Below is the breakdown of how much it cost Sarai to deliver her baby in a US hospital, which she received in three separate bills. While she was billed for over $47k, after insurance, she paid $2,205.09 out of pocket.
Not surprisingly, thousands of people swarmed the comments to compare how much they pay in their countries...or rather, what they don't pay at all.
People also called for "the girl with the list," referring to the woman who has been documenting her never-ending list of all the reasons why she never wants to have kids on TikTok (which includes the price tag).
As a little refresher, unlike other countries, the United States does not have universal healthcare, and instead offers a mix of public (e.g., Medicare, Medicaid, and the Children's Health Insurance Program), private, for-profit, and nonprofit healthcare and insurance options.
All that being said, I, like many others, was left with many questions following Sarai's bill. Like, who has tens of thousands of dollars lying around to pay a bill like this?
So, I reached out to Christy Snodgrass, a registered nurse and patient and healthcare worker advocate, to help me understand Sarai's bill — like why it costs so much, what she would do without insurance, and what people can do if they're unsure about charges on their hospital bills.
First and foremost, Christy is no stranger to these questions. In a previous TikTok video she made, Christy said she gets tagged in videos like Sarai's all the time. When people ask her how a baby delivery can cost up to $50,000, she explained, "It doesn't. It is a made-up price. Usually, it's called a chargemaster price, and it's essentially just a negotiation starting point between your hospital and your insurance company."
And while many of us often say, "Thank god for insurance," Christy noted that insurance companies benefit from the hospital's high prices as well. "When a hospital bills you tens of thousands of dollars for a service and your insurance company comes back and says you only owe a few thousand dollars, it looks like your insurance company saves you a lot of money — that's good advertising," Christy said.
"In addition, the more and more expensive that healthcare costs become, the more and more people there are that feel forced to buy insurance to avoid financial ruin. That's cornering the market."
Lastly, Christy noted that billing ridiculously high prices benefits hospitals when charging uninsured patients as well. "When uninsured patients get these astronomical bills, hospitals will often offer them a 'cash price discount.' This is where they mark down bills significantly, sometimes giving the patient up to 50% off their bill," Christy explained. "Then they look like they're the good guy giving the patient a huge discount."
So, while Christy said $50k can be "a very typical amount listed on a patient's bill," after giving birth, as it was for Sarai, it's important to remember that this is not what it actually costs a hospital to perform the services. "By keeping the starting price ridiculously high, hospitals are still able to make a profit even after the insurance company negotiates the price down," Christy told BuzzFeed.
So, let's say Sarai didn't have insurance and she was faced with this daunting $47k+ bill. Christy laid out three things patients can do to prepare:
1. First, Christy explained that the Pricing Transparency Act went into effect in 2021, which mandates that hospitals need to provide pricing information about the services they provide online. So, if you're expecting to deliver a child, you can visit the hospital's website to look at costs, and compare them to other hospitals in the area.
2. Second, Christy said that patients can ask the hospital for a Good Faith Estimate, which is a written estimate for the services expected to receive. Christy said, "If a patient who received a Good Faith Estimate is billed significantly more than what their estimate showed, there is a formal dispute process a patient can pursue to challenge the bill." However, Christy pointed out that while the hospital is required to give Good Faith Estimates for scheduled services, like a planned C-section, they are not not required to give estimates for unplanned services like a spontaneous delivery.
3. Third, Christy told BuzzFeed that many hospitals have financial assistance policies in place that can reduce or completely eliminate hospital bills based on a patient's income. Christy said, "Patients can typically view these policies on the hospitals website to see if they may qualify. If the patient has already received a hospital bill and needs help applying, the nonprofit organization Dollar For will help them apply for free."
And, if you're ever unclear about what you were charged, Christy said it's best to ask for an itemized bill. She said, "An itemized bill will be a line by line breakdown of the services you received. Itemized bills are a part of patient’s protected health information and therefore covered under HIPAA laws, [which] state that hospitals must give itemized bills to patients within 30 days of their request."
In a video detailing how to negotiate medical bills, Christy further highlighted just how important it is to get them itemized. She said, "Some patients will get a huuuge bill in the mail, and then when they ask the hospital to break down the charges, sometimes, the total of that bill *magically* becomes smaller."
While this certainly does not solve America's healthcare problems or medical debt, which was estimated to be at least $195 billion in 2019, I'm glad healthcare reform advocates like Christy exist to help inform us about our rights and resources available as a patient. Of course, I wish we didn't have to worry about this at all, but for now, I'm going to hold this knowledge close and recite it every night to myself until the American healthcare system is a little less broken.
