Becoming Mother

A book and a blog for first-time mothers

Tag: health care

Week 5: The Hospital Bill Arrives (A.K.A. Why You Can’t Shop for Health Care)

One of the major talking points of Republicans about their plans for replacing the Affordable Care Act is that…

“It will encourage Americans to shop around for their health care.”

To which I say…

Bullshit.

“Shopping around” for health care isn’t a thing in the United States.

You cannot shop around when you don’t know the prices ahead of time.

I mean… Duh.

(You also cannot shop around if there is only one hospital in your area, as is true for all Americans who live far from larger cities.)

If we’re “consumers” of health care, shouldn’t we have the same amount of information that we have when we are consumers of cars or computers, or even breakfast cereal?

But we don’t.

We often don’t know how much our health care costs until we tear open the bill that finally comes to our mailbox weeks later.

Surprise!

***

Before we had this baby, I tried to figure out about how much it was going to cost us out-of-pocket.

You know. For budgeting.

For planning our Flexible Spending Accounts.

You know. Because we want to be responsible. Because we want to make sure we’ve saved enough money to cover our health care costs.

We’re not in poor health. We don’t have pre-existing conditions. We’re fairly young. We’re gainfully employed.

Republicans should love us. Any plan put forth by them should definitely benefit us right? We’re kind of what they had in mind for good American health care “consumers.”

But the truth is you can’t blame “consumers” for the complicated mess that is the health insurance industry, nor can you blame them for the high costs of health care. You can’t tell Americans to just save their money and choose wisely.

I tried that approach and it didn’t work. Not because I didn’t try hard enough, but because the system is not designed to be transparent to patients.

The patients are an afterthought.

***

Our health insurance provider had some estimates for the costs of giving birth in the two main hospitals where I live. These costs were based on their negotiated rates for medical procedures with those hospitals.

But they were just estimates.

So I called the hospital’s pricing line, staffed by the billing department, for a more precise answer.

Ha. Ha.

First, no one picked up the line. It went straight to voicemail. Over and over again.

So I left a message.

Someone called me back the next day.

When I asked the billing department’s representative about specific prices for having a baby at their hospital, he said that he couldn’t give me any prices.

The pricing line. Couldn’t give me any prices.

So I got specific. I told him that I would be giving birth in the birthing center that is attached to the hospital, where I would be rooming in with my baby 24/7. So we wouldn’t be using the nursery. Would we be charged a fee for the nursery? I asked.

“Yes,” he said.

“Why?” I asked.

“Because it’s available to you.”

“So how much will the nursery cost us?”

“I can’t quote you a price on that. It all depends on your insurance and how long you stay.”

“But don’t you have average prices for average stays? Anything?”

“We have a price sheet you can look at, but it’s not going to be inclusive of all of your expenses.”

“I’ll take whatever you have,” I said.

So he referred me to this pricing list, published on the hospital’s website. Why he didn’t give this to me at the beginning of the phone call, I’ll never know.

hospital-claim-2

Indeed, these charges showed up on my insurance claim for the birth.

hospital-claim_ink_ink_li

But so did this mysterious $3500 charge. And a boatload of other charges that are all labeled “Ancillaries” and have no identifying characteristics other than a medical code that only medical transcribers can interpret.

hospital-claim-3_ink_li

I mean, really. Don’t I deserve a little more information than this? If we’re going to pay $1800, I’d kind of like to know what it pays for.

So I wait for the hospital bill to show up. Maybe they have more information than my health insurance company.

Not really.

IMG_20170306_134632

From this bill, I can see that the ambiguous $1850 charge on my insurance claim is actually for the “Recovery Room.” But the other charges?

Who can tell?

The underlying message here is,

Please just accept this price. Your insurance company and the hospital have already decided on a negotiated rate and it’s really just best that you accept this price, pay it, and move on. See how expensive this birth was? You’re lucky that your insurance company is paying so much. So just suck it up and pay. There’s no free lunch, Friend.

***

I’m not the only one who has a problem with this.

“Childbirth is the number one reason why people go to the hospital,” reports Vox’s Johnny Harris in this well-researched video on this very topic. He finds that prices for uncomplicated deliveries in the United States vary from $1189 to $11,986.

I have to admit, I am slightly jealous that their out-of-pocket expenses were only $841.

But who am I kidding? Many, many Americans now have deductibles as high as $6000 now, making my $1000 deductible seem enviable.

The truth is that knowing the costs of this birth would have been helpful for me and my husband, but it didn’t break our bank. We earn enough money jointly that we can absorb a financial blow like this.

But what about the millions of Americans who can’t save $5000 to have a baby in a hospital?

What about those Americans who are “too rich” to qualify for Medicaid, but not rich enough to afford any kind of useful health insurance plan? One that doesn’t deter people from seeing the doctor simply because of the cost?

So politicians, quit telling people that they should learn how to make wise choices so they can save for their health care costs.

And quit telling people that they should “shop around” for their health care costs. 

Not only is it demeaning, but often it is completely impossible.

When Pro-Life is Anti-Health

I’m an avid watcher of Samantha Bee.

I love her so much.

In a recent episode of Full Frontal, she dives into the murky intersection of women’s health, abortion, and miscarriage. While the media prefers the clear-cut terms of “pro-life” and “pro-choice,” Samantha Bee has brought together a collection of women’s interviews that demonstrate just how complicated these issues are.

Especially when those issues are governed by a specific set of religious views.

In these interviews, women describe how and why they were denied care by Catholic hospitals that were required to follow a Catholic health care directive that forbade doctors from providing birth control, performing tubal ligations, or performing abortions.

Even if the life of the mother was at risk.

I’ll let these women speak for themselves.

***

Mindy Swank: Forced by a Catholic hospital to continue an unviable pregnancy after her water broke.

“…he tried to breathe, he was turning blue… he wasn’t conscious. It wasn’t a magical time, like people think.”

Dr. Rupa Natarajan: Describes how the directives restricted her ability to care for her patients at the Catholic hospital where she worked.

“…to save her life, I needed to terminate the pregnancy. But because of this religious directive, I had to transfer her to another facility when she was medically unstable.”

Jennafer Norris: Denied a tubal ligation by a Catholic hospital during emergency c-section, even though her life would be at risk if she were to get pregnant again.

“I had to make a choice to survive and to give my child the best option.”

Melanie Jones: Spent two weeks bleeding and in unnecessary pain after a physician at a Catholic facility refused to remove her dislodged IUD.

“…Because my IUD was a non-hormonal type of birth control… (the doctor told me that) the sole purpose of your IUD is to prevent pregnancy, so we can’t help you.”

***

Take a good look at these women.

I hope that you remember them the next time you think that anyone–religion or government–should come between a woman and her health care.

I believe and will always believe that women deserve to be trusted to make the best decision. As Mindy Swank said,

“I was the only person in the world who loved my baby… and yet people who don’t know me and don’t care about us, who never have to live with the repercussions, were making decisions for us. And that just feels very wrong.”

Global Billing: Wait, You Want Me to Pay Before the Baby is Born?

Let’s imagine that I need knee surgery.

Let’s say the total estimated expenses for my knee surgery are $20,000.

I have “fairly good” health insurance (at least these days…) so I will pay my $1000 deductible and then 20% of the total costs as co-insurance, which is $4000. And of course, we’ll be paying with our credit card which has a 10% APR (because who has $5200 in their savings account anymore?)

When will I pay for these costs? After I have the knee surgery, right?

Ah, but then the surgeon says, “Yeah, we’re going to need you to pay for the procedure in full, at least a month before your scheduled surgery.”

Wait, what?

Seriously?

And this is becoming a standard practice for obstetricians now. Take a look at these discussion forums, in which mothers talk about the different variations of this wonderful billing protocol called “global billing.”

In some cases, you may have the added bonus of paying two deductibles if your baby was conceived in one calendar year, but born in the next. (Which, by the way, is anyone who conceives a baby from April-December.)

(And in case you’re wondering, it’s also terribly expensive to not have a baby. When I miscarried last year, our out-of-pocket expenses were $1500 for a D&C.)

Global billing can be useful. It simplifies all the billing involved in prenatal care by bundling all the prenatal visits and the obstetrician’s fees for delivery into one big package.

When I had my first child, that obstetrician also practiced global billing, but she didn’t send me a bill until all the services were performed. Then, we got a big, fat $3000 bill about a month after our daughter was born.

That was exciting.

money

***

With this pregnancy, our estimated out-of-pocket expenses begin at about $1400, just for prenatal visits and delivery.

And then there’s that lovely line in the letter explaining that they would like to start immediately collecting payment for all of these services… at my next appointment.

At 23 weeks.

Oh, and…

“These fees are to be paid in full by the 35th week of your pregnancy.”

Their administrative assistant delicately told me that these expenses would not include the hospital costs or ultrasounds.

So let’s add those expenses here:

  • One ultrasound at 20 weeks. (about $300)
  • Any non-stress tests.
  • My hospital bed for 2 days: $1720 (20% of $8600)
  • My baby’s bed in the nursery for 2 days: $1120 (20% of $5600)

Even if I don’t use it. That’s right. Even if I room-in the whole time, I will be paying for the availability of the nursery bed. Ha!

  • Anesthesiology fees, if I have that.
  • That newborn hearing test machine that will roll into my room and seem like a good idea. ($400. Not covered by insurance).

I mean, really. What other medical procedures do physicians require to be paid for in full before you have them done?

And by the way, I really hate referring to birth as a medical procedure. I did all the work until the baby came out. I humbly acknowledge how many people were required to pick up the aftermath of the birth and take care of me during recovery, but I was the one doing the “medical procedure” for the first 34 hours.

Maybe I should be paid. Ha!

When I told my husband about all of this, his response was, “They aren’t getting a dime until after January 1st!”

You know, when next year’s FSA accounts go into effect.

You know, after the baby is born.

The good news is the hospital’s billing department is agreeing to let us start paying after January 1st. Nice of them, huh?

But really, isn’t it a bit strange that we have to request this?

The Things You Can’t Leave Behind

I’ve spent most of my life counting.

Adding.

Subtracting.

For most of my life, everything has been numbers. Everything has had a price.

When I started to work at 16 years old, I learned that even my time had a price: $7.14 per hour. Eight hours of cashiering, standing on my feet, and pushing Target credit cards on customers–that was worth $57.12.

Minus taxes.

Plus the ten percent discount on anything I bought there.

Minus the cost of uniforms.

Minus the cost of gas and car insurance.

Plus a hot dog if I got to work the food court—and if there were any left at the end of my shift.

***

When I started college at Miami University in Oxford, Ohio, I was surrounded by new rules that I didn’t understand.

Why didn’t she finish her fries? Is she just going to throw them away?

Where did this “North Face” brand come from? Everyone here is wearing it.

Am I going to what? Rush? Rush what? What are you talking about?

At some point in my freshman year, I learned that thirty percent of my classmates were coming from families with an average income over $200,000. Over $200,000.

Oh.

I couldn’t even imagine it. $200,000. It was an astronomical figure. It was fourteen full-time Target cashiering jobs. Fourteen!

I was fairly certain that my parents may have managed to pull in about $75,000 together, at the height of both of their careers (but then downsizing and disability stepped in.)

Although I moved solidly into the upper middle class when I married my husband (yes, I’m one of those kind of women), I still don’t feel like I belong. For me, this new social class is a coat that I’ve been trying to zip up for the past ten years. I can’t ever get the zipper to the top to keep everything in place because it keeps getting stuck on past assumptions and expectations.

I feel this tension at odd moments—when I’m talking with another mother who is pushing to get her 2-year-old in the next class, because he can already count to twenty. Or when I overheard a group of college girls talking about when their flights leave for home. Or how about when I was sitting with other members of my church, and they were talking about just how many activities their kids have to do to get into college. Orchestra, soccer, show choir, it’s outrageous!

I find myself nodding politely in these situations, fake smile across my face, Oh yes, that’s a tough spot.

I feel like a liar.

I feel like an impostor.

I feel like at any moment, someone is going to figure out that I don’t belong here and call me out on it.

***

It wasn’t until I got married and we joined our bank accounts that I felt like I could really breathe. I had about $50,000 of student debt from my undergraduate degree (working while going to college didn’t make that much of a dent). Thankfully, my graduate degree came for “free.” All that was required of me was two years of my youth and my commitment to teach and grade stacks of essays for first-year composition courses.

Although my husband got a job as an electrical engineer as soon as he got out of college, I stumbled around academia and the world of on-line education for five years until I couldn’t stand making $18,000 per year anymore. During those five years, my time was segmented and measured unevenly. $11.00 per hour for the on-line tutoring job. $18.00 per hour for grading standardized tests on-line. $1200 for teaching a three credit hour course for ten weeks. Multiplied by three courses. Minus any benefits. Divided by the uncertainty of knowing if I had a job in another ten weeks. No one could decide how much I was worth and so *I* couldn’t decide how much I was worth.

From my first year of teaching at a university, 2006. Making maybe $17,000 per year for teaching a full-time course load.

From my first year of teaching at a university, 2006. Making maybe $17,000 per year for teaching a full-time course load.

When will we have full-time jobs? Well… we want to stay small. And your pay is similar to what others are being paid for the same work elsewhere, sooo…

Although everyone wanted a piece of me, no one wanted to take a big enough piece that they would have to insure me. And they certainly wouldn’t take a big enough piece of me that would require them to accept any criticism or–as I call it–“guff.”

Do your job, keep your opinions to yourself, and we’ll all get along fine.

As fortune would have it, when I finally decided that I had had enough of academia, the floodgates of international students opened and ESL teaching jobs became abundant where I lived. Full-time jobs for everyone!

Benefits? Yes! Full benefits! Can you start tomorrow? Do you have friends we can hire?

Ah, life.

***

It wasn’t easy for me to make the mental shift into the middle class.

I remember a few weeks after we got married in 2005, my husband and I were shopping for a Christmas gift for my parents. We decided to buy them new sheets and a new comforter set. We stood in Target and all I could do was look at the price tags: $69.99… $89.99… Oh, here’s one that’s only $49.99! I picked up the cheapest set of sheets and handed them to my husband.

He turned the package over in his hands and then gave it back to me.

“Sweets, we should get them nice sheets.”

I looked back at the price tags. Is he really okay with spending $69.99 on sheets? I reluctantly picked up the more expensive set.

He shook his head and picked up the $89.99 set.

I was dumbfounded. That set hadn’t even been a possibility in my mind.

“You don’t think that’s too much?” I asked.

“No. They’re your parents.”

I bit my lip.

“What about the comforter set?” I asked.

“Okay,” he turned to look at the options on the shelves. “Which one do you like?” he asked.

“We’re still getting a comforter?”

“Yeah, that’s what we came for, right?”

“I just didn’t know we were spending so much money.”

“It’s Christmas. It’s your parents. How much money did you think we’d be spending?”

I shook my head. “I don’t know… maybe $50?”

***

We had a lot of these conversations early in our marriage. Me, constantly dumbstruck that we had enough money to go out to eat several times on the weekend; constantly amazed that my husband never, ever looked at the prices of food when he bought them; constantly waiting for a bill to come in the mail that we couldn’t handle.

That moment never came.

Maybe I was so surprised by his somewhat cavalier attitude toward spending money because he also came from a working class family. He was the youngest of six kids. A Catholic family. His father was a carpenter, his mother a stay-at-home mom. Money was always tight—but somehow they made it work.

And that was how I remember my childhood. My father was a baker (and later a bakery specialist).

Dad in his element, 1990

My father in his element, circa 1990.

My mother was a cake decorator. Our family of six moved from rural Minnesota when I was four to a rough part of Dayton, Ohio. We adopted my youngest sister (my biological cousin—a long story) and became a family of seven.

In urban Dayton, I learned the difference between poverty and working class.

Poverty was the children at my school who descended hungrily on their hot school lunch trays,  ripping the plastic film that sealed them, scraping the sides of each compartment clean. Not one carton of chocolate milk went into the trash.

Poverty was a friend’s house that I visited when I was six—its carpet spotted with dog shit.

Poverty was that friend’s refrigerator, warm to the touch, holding ketchup and orange soda.

I was not in poverty.

***

When I was seven, we moved away from the urban Dayton to a working class suburb, Huber Heights, Ohio. There, we rented a three-bedroom ranch house for the seven of us. My parents got a room. My two brothers got a room. My sisters and I got a room. It was 1,080 square feet of close quarters. We furnished it with a living room set from Rent-A-Center and my parents even splurged on a Nintendo (five years after its original release date).

But it was home.

Sadly, one of the best kid pictures we ever took. I was especially proud of my pink sweatsuit. (circa 1989)

Sadly, one of the best kid pictures we ever took. I was especially proud of my pink sweatsuit. (circa 1989)

***

For me, I still see the world through working class eyes. I feel deep compassion for issues like increasing the minimum wage, providing universal, affordable health care, and fighting food insecurity. I’ve seen the difference that an extra $100 can make. It means a week of groceries from Aldi. It means you can afford to stay home from work while you’re sick.

Seeing the world through upper-middle class eyes feels like an exercise in putting on someone else’s glasses. Everything is distorted. Prices seem too expensive. I underestimate how much my time is worth. But it’s more than money. I also do this with possibilities and opportunities. The world is not my oyster–at least this is my default mode. I have to jazz myself up with positive self-talk and assurances that things can change. My life can be different. I can reach the goals that I have set for myself. If I lose that rational, optimistic side of my brain, I become a prisoner to my own self-doubt.

***

Growing up as a child of a working class family shaped my core identity. It set limitations and boundaries on my dreams. (Maybe I could be one of those typists in a courtroom!)

It taught me that my chief value as a human being was determined by what I could do for others, especially when I could be used to help someone else make a profit. In those situations, I had the most value. I wasn’t explicitly taught these lessons. Instead, I learned them by observing my father put up with a stressful job his whole life, rather than looking for another job somewhere else. I saw his fear of the uncertain–the fear of redefining himself. He was a bakery specialist. That was who he was, damn it. How could he be anything else?

***

I’m keenly aware of my own struggle to define and redefine myself.

Fat girl, thin girl. Poor girl, rich girl. Retail girl, academic girl. Single girl, married mother. All of these boundaries I’ve crossed and all of those that still remain ahead of me.

And yet…

…it’s not like crossing over, as if you leave those things behind.

I’m still overweight and poor, a retail worker and a single girl.

It may have been years since others have seen these facets of my identity, but they are still there, buried beneath the others layers of self that I’ve put on over the years.

I still have all of those identities. I don’t think I’ll ever be able to leave them behind because they are too much a part of who I am.

Who I am is… every version of myself that I have ever been.

These are the things I can’t leave behind.

***

This might be the biggest weight upon my shoulders as I consider parenthood–knowing that the life that I build around my daughter is creating its own set of assumptions, limitations, and boundaries. This life that we are creating for her is also creating things that she won’t be able to leave behind.

This cannot be avoided–it is a part of socialization.

But I feel that one of my greatest responsibilities (perhaps even greatest “calling”?) as a parent is to create opportunities for my daughter to see the world through someone else’s eyes.

Because this fosters compassion.

And compassion, I believe, is the only thing that has ever changed the world for the better.

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