in the UK? Do you know how much you pay a year for healthcare?
- rupertj 9y ago
  UK taxpayer here. We get sent an annual summary of the tax we paid and what it paid for. It looks like this: http://i.telegraph.co.uk/multimedia/archive/02871/taxtable1_2871685b.jpg http://i.telegraph.co.uk/multimedia/archive/02871/taxtable1_...
- isostatic 9y ago
  For my family it's about £2800, or $3900. My wife doesn't pay tax, but I earn in the top decile. Probably a little more due to spending on vat and other indirect taxes (petrol tax etc), call it $4200. However my parents, gran, and my mother in law combined pay under $1000 a year between them. On the other hand a premiership footballer pays about $250,000 a year for health. Plus their own private health care costs of whatever. That's the price they pay for living in our society though, a society where people aren't afraid to go to the doctors to check out that mole, or rush to give birth because they can't afford an extra day in hospital.

adimitrov 9y ago

> We said okay, but if I had more closely read my policy I'd have learned that the policy had a $1500/day copay for labor and delivery. We'd have taken our chances and gone home had we known. What the bloody flying everliving fuck?? Does this not seem absolutely absurd to anybody else? You'd have risked a severe infection for the mother of your newborn child had you known there was a monetary cost attached to not risking it? This is patently ridiculous, and it is inhumane that people have to make such calculations. You go to the place with the people in white robes when you're sick. No ifs, no buts, no strings attached. This is how you keep a healthy, productive populace. No wonder the US, the largest economy in the world, ended up with a terrible infant mortality rate… https://www.cnbc.com/2018/01/08/us-has-worst-rate-of-child-mortality-among-20-rich-nations.html https://www.cnbc.com/2018/01/08/us-has-worst-rate-of-child-m... EDIT: from the article: > "Persistently high poverty rates, poor educational outcomes, and a relatively weak social safety net have made the US the most dangerous of wealthy nations for a child to be born into." … yeah. As a young person who's planning on having a family: I will go work in the US exactly never.

watwut 9y ago
Socialized medicine (e.g. one paid by state) also weights costs and risks. You just don't see it and don't have to make those decisions by yourself. You don't know how much for them 1500 wad nor how high the risk nor whether coming back from home was that much dangerous in case that bacteria happened.
- theaeolist 9y ago
  That's nonsense. You do know, statistically.
  - watwut 9y ago
    Parent I responded to does not know. He is just horrified that couple would save on healthcare. If you live in system with socialized healthcare, you don't have to make these decisions. However, if you pay out of pocket then you do have to make those decisions personally. Else you will be taken for financial ride.

kodablah 9y ago

To add, I have almost identical numbers across the board w/ a delivery in 2017. My bronze plan is up to $1100/mo though and I get no assistance. > If I lived in a more market-based system [...] Unfortunately you can be vilified for saying this stuff in public. If you believe others, you are helping subsidize the poor and those with preconditions. In a market-based system you end up paying for what you need which, while it seems rational, is often considered amoral.

Brendinooo 9y ago
I think that's one of the biggest disconnects when it comes time to purchase. I'm being asked to purchase a product, but that product is being used with other goals in mind. In other words, I bought a bronze plan because it fit best with my family situation and my budget, but was I selfish doing so? Should I have purchased a gold plan and therefore put more money in the system which would hopefully help more people? I think there are a lot of potential solutions to the healthcare issue; either market-based or single-payer, if well-implemented, would be better than what we're doing now.

ThomPete 9y ago

My first son was born 10 weeks too early, we lived in Denmark at the time, cost 0. My second son was born in New York and we had good health care coverage costed us nothing. Right now we are on Cobra and we are fine. But once thats up we will have to find something else and I worry about the cost of that plan. One thing I have learned though is that it's normally possible to negotiate the price down quist substantially (more than 50% sometimes) especially because these days it's the hospitals themselves who need to do the collecting and they simply aren't prepared for that (patient cost sharing up 230% and deductibles up more that 60%) They just want some money.

sytelus 9y ago

Insurance through employer is not a “no cost to us”. Employer is taking a significant chunk out of your income and giving it to insurance company. Government has already made insurance “self-funded” through HSA as well. So first few thousands dollars are coming directly out of your pocket.

Brendinooo 9y ago
I understand that's objectively true. "There ain't no such thing as a free lunch", etc. Practically, it's hard to think like that. I don't know what her employer was paying the insurance company for premium subsidies or the care we received.

apercu 9y ago

Why Americans don't demand some sort of national health plan is beyond me. That's one of the key reasons I moved to Canada.