The anatomy of a bill

by Catherine Lutz, Aspen Journalism
Normal vaginal childbirth is typically considered to be one of the more standard services a hospital offers, and therefore average charges should be easier to pin down than other diagnoses.

The unpredictability of childbirth costs is particularly frustrating for new families who are trying to budget for this most important life event. A number of women interviewed for this story expressed the stress the financial aspect layered onto an otherwise happy time.

“During my pregnancy and beyond I spent hours each month going over bills and explanations of benefits and arguing with my insurance company about coverage,” said Karyn Spiropoulos, a local mother who gave birth to her daughter at AVH in 2011. “They were determined to find any loophole to get out of covering me.”

In the end, insurance covered Spiropoulos’ hospital bill (after she met a $7,500 deductible), which was just over $17,000 for a normal natural childbirth and newborn care. That’s significantly higher than the $10,900 that the Colorado Hospital Association reported as the average charge for vaginal delivery and newborn care at AVH.

Another local mom had $8,300 in hospital charges at AVH for herself and her newborn in 2010 for a normal, natural delivery (well under the 2011 averages). This writer incurred just over $8,500 at AVH the same year (see detail below).

Why the big differences? What may seem to be relatively minor to a patient can dramatically bump up costs. Spiropoulos, for example, said that the only abnormality in her situation was “a slight case of jaundice” in her baby that required only an extra doctor’s visit.

Aspenite Catherina Lemons ended up paying much more than she expected for the birth of her daughter in 2010, which included $26,000 worth of hospital bills. Though she too had a normal delivery, she was admitted to AVH one extra night (in advance of the birth) due to high blood pressure. Lemons’ unexpected costs were mainly items her insurance company wouldn’t cover; the biggest was having a separate deductible to meet for her baby, something she said wasn’t explained in advance.

C-section births are more than double the cost at valley hospitals — an average of $18,900 at AVH and $24,100 at Valley View.

Local mom Misheel Chuluun, who had planned on a home birth at a cost of about $4,000, had an emergency C-section at Valley View to deliver her first son in 2010, and a planned C-section in 2012. With hospital bills of about $22,000 apiece, the total cost of the births of her two children was about $70,000.

 Chris Council/Aspen Daily News
A pharmacy technician works in the lab at AVH.

If you think having a baby in Aspen is expensive, try San Francisco. Aspenite Carmen Busch had hospital costs of $60,000 for a normal delivery at California Pacific Medical Center, a nonprofit academic medical center that apparently boasts one of the best neonatal intensive care units in the country. That and other state-of-the-art technology and maternity services probably drives up the operating costs exponentially, Busch said.

In order to give a sense of what goes into hospital charges, below are the details of two final bills I received from AVH after the September 2010 natural birth of my daughter. Total charges for baby and mother were $8,567, which did not include $3,700 in prenatal care and delivery charges from the OB/GYN’s office, nor in-hospital pediatrician visits. By contrast, the natural home birth of my second child, in 2013, cost $4,880, which included all prenatal and postpartum care, as well as newborn wellness visits for up to two months. The itemized charges shown here simply highlight how much higher hospital costs are than the perceived value of the item or service.

Maternity care:

• OB semi-private room (two nights): $2,576

• Pharmacy (over-the-counter painkiller): $11*

• Medical/surgical non-sterile supply: $366.44

• Medical/surgical supply/device sterile: $4.50

• Laboratory: $140

• Lab, hematology (blood test): $140

• Lab, urology: $25

• Labor room (based on time spent): $1,836

• Labor and delivery (nurses and other staff): $1,044

Total: $6,142.94

Newborn care:

• Hospital visit process fee (charge for hospitalist, doctor who manages overall care): $330

• Newborn nursery, level IL $1,676**

• Pharmacy (saline solution): $30*

• Medical/surgical non-sterile supply: $131.79

• Laboratory (newborn screening panel and blood draw): $169

• Lab chemistry: $87

Total: $2,423.79

*While it was shocking to get charged $11 for a Tylenol and $30 for salt water, here’s how Valley View CFO Larry Dupper explains it: “If you buy aspirin from the store, it might cost one penny. But for every aspirin we give, we have to spend 15 minutes documenting, keep the records for two decades, do the billing and more. So it literally does cost that to give one aspirin.”

Aspen Valley Hospital CFO Terry Collins said that the $11 aspirin is only problematic from a public relations perspective. It’s a charge that he would like to eliminate from patients’ bills, but that would have to be absorbed somewhere else to cover costs.

**A nursery charge of over $800 per night is added to all newborns’ hospital bills, whether or not the newborn spends time there. Hospital officials explained that this is akin to reserving a hotel room — you may or may not end up using it but it costs the hotel staffing and other resources to keep it available for you.