An Itemized Billing Statement Hates To See Me Coming
Raging postpartum mom: 1. Hospital billing department's suspect labor and delivery charges: 0.
*This is a one-off digression from my usually creative-focused personal essays, but I finally resolved a months’ long battle with a hospital billing department and want to help other mothers feel less stressed than I did after receiving my (inaccurate) labor and delivery bill.
Life admin after the birth of my daughter came for me at full force.
Wells Fargo, an unethical company I will publicly bash in perpetuity, erroneously closed my bank accounts without notice six days after I was discharged from the hospital following the birth of my daughter.
My local branch had called me a few weeks before my scheduled c-section about an “address discrepancy.” For a business, the address listed with a bank must be a physical address, which had already been on my accounts for six years when I first opened my virtual law firm. Apparently, my account was flagged by a robot. Go AI!
After spending two hours inside my local branch several days after that initial call, waddling around the lobby hoping my water didn’t break on the linoleum floor, the banker who was attempting to resolve my issue did not understand the policy and could not give me a solution.
No, I cannot come back next week. Yes, I have given you everything you’ve ever asked for. No, I have never had any problems. Yes, all of my licenses are active.
A little over a week later, despite no formal warning as required, Wells Fargo permanently closed my bank accounts, including my law firm’s trust accounts. Which meant I had no way, six days postpartum, to receive income, ensure compliance with the state bar, pay my bills, or receive my state maternity leave.
Wells Fargo didn’t care that I was leaking milk, rolling on the floor with mastitis, unable to sit-up on my own. It didn’t care that I would now be saddled with an onslaught of tedious logistical tasks in the throes of my first weeks postpartum when I should be focused on helping my baby latch to my breast.
It also didn’t care that I had run hundreds of thousands of dollars through its company throughout the past two decades. I was just a number in its system. I would find a new bank and the company would never hear from little old me ever again — except on this Substack rant. Who was I but a mere pregnant lady, just one irrelevant droplet in an entire profit-driven ocean?
Shortly after this whirlwind, a second life admin hiccup came upon me: my labor and delivery bill from the hospital where I birthed my daughter, which was, unsurprisingly, incorrect.
Moms, humans, you have rights. You don’t have to pay thousands of dollars you don’t actually owe to for-profit medical conglomerates. I know you’re tired of all of this nonsense, but you must know that you can fix it.
Every mother deserves to be treated with dignity in healthcare.
EVERY BODY deserves to be treated with dignity in healthcare.
For the moms especially, I’m sharing this post to provide some strategies to help you navigate the messy, bully-ish system of medical billing before and after you give birth so you hopefully have less surprises than I did.
*References here to my “provider” are to the hospital facility where I delivered, not my actual OBGYN and her wonderful practice.
Before Birthing
Request Estimates
1 — Ask your medical provider for two estimates in writing for a standard birth without complications: one for a vaginal birth and one for a c-section.
You will usually need to contact the hospital or medical facility you’re planning to deliver at directly, as they will be responsible for submitting the CPT codes (each CPT code corresponds to a specific procedure). Most offices should be able to provide this for you. I got the runaround the first time I asked, hearing “We don’t know what the charges will be, it depends on what happens during delivery.” If you receive this notation, ask for a higher-up; it’s not true. They can give you an estimate.
Vaginal (uncomplicated) routine delivery: CPT 59400
Cesarean (uncomplicated) routine delivery: CPT 59510
*These are the standard CPT codes; your facility may have their own procedure codes, but you should be able to receive estimates with these codings.
My estimate was provided on MyChart through my provider’s portal. If your provider doesn’t comply, you can also ask your insurance company to follow-up on your behalf.
2 — Ask your medical provider if the estimates provided include the standard charges for routine newborn care without complications. If yes, ask for confirmation in writing. If no, ask for an estimate in writing for your baby’s standard newborn care.
I didn’t know this, but your newborn will receive a separate bill after birth.
The general estimates do not always include the separate charges for your newborn and care for your newborn is not considered “postpartum care.” The system views your new baby as a new patient to bill, even though the baby’s bill is obviously yours. Welcome to the world, young taxpayer!
Fun conversation with my insurance company: “Your baby didn’t meet her deductible, that’s why there’s also an added copay in addition to your copay.”
Oh, I’m sorry, was she supposed to do so while swimming around my placenta, or did you expect her to meet her deductible on her way out of my abdomen?
After Birthing
Request Medical and Billing Records
1 — Download all records from your medical portal.
The provider does not always dictate your medical records correctly. As soon as your records from labor and delivery are published to your patient portal, download them.
If there are inaccuracies, your provider will have an amendment form (you may have to call for this) that you can fill to correct your record. This is especially important if you plan to apply for life insurance — my record had a “smokeless tobacco” history marked that was entirely random and negatively impacted my application albeit inaccurate.
You will also need to contact your provider to add your baby to your medical portal. There is a sneaky set of separate newborn records that aren’t automatically added to your own account. You have to ask to connect your child’s separate account to your portal.
2 — Request all records via HITECH Act.
For anyone needing to request bulk medical records, you should submit a request under the HITECH Act. Some providers will provide your labor and delivery records for free using the facility’s own HIPAA form, but if there is indeed a massive charge, you can pull the request and submit a new one via HITECH Act.
Re HITECH, the provider CANNOT charge you more than the cost of retrieving the records, usually maxed at $7. They will be delivered electronically.
Here’s the HITECH Form I use for my clients (the medical records requested, aka the bulleted items, can be customized):
Review Your Bill
1 — Review the charges listed on your bill.
You will likely receive your bill about two months after delivery. Review this in detail. What to look for?
Umbrella charges — a provider cannot simply write “newborn care.” Every medical procedure, medication, activity must be delineated and itemized.
Double-billing charges — do two charges look similar? Do you and your newborn have an identical charge? If so, it’s likely double-billing. A hospital is not permitted to bill you for the same charge twice. Usually, this looks like a slightly changed descriptor for a duplicative service.
Charges for services not provided — were you charged for a warming bed even though there wasn’t one in your room? Flag it.
2 — Request an itemized statement of the charges provided.
Most bills will not have your procedures itemized. A hospital is required to provide an itemization of all services rendered, and you usually have to ask for this separately after the bill is published.
My provider itemized my cesarean procedure but umbrella charged my newborn. An umbrella charge is generally impermissible because it indicates that you may have been charged for services that were not actually provided (some facilities use an umbrella charge for routine newborn care to make billing more “efficient” but you should be notified ahead of time of what exactly that includes so you can take advantage of all services provided).
You can ask your provider before labor and delivery if they use umbrella charges for newborn care to prevent any such surprises.
3 — Ask the billing office for an extension to pay the bill.
If you’re uncertain about the accuracy of any amounts owed, call your provider’s billing office to ask for an extension, which can usually be granted up to 3 months past the original due date. An extension can also be renewed if the bill is still under formal review and you update the billing department.
4 — Negotiate payment of your bill.
If your bill is accurate, you can still ask the provider’s billing office to reduce the charges. You simply need to ask.
Most facilities will offer a discount if you offer to pay the balance in full on the phone (typically a 10% to 20% reduction). If the first customer service representative says no, ask for a manager.
Most providers also offer interest-free payment plans.
Lastly, you can ask your insurance company to resubmit a claim to ensure all charges were paid for accurately and fully per your insurance contract.
Request Oversight
If you believe you have been incorrectly billed, you have several options:
Contact the provider’s billing office directly. Ask for a formal review in writing to verify the accuracy of the bill and clarify any discrepancies notated.
File an appeal with the provider’s billing office. I don’t find this avenue to be particularly helpful because the provider will usually self-certify its own wrong-doing, but each facility should have a procedure to do so as an option.
File a complaint with your state’s Attorney General’s (AG) office. Don’t be afraid of this! This is not a lawsuit — it is simply an online, administrative inquiry form that triggers the AG to inquire on your behalf with the provider. Usually, this indicates to the provider that (1) you’re willing to involve the government and (2) you’re onto them so they better rectify any potentially impermissible activity.
If you pursue any oversight options, you should include a letter outlining the specific issues you’re alleging. I included things like this in my own AG complaint:
This complaint centers on two primary issues: (1) double-billing my daughter for the same charges already paid under my name and (2) impermissibly charging me two “umbrella charges” for services not actually provided in the amounts of $4,300.
Within these central issues, XXX has also utterly refused to provide an itemization for the “umbrella charges” billed to me, and has provided a self-certifying “confirmation” letter authored by nobody in particular that states the charges provided are accurate, despite the fact that not a single person on the hospital staff or in the billing office can even give me an explanation of the ICD-10-PCS codes billed under my newborn daughter’s name.
Purpose: to summarize the primary issues and to demonstrate non-compliance.
“Evaluation and postpartum care…intake/output monitoring…routine screenings (someof which I declined), and complete physical exam of the newborn” are summaries of services, not services actually performed. For each of these healthcare actions, the services should be documented in my medical billing record. There is no distinction in the billing “description” between these “services” or the room and board charge, allowing XXX to attempt to deceptively get away with double-billing for one room. If the umbrella charge covers nursery and medical costs, it should distinguish between the two, but it does not. Also, again, the medical costs are not itemized.
Purpose: to illustrate the provider’s failure to provide verification of its own charges, supporting my notion that they are indeed incorrect.
On the attached Explanation of Charges, under my own name, XXX has billed HC R&B-Semi-Private OB twice. This was for my hospital room. The amount is $4,342.00 per night. This is nearly identical in code, description, and amount as the “umbrella” charge is for my daughter. In other words, XXX bills the mother $4300 for “room and board” (R&B) then changes the code slightly and calls it an “umbrella charge” for newborn care (R&B). This is the same charge with a slight variation designed to appear “different” when it is in fact double-billing.
Purpose: to show sneakiness, supporting my notion that there is an attempt to over-bill me.
XXX has an online “estimator” tool for labor and delivery charges. I submitted my information for my expected cesarean section delivery prior to my due date and received a formal estimate that detailed I would owe $0 based on my insurance. While I understand this is an estimate, the tool completely neglected to inform me as a patient that my daughter would have an entirely separate bill upwards of $10,000. This is inherently deceptive.
Purpose: to show a lack of transparency. This above-quote, stuck at the end of my letter for emphasis, is what ultimately solidified waiver of my bill.
I know this was a boring love letter, but I hope it helps you anyway (in the words of Bluey’s mom, “Sometimes the boring things are important.”).
We will return to the Land of Imagination next week — and stay there.
In the meantime, you’ve got this, moms.
💌
Xo,
Violet Carol
Thank You for Reading 🩵
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On Call for the Mothers! Assemble series — Body Image Postpartum 🗯️
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Mothers Assemble #2: On Body Image in Pregnancy (feat. 6 Substack mothers)
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What a generous love letter — to share this info with other mothers. Will share to US friends. Also, wow. I cannot believe the shit you have to deal with. We’re so lucky in the UK/Australia — and anywhere else you can give birth for, essentially, free.
Such important information!!! So wonderful you shared this.💗