Tips for Negotiating Your Health Care Costs – Insurance – Investopedia
The health care cost of pregnancy and childbirth in the U.S. can easily top $10,000, however you may be able to take steps to try to lower your bill. You may be able to negotiate your medical bills with providers or established a pay plan. But there are limits on how you can lower your bills. For example, you cannot negotiate with your insurance company about health care prices outside of appealing a decision.
Learn more about your options for reducing health care costs so you can try to save money both before and after the bills arrive.
Planning how you will cover your potential expenses prior to giving birth can save you money in the long-term.
Complications with a childbirth or pregnancy can add to costs. The median cost of a vaginal birth with no complications is about $15,000, but the median cost of a Cesarean with complications is about $26,000, according to research from the Peterson-KFF Health System Tracker.
To prepare for the costs, become familiar with your plan. If you are planning a pregnancy well in advance or are pregnant during an open enrollment period, you may be able to change plans to one with more comprehensive pregnancy and childbirth coverage. You can compare policies, or contact a licensed health insurance agent to get help choosing a plan that matches your needs.
Learn the deductible and out-of-pocket maximums for your insurance plan. Your plan will have an individual deductible and a family deductible, as well as an individual out-of-pocket maximum and family out-of-pocket max. When your baby is born, your health care costs will likely reach your annual deductible limits both for yourself and for your baby. The family out-of-pocket maximum is likely the highest amount you’ll have to pay.
Most health plans give you access to a specific network of providers, including doctors and pharmacies, that agree to provide services at a lower rate. Out-of-network providers, meanwhile, can charge their full rate, which is usually more than the discounted in-network price. So staying in-network as much as possible can help reduce costs.
With health care costs rising, new services have come onto the market. Birth centers may charge a flat rate for all prenatal, post-natal, and childbirth costs in their facility. Flat rates are often less expensive than the amounts after insurance, especially for people with extremely high deductibles or out-of-pocket maximums.
You may qualify for Medicaid to cover costs related to your pregnancy and childbirth even if you don’t qualify for Medicaid normally. Many states offer a limited version of Medicaid coverage. Some states like California even have a third tier of coverage called the Medi-Cal Access program.
You can review the income limits for your state on Medicaid's website. Include the child you’re expecting in your household size when you're providing application information.
If you don’t qualify for pregnancy services through Medicaid, you may still qualify for financial assistance directly through your hospital or provider. Contact the hospital network providing your services and speak to the patient advocate, who is generally a social worker who can connect you to resources and assistance. If the hospital does not have a patient advocate, contact the billing department to see whether you qualify for alternative solutions that would reduce your costs, and try to get estimates of those costs.
If you have the funds to pay the bill all at once, you may be able to negotiate a discount for doing so. If you cannot lower costs and you can’t pay your bill, you may have other solutions to keep you out of financial trouble.
First, ask for an itemized version of the bill from your provider. Then, get an Explanation of Benefits (EOB) statement from your insurance company detailing what was billed to them and what they paid, On the itemized bill from the provider, look for any errors: these can include double billing, incorrect coding for procedures, and any discrepancies between the bill and your EOB.
You can also connect with organizations that may help with medical bills such as HealthWell Foundation, Patient Advocate Foundation, or RIP Medical Debt. If you don’t have the funds to pay the full bill, you may be able to get on a payment plan with the provider in which you can make monthly payments that fit into your budget. Or you may consider taking out a personal loan that can help with debt consolidation and make your overall debt load more manageable.
The cost of health care can lead to debt if you can't pay your bills, and carrying debt can, in turn, have significant consequences for your financial health. When you don't make your payments, your costs will increase with late fees and interest payments. Even if you are on a payment plan, you may face a tighter cash flow that could make it more difficult to pay all your bills. Consumer debt in the U.S. included $88 billion in unpaid medical bills as of June 2021.
Unpaid medical debt in collections can show up on your credit report. However, as of 2023, medical debt that is less than $500 will not appear on your report. Also, any medical debt you've paid off will be cleared from your credit report as of July 1, 2022.
Pregnancy can be considered a qualifying life event to change your insurance plan. Qualifying life events are significant events that make you eligible for a special enrollment period. Having a baby is generally considered a "changes in household" qualifying life event.
Your insurance can deny coverage of things that it deems medically unnecessary, so you can be billed beyond your out-of-pocket max. If this happens, you’ll be sent a notice from your insurance company detailing their decision and giving you options to appeal. You can then follow the steps in their appeals process, and ask for an internal review or a review by a third party.
The birthday rule is that if each parent has their own health insurance, the child is covered under the insurance of the parent whose birthday falls earlier in the year. If you and your partner both have health insurance separately, consider if the parent with the better coverage has a birthday later in the year. It may save you money in total costs if you switch to the better coverage for you both, even if the premiums are more expensive.
Having a child can be expensive, but you can work to reduce some of those costs by connecting with your provider. You may be able to negotiate some costs, or set up a payment plan that can make costs more manageable. However, you cannot negotiate costs with your insurance provider.
Planning ahead for your pregnancy and childbirth costs can save you money in the long-term. Review your insurance plan and consider switching to one with more coverage for childbirth costs, if possible. Shop around for providers and see if a flat-fee option is available in your area, and compare costs to see if it's right for you.
Finally, connect with local organization that may offer financial assistance programs to help with the costs of pregnancy and childbirth.
Peterson-KFF Health System Tracker. "Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care."
Kaiser Family Foundation. "Average Annual Deductible Per Enrolled Employee."
Cigna. "In-Network vs. Out-of-Network."
Centers for Medicare & Medicaid Services. "Implementation Guide: Medicaid State Plan Eligibility Medically Needy Pregnant Women," Page 2.
Los Angeles County Department of Public Social Services. “Pregnant Persons.”
Centers for Medicare & Medicaid Services. “Medicaid, Children’s Health Insurance Program & Basic Health Program Eligibility Levels.”
Consumer Financial Protection Bureau. "Medical Debt Burden in the United States," Page 2.
Consumer Financial Protection Bureau. "CFPB Publishes Analysis of Potential Impacts of Medical Debt Credit Reporting Changes."
Health Insurance Marketplace. “Qualifying Life Event (QLE).”
Health Insurance Marketplace. "How to Appeal an Insurance Company Decision."
National Association of Insurance Commissioners. "NAIC Model Laws, Regulations, Guidelines and Other Resources—120-1 Coordination of Benefits Model Regulation," Page 7.
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