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KHN Report on Hospital Billing Practice of Turning Routine Delivery into High Cost Emergency

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A Kaiser Health News (KHN) report found a routine vaginal delivery of a full-term infant cost $16,221.26. It found a quick exam to evaluate labor in a small triage room generated substantial charges with a $2,755 charge for “Level 5” emergency department services, which was the biggest item on the bill other than the delivery itself.

Level 5 charges are supposed to be reserved for serious cases — “a severe threat to life, or very complicated, resource-intense cases” — not for patients who can walk through a hospital on their own. Emergency room visits are coded from Level 1 to Level 5, with each higher level garnering more generous reimbursement, in theory commensurate with the work required. In this case, the emergency room charge was actually the OB triage little area before they take you to the labor and delivery room where a nurse placed an IV for antibiotics, and her doctor checked her dilation and confirmed her water had broken — although none of that was performed in the Emergency Department.

Some hospitals provide that package of services via an “obstetrical emergency department.” OB-EDs are licensed under the main Emergency Department and typically see patients who are pregnant, for anything from unexplained bleeding to full-term birth. They bill like an ER, even if they aren’t physically located anywhere near the ER.

Expectant parents should be aware that OB-EDs are a relatively new feature at some hospitals. They recommend using a price comparison tool for common medical procedures, including vaginal delivery, such as the price comparison tool provided by the Center for Improving Value in Health Care in Colorado.

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