Finance Info, Insurance, & Pricing

Finance Overview

The cost of medical care has to be one of the most complex topics known.  One need only look at an EOB (explanation of benefits) received after a visit to your physician to find evidence of this.  I can’t understand the EOBs resulting from the care I personally provide. It is popular for politicians and policymakers to talk about “price transparency” and their plans to make us all better consumers of healthcare services through access to better cost information.  However, the implementation of this strategy has left us with nothing resembling a better understanding and it’s made us only more confused consumers.

Try calling a hospital and asking them how much the charge will be for simple, routine vaginal birth.  As evidenced by this recent article in the Journal Gazette, despite the new law requiring hospitals to publish standard prices online, information is no easier to obtain and what is available is often incomprehensible.

You may be shocked to learn that one of our local hospitals charges over $7,000 to rule out false labor. It is our goal to make out-of-hospital birth available to anyone and everyone who desires it.  We have and will continue to do all within our power to keep the facility fees as low as possible.

It is our goal at the Holy Family Birth Center to actually achieve transparency in pricing.  What follows is our attempt to make this remarkably complex topic understandable and provide information that you can use effectively.  Below you will find the most transparent, honest discussion of fees you will ever encounter. It is our hope that we set a standard that others choose to follow.

Professional Fees

Professional fees are charged by your provider(s) for pregnancy care.  This is usually referred to as a “global fee” that includes prenatal care through the pregnancy, labor and birth, and postpartum care. This fee will vary depending on the specifics.  For instance, if a cesarean section is performed the global fee is higher than if a vaginal birth occurs. Ultrasound exams and laboratory studies are not included in the “global fee” and are additional charges. Professional fees are billed to your insurance company and they are included with the hospital facilities fees in terms of meeting your deductible, out-of-pocket limits, etc.  

Facility Fees

Facility fees are charged by the facility in which you give birth for the use of their facility. These fees will vary based on the specifics of your labor and birth. In a hospital, for example, a routine vaginal birth will have lower charges than a cesarean birth. In general, the insurance company is not concerned with the actual facility you utilize, although increasingly insurance companies are directing you to use one facility over another.

Both the professional fees and the facility fees are paid by your insurance company based on negotiated rates with each company.  For example, United Health Care may pay the hospital more than Aetna for the same procedure (a birth, in this example). The amount the insurance company pays the hospital (facility), in general, is not related to the amount the hospital charges, but rather on negotiated rates set in advance.  The same is true of professional fees. That is, the amount a given insurance company pays a provider for the global fee is not typically related to the amount charged by the provider. Rather, it pays a fixed amount for the global fee that is negotiated in the contract between provider and insurance company.  

In most cases, the combined professional and facility fee charges will be greater than your deductible.  Therefore, you will pay out of pocket the amount of your deductible and your insurance company pays the remainder up to the maximum negotiated amount.  So both the professional and facility fees contribute towards meeting your deductible.

So how will things work with Holy Family Birth Center?

Unfortunately, your insurance company does not value birth center birth.  Of course, they should because, if for no other reason, the cost of a birth center birth is a fraction of the cost of hospital birth.  You would think the insurance companies would be encouraging families to choose birth center birth…but that discussion is for another place.  

Your insurance company will receive a bill for the professional fees (your prenatal care and any additional tests such as ultrasounds, the birth, and postpartum care after your birth at the birth center).  This will be handled by your insurance company just as it would if you were to give birth at the hospital. The facility fee from Holy Family Birth Center will not be billed to your insurance company.  You will be responsible for the facility fee and we will give you a “superbill,” which is essentially a receipt that you can submit to your insurance company.  Many companies will reimburse you a portion of that facility fee. Some, however, will not reimburse you, but rather treat it as an “out-of-network benefit.” This means it will be applied to your special out-of-network deductible, which in the majority of cases is greater than the facility fee.  This means in all likelihood you will be responsible for the entire facility fee.

Professional Fee: $3,415

The professional fee for basic prenatal care, labor and birth care, and care during the postpartum period will be submitted to your insurance company by the providers of the Fertility and Midwifery Care Center (FMCC). This fee will be paid to FMCC by your insurance company, less your deductible, based on the specifics of your individual insurance plan.  This fee is $3,415.

Additional Potential Fees

There are potential, optional additional facility fees including: nitrous oxide for anesthesia ($150), IV saline lock ($25), IV ampicillin ($25 per dose), vitamin K injection for baby ($75), among others.

Facility Fee: $4,000

The facility fee for labor and birth care is $4,000.  The fee is the same if you labor a few hours or a few days.  The fee includes postpartum stay for the mother and baby of up to six (6) hours.  There is the option of staying beyond six (6), but no more than twelve (12) hours after the birth of your baby.  There is an additional $100 per hour charge for every hour beyond the sixth (6th) postpartum hour.  Should it become necessary to transfer to the hospital before or during labor there will be a partial refund of the facility fee. If transfer occurs after 36 weeks of pregnancy but before labor there is a nonrefundable fee of $500.  If transfer occurs during labor but at less than five (5) hours in the birth center, the fee is $1,000 ($3,000 refund).  If transfer occurs during labor, but after five (5) hours, the fee is $2,000 ($2,000 refund).  The cost of educational classes through Birth Matters is not included in the facility fee (see www.birthmatters.com).

Additional Potential Fees

There are potential, optional additional facility fees including: nitrous oxide for anesthesia ($150), IV saline lock ($25), IV ampicillin ($25 per dose), vitamin K injection for baby ($75), among others.

Payment Schedule

The facility fee must be paid to Holy Family Birth Center in full by 36 weeks of pregnancy.  If the fee is paid by 28 weeks of pregnancy there is a 10% discount.  If paid by 32 weeks of pregnancy, there is a 5% discount.  If a credit/debit card is used there is a 2% surcharge.  All fees are health savings account (HSA) eligible.  There is 12-48 month financing available through United Medical Credit with interest-free options for qualified applicants.

Insurance

Anthem Blue Cross Blue Shield

We are so excited to announce that as of May 1, 2020 the Holy Family Birth Center will be an in-network facility for patients with Anthem health insurance.  This means, among other things, that the out-of-pocket costs for a family utilizing the birth center will be the same as that of a hospital.
We know many of you have been anxiously awaiting this announcement and it couldn’t come at a better time with so many families hoping to avoid being in a hospital during the coronavirus pandemic.  Of course, the same rules involving deductibles, co-pays, etc. will apply to the birth center facility fees as they would if you used a hospital for your birth. Note: HFBC will not be listed as in-network on the Anthem website for several months.
Please Note: Anthem Medicaid Insurance is not credentialed

A note of future health insurance coverage:

It is our hope that more insurance companies will follow Anthem’s lead and come to recognize the outstanding value of birth center birth in terms of lower overall costs, greater safety, and quality outcomes, and superior patient satisfaction.

Questions?

We hope this discussion has been helpful.  Should you have questions about the fee structure at the birth center please don’t hesitate to contact us and we will be happy to address your questions.  If you are interested in the birth center, but feel you cannot afford the facility fee please contact us.  We pledge to do our best to find a way to make birth at Holy Family Birth Center a possibility for everyone who desires it.