The Cost Of: Prenatal Care, First Two Trimesters

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With any medical care-related expense in the US that's billed through health insurance, it's not necessarily that meaningful to hear about anyone else's experience. So much depends on the vagaries of one's own health plan, something I personally find nearly impossible to decipher or predict before my bills after insurance actually come in. (That's as someone who litigates multi-million dollar commercial contract disputes at my day job, no less!) 

Nonetheless, I always like to read about how much things cost, including American healthcare. I was originally hoping to do a post like this earlier in pregnancy, potentially one for each trimester. As it turns out, the billing department at my OB-GYN's office can be quite slow, so it was only recently that what I think(?) is the last bill from before the end of my second trimester - nearly 7 weeks ago - was finally processed with my insurer. 

This kind of timing isn't necessarily a huge shock in the American system, either. For instance, it was only this June that I finally saw a record pop up with my insurer for a PCR COVID test I took last December, during the start of NYC's Omicron surge. (That length of delayed billing is pretty unusual though, in my experience. There wasn't actually a bill to me involved either, because COVID testing in NYC was generally still free to the patient with government support back in December 2021.) 

For my prenatal care throughout the first two trimesters, through 26 weeks of pregnancy, the amounts I paid out of pocket for expenses that were - or could have been -  put through insurance was: $1,827.68. 

Unfortunately, I think this solidly establishes my health plan as being "not very good," in terms of the extent and quality of my coverage. Which is something I did already know beforehand. Many biglaw firms are known for offering associates extremely expensive health insurance plans, sometimes with poor coverage. My health insurance premiums aren't as bad, but the co-pays and other terms keep getting slightly worse by the year. For one random data point of comparison, a YouTube vlogger I follow who also lives in NYC only paid around $366.00 out of pocket on her insurance for prenatal care through roughly the same point in her pregnancy.

Some major line items going into my total out-of-pocket spend of $1,827.68 were as follows: 

• Specialist visit co-pays: $60.00 or $75.00/each x 5 visits = $345.00 
• Myriad genetic carrier screening*: $249.00
• Myriad NIPT screening*: $249.00
• Diagnostic ultrasounds**: $289.38 x 2 visits = $578.76

Under the terms of my health insurance plan, my specialist visit co-pays (initially $60/each and now $75/each due to annual changes to the plan negotiated between my employer and the insurer) don't go to my deductible (the amount I need to pay before my co-insurance kicks in further to reduce part of my required after-insurance out-of-pocket spend). Which is particularly unfortunate, because starting in third trimester, prenatal appointments for even a textbook low-risk pregnancy may take place as frequently as once every two weeks, and then once every week after 36 weeks. And because my gestational diabetes care is partially covered by another specialist, I'll also have had another handful of separate appointments for that by the end of my pregnancy. 

The remaining items going in to my total out-of-pocket spend were various much smaller charges for things like blood draws or certain blood tests. I've always found the billing for medical lab tests particularly confusing, as many of the individual tests can be billed separately even if they were all done on the same blood sample, and the out-of-pocket costs seem completely arbitrary. Each individual test generally doesn't cost too much, generally $25 or less after insurance, but the total bill can really add up sometimes. 

At some point, once I think I've received all my remaining pregnancy-related medical bills, I'll check in again about my out-of-pocket, post-insurance expenses for the rest of the pregnancy, including for delivery. I imagine that most of you who live outside of the US pay or paid at least somewhat less for pregnancy-related medical care, if you've had experience with that? 

And ah, I suspect many of my fellow Americans also pay somewhat less, maybe significantly less, for prenatal care through the first two trimesters. Though I think the bills for a hospital delivery are often going to be four figures to a low five figures through insurance, even on better health insurance plans than mine. That's also the general number I'm expecting once I get there. 

*There's an asterisk when it comes to the "through insurance" part on these line items. I paid for these prenatal genetic screening tests out of pocket at the indicated cash price (which is fairly reasonable by US standards) without first asking to have the charges run through insurance. That was partially due to some rather extreme "hard sell" messaging from the testing company, Myriad, regarding how they approach cash price versus through insurance billing. Before getting your results, Myriad essentially tells the patient you can either choose to pay the cash price upfront or try to bill it through insurance and, in so doing, forfeit your right to ever claim the cash price if your insurance company declines to cover the test (which is not uncommon), potentially leaving one on the hook for a four-figure bill. My insurance plan documents also said something about only covering one prenatal genetic test per pregnancy, and I had no way of knowing beforehand whether I might end up needing something like amniocentesis later. 

**I've been pretty confused by the way ultrasounds are billed through my insurance. My OB-GYN's office does an ultrasound at each prenatal visit for all pregnancies, which is not standard with all OB-GYN practices in the US. (I don't mind it and am even thrilled to pay for it, as I'd otherwise get too nervous if I couldn't see our little bean every time.) My initial ultrasounds - first, to confirm pregnancy, and then a second dating scan because at the earlier ultrasound it was too early to see much - each cost $289.38 after insurance. The receptionists at my OB-GYN's office keep telling me subsequent ultrasounds could cost up to $500 each after insurance. Yet to date I haven't seen an after-insurance bill for anything but my specialist visit co-pays for any of my subsequent ultrasounds after the first two! Not sure if I'm going to get a giant bill for them sometime later, or what.