How Do Hospitals Charge for the Baby's Nursery?

Updated on February 16, 2010
S.M. asks from Plano, TX
9 answers

One of my babies was born under 6 pounds. The hospital said she was in the "intermediary" nursery because of her weight. They were allowed to code the claim/charges a certain way and it cost a LOT more than regular nursery. The problem I have, is that there was nothing wrong with her...she stayed in my room most of the time...and her twin (who was with her) was charged "regular" nursery until one day she dropped below 6 pounds.

Do all hospitals charge babies/infants based on their WEIGHT and not on the services or conditions?
I really feel this fraud to the consumer and to the insurance companies (which is the consumer ultimately).

I understand that you have to pay for a nursery bed, even if the baby stays with you...but to be charged THREE times the regular amount just because she was under 6 pounds sounds absurd. I can't imagine what they would have charged for NICU.

A co-worker said that I should look in to a class-action lawsuit. I'm not an expert on hospitals or medical costs, so I don't know what is the norm. Even if this is the norm, it is not right.

Just an update and clarification: My twins are now 22 months old. It took until they were 18 months old for the bill to get settled. My company self-insures (its not good coverage but better than nothing) the insurance company is not going to fight anything...they just administer. The Insurance company ended up eating the EXTRA $1000 because of their mishandling. I have been working with the hospital billing for well over 6 months. The hospital is part of one of the largest hospital chains in the nation. I asked for audits/appeals. They specifically called out it was for her weight - she was under 6 pounds. Period. No - it was not that she received or needed service - it was weight. This question is not just about me...and my measly $1000 extra that I was supposed to pay. I truly wonder how many others this happens to? If we all just say "oh well"...then it continues, and it snowballs and affects many. I even compared to my co-worker at another large hospital in the same city. Her child was over 6 pounds and had jaundice real bad...and he was charged as "regular" nursery...nothing special. And, insurance policies are all different. For instance, they first charged (coded) this twin the regular negotiated rate. However, the hospital re-submitted the claim with a different claim, and their "allowed" rate was triple the regular rate. Its bizarre...but even the insurance company spent many months on this and said that it sounded legit. I was even "warned" that the other twin may have been coded incorrectly (in my favor) and I had to watch out in case they resubmitted her claim. I could warn my Company that maybe the insurance company isn't being diligent enough...but I feel the issue is bigger than just my company.

I really appreciate these responses! I love this site!

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answers from Houston on

Dropping weight in infants is a very big deal and could be a symptom of other problems, especially with twins who are almost always born premature and are at risk for under developed lungs and other respiratory issues. So yes the hospital can charge more. You may not feel that they had a right to charge more, but they do so because those babies were classified as in need of different care. You may not have seen the extra monitoring, extra nurse or doctor visits, but they were there, even if a doctor just looks at their charts one extra time it will cost more.

If you have insurance though, it does not matter what your hospital charges because they can only bill you what your insurance states is your copay/coinsurance.

If you don't have insurance, call the billing department and ask for a medical review of the charges and diagnosis and state exactly what you said here that you do not feel that the service were warranted. They will have the medical records reviewed and have an explanation for you on why the charges are higher, or will remove any unnecessary charges. If that does not work you may have to write a dispute letter and/or request your medical records. Also ask what kind of financial arrangement they can make. many hospitals will discount the services if there is no insurance, they will definitely set up a payment plan, and also most offer prompt pay discounts.

I've been working in insurance and hospital billing for 15+ years, please feel free to send me a message if you need any more info or assistance.

R. :)

1 mom found this helpful


answers from Cleveland on

Don't waste your time, effort or money on trying to file a lawsuit. You would never win. And I doubt any lawyer would agree to take it on. If you have insurance, the insurance company will fight the bill if they deem it to be innacurate or inflated. Just be grateful that you have a healthy baby and focus your time and energy on your baby.

Hospitals charge what they have to in order to maintain their equipment and staff so that they can save lives. How many babies out there never would have made it if that hospital did not have the equipment and means to care for them? Also, keep in mind that frivolous lawsuits are part of the reason that healthcare costs are so high. And I don't mean to be rude, but this would be a very frivolous lawsuit!

If you want to have your baby in the safety and security of a hospital, then you have to pay the bill. If you are truly worried about the well being of your insurance company then I suggest you write your congressman and tell him how the government should change the laws in order to better protect the insurance companies.

Enjoy your baby!



answers from Salinas on

Hi S., my advice to you would be to not waste your time trying to sue. That is just a whole bunch of extra stress that you don't need right now. Enjoy your time with your new baby girl. Remember that extra stress can affect your breastmilk and your baby can feel your stress as well. Unfortunately, hospitals charge too much for everything and get away with it. Our local hospital accepts all insurance but is not a "provider" of any insurance so they can charge whatever they want. My insurance pays it's portion and I pay the rest of whatever the hospital bills for, that's how it works unfortunately. It's crazy and unfair but that's just how it is. I work at a surgery center and we use so many of the same supplies. It's ridiculous, the hospital will charge $100's for something that cost them pennies....literally. Like a bag of IV fluid costs them less that a dollar a bag and they will charge the patient $100.00 for one bag. It's like robbery. That's how the hospital makes it's money I guess.
Anyways, I have a 4 month old baby girl and she was born premature and weighed 5lb12oz. I was also charged an additional nursery fee and that was basically because they took her to the nursery for about 45minutes because her temperature was cooler than they it should be. They put her under the heat lamp to warm her and that's it. She was with me the rest of the time. Even though my husband went along and stayed with her the whole time, we were still charged the additional fee. I found the bill to be outrageous myself but there were too many other things going on and just trying to take care of her was enough. Stressing over the bill would have just made my life more complicated than it already was. I have a payment plan with the hospital that works for our budget and i'm just doing what I can.
I'm sure that they didn't charge the extra fee based on "weight", but it was probably because of the extra attention she needed. Babies that weigh less can get cold easier and maybe they had to warm her. It could have been any number things. Anyway, I think that you shouldn't worry yourself over it. Spend this time enjoying your new one. Be thankful that she's healthy and best of luck to you...........BTW. One week after she was born we were back in the nursery for 4 days due to high biliruben(jaundice). That bill was almost as much as the first.



answers from Sherman on

Both of my girls were well under 6 lbs, 4lbs 15 oz and 5 lbs 13 oz. Both healthy and went home in 2 days. We were charged the same as our 6 lb 3 oz son. I would call the hospital and dispute the charges



answers from Seattle on

I agree that you should not waste your time or money on this... not any more than you already have anyways.
Billing dishonesty is one of the absolute dealbreakers for me when I choose a provider. I would find a different doctor/hospital if you ever need hospitalization again and have the option - and warn your friends and relatives to do the same.



answers from Dallas on

i would ask your insurance company, if they feel the charges are appropriate, seriously, i'd just drop it. with newborn twins, you do not have the time and energy to fight this battle, and honestly, you probably won't win. congrats on your new babies!



answers from Sacramento on

If your your little one had "any" type of problem, even something as simple as jaundice they can charge for a higher level of care ( or nursery room & board).I use to work in the billing department at a hospital, and it was very hard to explain to patients that a lot of the time it's not necessarily the room she is staying in they are charging for but rather the level of care she had received. This is the same for any ER visit as well. Her lower birth weight may have required a little bit more care than your other twin.

You have every right to contact the hospital and or insurance and have them review the level of care charge. Sometimes it can be a coding error other times it is what it is. In most cases the level of care is diagnosis driven, as well as a check list of services rendered to your daughter. My suggestion is just to call the billing department and have them review the nursery level charges and tell them you just "can't fathom that your daughter received that much more 'care' than you other daughter", if they tell you its based off of her diagnosis of having a lower birth weight, you can ask the OB director to give you a more thorough explanations.

FYI: Also depending what insurance plan you have, changing the charges will not change your out of pocket expense. Most plans are based off the contractual rate which doesn't change, with reducing charges. Basically the hospital will get paid a flat amount for the room charge/day the insurance doesn't really look at the "charged" amount that you see. So yes they will be paying more, but in the grand scheme of things its not 3 times the amount like what we see.

But if its a principality issue then I would go ahead and pursue whatever you feel needs to be done! Hospitals do make mistakes, and the OB department is one I was more likely to see errors in!!



answers from Kansas City on

I like to say they charge an arm and a leg for whatever they can. I got a full bill when we had my daughter and it made me sick at what they charged for things! But I have never heard of them charging by weight but yes they still charge for the nursery even when the babies stay in your room.



answers from Philadelphia on

I'm at a loss here. The only thing I can think of is that maybe using their weight somehow corresponds to additional medical equipment/staffing that would result in the increased fee.

If you think about it that way, a NICU stay would most certainly cost more (equipment, procedures, staff, etc). But it doesn't make sense that if your babies were completely healthy, why their bed classification (for lack of a better term) would change if their health didn't change.

Like I said, I'm no expert. But dig into it and see what you find out. I would start with the insurance company and/or the hospital billing department. You have every right as a consumer and ultimately the person paying the bill, to question what you have been charged.

Good luck and congrats on your twins!

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