I've always wondered how people who can't afford kids can afford grad school.

Serious question. How can married couples with kids afford it? The time & money.

How does it work? I don't understand.

"It was unreal," Ms. Martin said. "I was like, How could you not know this? You're a hospital."

Anyone else imagining that finance offer at luch with his/her freinds?

" . . and then she asked how could I not know. And I was thinking of saying back 'Bitch please, you were the one who decided to get pregnant how could you not know? You want I should look in my crystal fucking ball to ask the spirts if you'll have a placental abruption and require surgery or get gestational diabetes? How the fuck am I supposed to predict the totality of every concivable outcome in your future?'"

"One wonders what happens to the baby when she's off at school."

Yes, and who she thinks should pay for it. I doubt that she thinks she should.

The ultrasound "...took only 20 minutes of a technician's time using a machine that had been bought years ago."

The price for an ultrasound has to be enough to cover the cost of acquiring the machine, plus the cost of operating it (including the cost of the technician and all the support staff), plus the cost of acquiring the next machine when the old one wears out, plus enough to keep the investors from regretting having invested in it.

So she's already got a bachelors - in what I wonder, and going for a masters, also in what?

At to the articles complaints about the cost vs other industrial nations. three points
1. They pay far more in taxes than we do
2. We have been paying for their national defence for the last 60 yrs
3. We have been subsidizing their 'contributions' to thing like NATO and the UN and humanitarian aid for the last 60 yrs

And even with us picking up the tab their heath systems are falling apart

As to the articles comparion on infant mortality rates.

If a baby born 3 weeks premature dies in the US it is counted as a death. In some european countries it is counted as a miscarriage even if it was a live birth and lived for a week. Some countries dont even record a birth as live unless the child survives nearly 6 months.

I wonder are the people who write these articles simply ignorant to the point of stupid, or are they aware of the difference in stat collections and deliberatly misleading their readers?

"When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000."

Why aren't you seeing that this is the product of "insurance" coverage?

No one controls costs at the provider because anonymous "others" will do that. Meanwhile, every patient WITH coverage says, "OK!" to every padded bill.

And padded they are. I have correspondence from Blue Cross / Blue Shield that would be hilarious if it were not for the magnitude of incompetence it reveals. Billed twice for the same anesthesia, the company first SUBTRACTED "discounts" for the service NOT rendered, then subtracted the service - thus magically arriving at the very same amount on the bill. When I pointed this out, the bill was magically zeroed, and hundreds of dollars vanished.

This is what happens when dozens of people totally uninvolved with your medical care handle the money, and this will only be worsened under the Affordable Care Act.

Well, yes, but there are other issues here beside the insurance:

1. Why is she going to a hospital for a normal birth? Midwives have been delivering babies since time eternal; birthing centers are a lot more pleasant than hospitals, and a fraction of the cost. In case of an emergency, birthing centers have doctors and hospitals that they refer to.

2. For routine prenatal care, just like anything else, the trick is to shop around, and ask the price *before* you buy. Many, many doctors have a "cash discount": they don't have to mess with insurance paperwork, you get your care for less. If you don't ask up front, you wind up being billed for the normal price.

Been there, done that. We had our first (of four) kids without the maternity rider on our insurance.

Total cost came to over $20,000. It was like buying a car. And you know what? We paid it off like a car, too - four years of payments.

It sucked. Big deal. We purchased a service.

Now, I'm not going to defend the hospital/health care/insurance system because the bill was indeed wildly padded - when it's "free" (i.e. paid for via insurance), the hospital expands the services to fit the amount of available "free" money. (New Moms Get a Steak Dinner!)

In fact, if there's a "news" story here, it should have been the need for more transparency, cost-control and patient empowerment.

But it's ludicrous for this woman to complain about having to pay for something that is, in the end, a purchase of services that someone else is providing. She could have added the rider and paid more (which we did for our other kids), but she didn't.

To each offer, she had one gnawing question: "How much is that going to cost?"

Indeed. Why should anyone ever have to ask how much something will cost?

Everything should be free!

Yeah, so she's probably got a degree in art history or something. In spite of that, she managed to find a decent job. So... now that she's just had a baby, she's going to give up that job and go to school to get a master's in art history. (Presumably, she expects her husband to work full-time to support her, and do half of the child care and housework, while she indulges herself.) America! What a country!

Of course there's a wide range in price, there's a wide range in possible problems. Everything goes perfect = cheap. Complications = pricey

Birthing isn't terribly expensive if you talk to your doctor/hospital in advance, prepay it, and pay cash.

It becomes a negotiation. It is still going to be expensive, but not as much if you let it go to the last minute. She should have been saving money already. Instead, she'll have to borrow from the hospital, and pay them back with interest.

Everything should be free!

I like this. Put the 90" LCD TV over there, would ya?

I paid an extra $200 per month over 20 years ago as part of an HMO to get maternity coverage. Guess what? I got a sonogram only because my doctor could figure out a medical "need." Since my husband had pyloric stenosis, he was allowed to order one - and one only. A birthing tub and epidural were deemed unnecessary and so were not covered.

With an HMO, the less your care costs, the more money can be made. On the other hand, with traditional health insurance, the more services that are provided, the more money the hospital makes.

The whole negotiation/talk-to-the-hospital/ask-how-much-it-costs thing: Easier said than done. The current system is designed to be impenetrable by the layman. They intentionally hide costs, add-on things after the fact and double-bill.

ObamaCare - which I despise - couldn't have happened to a more deserving industry.

I've paid a couple hundred dollars a month extra for insurance that will cover maternity care for several years now, specifically because I've already had one c-section and would probably have another one if we have another baby. Do I like paying thousands extra every year for insurance? No. But I do it.

Anyway, I've had more than one friend pay cash for their maternity care and a hospital birth. You have to reseach, you have to call around, and you have to get things in writing... but it can be done. I also know people who had home births using midwives. You make your decision, you pay for it, you live with the consequences. That's life.

“It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

This is a pretty reasonable complaint. The hospital should be able to itemize this stuff for her in advance. Imagine if you needed to call a plumber and he told you his services would cost anywhere between $400 and $40,000.

I've always wondered how people who can't afford kids can afford grad school.

I doubt this applies to the author, but I didn't have to pay for grad school. In a STEM field at least, you are paid to be a research or teaching assistant (or can get fellowships, which I had for 5 of my 6 years of grad school).

I don't have kids (and won't) but if the timing is right, grad school is a great time to have children. You don't have much money but you have flexible time and youthful energy. Better that then trying to get tenure while staying up at night with an infant.

“It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

This is a pretty reasonable complaint. The hospital should be able to itemize this stuff for her in advance.

Indeed. I'm very much against overregulation in business, but the hospitals are already suckling at the government teet so much that I'm fully in favor of some sort of consumer-friendly transparency.

This is a pretty reasonable complaint. The hospital should be able to itemize this stuff for her in advance.

Itemize stuff sure, but according to the article she didnt ask for an itemized list, she asked for the total cost

Imagine if you needed to call a plumber and he told you his services would cost anywhere between $400 and $40,000.

So you got a leak? Know where it is coming from? How much of the wall I'll have to tear out and subsequently fix, what kind of piping you have, how old it is and whether new building codes will force you to replace it all, or force me to tell the government if you dont so I wont lose my licence to work?

You want a seepcific price you have to give the service provider every last detail of the situation

You want a specific price you have to give the service provider every last detail of the situation.

That's really moving the goalposts. How about simply a dollar amount for an epidural? They don't even know. Why? Because there's usually a drug cost, some sort of equipment cost, a hospital cost and a physician cost. Often, the physician cost is billed through a completely separate entity. So when you're quoted a price it's hard to get an "all-in" calculation. And when you think you've paid, then you get another bill in the mail.

That's one procedure that's pretty much standard. How about seeing a $5 charge for a Tylenol on the final itemized bill?

Complications happen (hence the $20,000 bill for the first kid - and I would NOT recommend going the midwife/home birth route). Fine. But straightforward billing is impossible in the system dominated by third-party payers.

The company I currently work for owns 23 acute care hospitals and 197 behavioral health centers (psychiatric hospitals).

A little over 17% of the price of services provided in these facilities is never paid for. The company eats it.

Even still:

The CEO recently boasted of a net operating margin (total revenue received for services provided minus total cost of providing those services) of greater than 16% for the acute care hospitals and 28% for the behavioral health centers - over 18% for the company overall (the stock price has nearly doubled in the past year).

The CEO l o v e s Obamacare. In a recent press conference he said that he expects obamacare to cover most or all of that 17% of services the company never gets paid for. He said, "And that goes straight to the bottom line! Straight to the bottom line!"

And that's what it's all about for the politicians and the big corporations that worked so hard to create and pass obamacare.

a_random_guy: "For routine prenatal care, just like anything else, the trick is to shop around, and ask the price *before* you buy."

Amen! People should put at least as much effort into researching and buying important health care services as they put into buying a new car or a house.

AB: "How about seeing a $5 charge for a Tylenol on the final itemized bill?"

In a hospital the cost of delivering two Tylenol and a glass of water to your lips is a lot more than $5.

First, the nurse has to know why you need Tylenol. Every minute of her time you take telling her all about it costs at least $1. She has to make her own assessment, possibly check your vital signs, O2 sat, temperature... whatever she believes might be relevant to your complaint. That all has to be documented in your chart. Then she needs to get an order from a doctor if there isn't one already. The contact with the doctor has to be documented in your chart, and the order has to be transcribed on the medication administration record (MAR). The order has to be transmitted to the pharmacy so it can be included on the updated MAR for the next day and/or entered onto an electronic MAR. Then the nurse has to get the Tylenol from the med room - and document it of course. Then take the Tylenol and a cup of water to you and give it to you. However much of her time it takes you to bask in her attention, shoot the shit and finally swallow the pills costs about $1 a minute - that's just for the nurse's time; that doesn't include the space you're taking up, the cost of any equipment used, the pharmacist's or doctor's time. Then she has to document on the medication administration record that you took the pills. Then she has to check on you later to find out if the Tylenol was effective. And of course document it.

It costs a lot in time, effort and money to deliver a Tylenol to a hospital patient in a way that won't bring a lot of grief later to the hospital, doctors, nurses and pharmacists.

In a hospital the cost of delivering two Tylenol and a glass of water to your lips is a lot more than $5.

BS. I know it's BS because at many hospitals as many as 50% of the people who walk through the door don't pay. More never see the bills because they're on government insurance. So the hospitals pad the bills of the people who do pay. My $5 tylenol is paying for the tylenol for 2-3 other patients.

Besides, I'd have a much easier time believing the embedded cost argument if the nurses, specialists, equipment and time weren't also itemized on the bill.

Finally, I would gladly go to a hospital that even made the attempt to compete on price. None do. They thrive off of the "someone else sees the bill" lack of transparency. Responsible patients get padded bills to cover the free riders, but not enough fight back because there's no transparency up front. The hospitals drive up costs with anything they know will have the highest reimbursement rate from insurers/government, and placate the patients (for whom everything is "free") with idiocies like 47 different "facilitators," steak dinners and high-end amenities that you'd otherwise find in hotels.

The analogy is higher education - another industry where there's easy money available through a third-party source and the end-user doesn't see the bill until it's too late. Universities simultaneously plead poverty, overcharge for everything, and build new facilities. It's a counterintuitive and seemingly-impossible combination made possible only by the influence of government subsidies, crony capitalism and the lack of consumer empowerment. Hospitals are doing the same thing.

"With an HMO, the less your care costs, the more money can be made. On the other hand, with traditional health insurance, the more services that are provided, the more money the hospital makes. "

This is why I don't think that doctors' concierge services are going to work. Because care is paid for in bulk in advance, once it's paid for, the patient has every incentive to use it as much as possible. Simultaneously, the doctor's incentive is to deliver as little care as possible, because every service delivered comes out of the profit margin. Nothing is going to work until major medical is separated from routine care.

Ran into an interesting situation a couple of years ago.

My daughter ended up in the emergency room about five years ago with a dog bite that happened late at night. In retrospect it could have waited until morning but she got a little panicked when she could not stop the bleeding.

Two weeks later an itemized bill came from the emergecy room physicians. It was about 600 bucks and we paid it immediately.

Four days after that another bill came from "the hospital".

It was not itemized. I called and made them send an itemized bill. The itemized bill was for about 700 bucks, and every item on it, except for a couple of small items had been billed also on the Emergency room services bill, that we had already paid.

In other words, double billing is a regular part of the system, and it will trap the unwary.
I wrote a letter for her, refusing to pay the second bill, and the reasons why she would not pay.

We did pay about fifty dollars worth of charges that were not for items on both bills.

In my opinion, hospital billing, is probably one of the biggest scams around. If they get double paid, by the unwary, fine. If they dont get paid at all, they write it off as a double loss against their profits, and then scream to the politicians, how they arent making any money because of all the deadbeats.

Win, win.

In my opinion, hospital billing, is probably one of the biggest scams around. If they get double paid, by the unwary, fine. If they dont get paid at all, they write it off as a double loss against their profits, and then scream to the politicians, how they arent making any money because of all the deadbeats. -- Isab at July 3, 2013 1:51 PM

I had a similar situation happen to me. I went to the hospital after slashing my hand and had seven stitches. I screwed up and never paid the $75 co-pay. But the original bill was about $575 total and $500 was paid by the insurance company at the time.

The hospital was bought out by an expanding chain and my bill was then turned over for collections, at the uninsured amount (~$1149).

So after trying to fight it (they could never find the insurance payment); I finally agreed to settle. They quoted a $569.34 or some number like that. I sent them $515 from the bank with a memo line "FINAL AMOUNT". They accepted it and cashed it. Then about three months later they called saying I still owed.

I told them "You can either return the money and take me to court or go fuck off." I haven't heard from them since.

I will also not cross the threshold of the chain anymore unless I'm unconscious.