Unexpected Pregnancy Costs and How Health Insurance Covers (or Doesn't Cover) Them

Having a baby is stressful and expensive enough without throwing unexpected costs and issues into the mix. Thankfully, U.S. health plans cover quite a few of them.

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There are so many "expected" medical services, procedures, and expenses to worry about when you're pregnant that it can be easy to overlook some or all of the unexpected ones.

After all, according to at least one source, prenatal care and delivery costs can add up to more than $250,000 in certain situations.

Granted, you won't see such astronomical bills if you have health insurance. (And what if you don't? Check out our article about how to choose the best health insurance plan for your pregnancy.) But even if you're only responsible for a small percentage of them in the end, they're still likely to be unnerving enough to keep you from thinking about the many surprises that can spoil an otherwise uneventful pregnancy.

That's a problem because some of those unexpected issues and procedures and tests can be expensive.

Which medical issues and procedures and tests are we talking about here? Keep reading to bring yourself up to speed on them.

As you do that, though, keep in mind that the figures highlighted below are only estimates. How much you pay for a doctor visit, screening, ultrasound, or other form of care will depend on where you live, how (as well as where) you give birth, whether or not you encounter any complications, and more.

The only way to know for sure what you’ll be billed after you give birth is to contact care providers and health insurance companies before you welcome your little bundle of joy into the world.

Extra Prenatal Doctor Visits

Visiting your physician or obstetrician a good number of times between when you become pregnant and when you give birth should be expected, of course.

What isn't always expected: visiting him or her more than 12 or so times during your pregnancy.

Should you need to see your doctor more than is typical in the run up to your delivery, you'll pay for it--both literally and figuratively.

Specifically, you'll have to deal with whatever copayment your health plan (if you're insured) charges you for these visits. Usually this amount is between $15 and $35, but check your policy or contact your insurer if you want to be certain.

If you don't have health insurance, though, expect to pay at least $100 to $200 for each trip.

Unexpected Diagnostic Tests

The majority of the prenatal blood tests and screenings your doctor will order in the nine or so months leading up to your delivery won't be surprises. (For more information on the most common, read this article of ours: "Expected Pregnancy Costs and How Health Insurance Covers and Sometimes Doesn't Cover Them.")

A few of them may seem to come out of nowhere, though--especially if any problems or issues pop up while you're pregnant. Here are some examples:

Chorionic Villus Sampling

Physicians and obstetricians typically order this test during the first trimester and reserve it for high-risk pregnancies. It uses a sample of cells taken from a woman's placenta to detect birth defects, genetic diseases, as well as other potential complications and issues.

Unfortunately for moms-to-be, it is as important as it is pricey. Without health insurance, you might have to pay as much as $5,000 for it. The low-end cost estimate: around $1,400.

Even with insurance, though, you'll probably have to chip in to cover some of its cost. How much you have to chip in depends on your plan and whether or not you've met your yearly deductible. After that, you shouldn't have to pay more than about $100, but don't take that as gospel. Check with your insurer or your care provider if you want to be sure before you add a chorionic villus sampling (also known as a CVS) to your calendar.

NIPS Test

This test often is done in the first trimester, too. And it also checks for certain birth defects or genetic disorders.

Like CVS, NIPS tests (NIPS is short for Non-Invasive Prenatal Screening, by the way) usually aren't cheap.  In fact, the experienced moms on the whattoexpect.com forums say it can cost up to $2,000 if your health plan doesn't cover it.

Others reported being charged as little as $200 for a NIPS test, though, so you'll definitely want to check with a number of clinics and labs if your physician or obstetrician recommends you have one done at some point.

Contact your insurer, too, if you have health coverage. Some plans do a better job than others of paying for the cost of a NIPS test. The last thing you want to do is have one done and then find out yours covers just a small portion of the resulting bill.

On a related note: most health insurance plans only cover these tests if a doctor considers a woman's pregnancy to be "high risk."

Amniocentesis

Once again, not every woman has an amniocentesis done while preparing to have a baby. That's because, as was true of CVS and the NIPS test, care providers commonly limit this screening to high-risk pregnancies.

As a result, don't expect your health plan to pay for an amniocentesis if your doctor doesn't consider it medically necessary. And even if that's the case, you'll probably be responsible for a copay or a co-insurance fee.

If you're uninsured, watch out. An amniocentesis, which analyzes a woman's amniotic fluid for genetic conditions like Down syndrome, costs anywhere between $1,000 and $7,000 or more.

Additional Ultrasounds

Most mothers-to-be have at least one ultrasound done in the nine-ish months between when they became pregnant--or when they first become aware of their pregnancy--and their due date. Many undergo more than that.

Although the majority of U.S. health plans cover an ultrasound that's performed around 16 to 20 weeks (it checks on the position of your baby and otherwise examines its health), a lot of them stop there. Unless, of course, a physician or obstetrician believes they're needed for the health or well-being of mother or child.

In other words, if you just want to sneak a peek at how your baby is growing every few weeks or so, don't be shocked if you have to pay for them out of your own pocket.

Ultrasounds aren't horribly expensive, thankfully, but they'll still cost you $200 or more without your health plan's support. This amount can vary quite a bit depending on where the procedure is performed, so don't be shy about shopping around if you need to pay for any ultrasounds out of your own pocket.

All Sorts of Complications

There's no shortage of complications that can trip up a pregnancy. A handful of examples:

  • anemia
  • dangerous umbilical cord positioning
  • irregular blood pressure
  • jaundice
  • neurological problems
  • premature rupture of the amniotic sac
  • amniotic fluid embolisms

Some of these complications are more common than others. And some of them are more costly than others.

All of them have the ability to increase your pregnancy costs--your delivery costs, in particular. For instance, parents.com reports that "a delivery stay costs an average of 55 percent more ($5,900) for a woman with diabetes."

Health insurance should cover the bulk of these costs, but don't assume that. Review your policy or contact your insurer to get the whole picture of your specific situation.

Premature Birth

According to the Centers for Disease Control and Prevention (aka the CDC), one in 10 babies are now born prematurely in the U.S.

Despite that, they're still usually unexpected. That's a problem for pregnant women and partners for all sorts of reasons, one of which is that a March of Dimes study found that healthcare for these newborns is nearly 11 times more expensive than it is for those without such complications.

Given how many different aspects of a pregnancy premature or preterm birth can impact, it's difficult to say how much health insurance will or won't cover its costs.

If you're insured, though, your plan should cover at least some of them. To find out how much it'll cover them, call your insurance company. And if you're uninsured and struggling with your healthcare costs, consider reaching out to your local Medicaid agency for help.

Other Unexpected Delivery Costs

As has been made clear a couple of times already, giving birth tends to be expensive. Even if you have health insurance.

Most expectant moms plan for that, but that doesn't mean they plan for every single fee and expense.

The fact is, a number of services and other components combine to create the whopping "delivery bill" that shocks many new mothers (and their partners, when applicable). A few typical examples, courtesy of costhelper.com:

  • the services of an obstetrician or gynecologist
  • the services of an anesthesiologist and epidural (if used)
  • the cost of your hospital room
  • a nursery fee
  • various lab fees
  • any medications or medical supplies

Any one of those expenses can skyrocket--or at least surprise--if any issues or problems whatsoever pop up before or during your big day. Given that, as much as is possible, it's important to stay on top of what's being done and what you might be charged for it.

This is especially true if you don't have health insurance at the moment. Does that describe your situation? Read our article about how to pick a health insurance plan. Or check out this article: "Everything You Need to Know to Apply for Health Insurance."

Lactation Consulting and Breast Pumps

It's doubtful many expectant moms get to the point of delivering their babies without knowing about breast pumps. As such, the argument could be made that this isn't the greatest candidate for an unexpected pregnancy cost to highlight in an article like this.

That said, it's likely a good number of mothers-to-be aren't aware health insurance often covers breast pumps. And it often covers lactation consulting, too.

You can thank the Affordable Care Act, also called the ACA or Obamacare, for this. Because of it, most U.S. health plans have to cover a wide range of preventive health services. An example is breastfeeding counseling and support--with supplies like breast pumps being one type of "support." (For more general information on this topic, read our article about health insurance and preventive care.)

As you might expect, just because health plans have to cover breastfeeding counseling and support, that doesn't mean they all cover those areas equally. A case in point: some only pay for manual or electric breast pumps. Or they only pay for rental units. Some put limits on how long they'll pay for rental pumps. Or they might stipulate when you can rent or buy a unit (such as before or after you give birth) for your plan to cover it.

Given all of the above, contact your insurer as soon as possible during your pregnancy and ask which breastfeeding services your policy covers. During that chat, specifically ask about breastfeeding consultants, counseling, and classes as well. Your health insurance may pay for some or all of their costs, too.

You won't save big bucks here if your health plan steps in to help out, but you could save a few hundred dollars. On the flip side, if you don't have insurance and you have to pay for a breast pump or lactation consulting out of your own pocket, at least you won't be on the hook for a lot of money in this instance.

Frequently Asked Questions

Q: How much will I pay for prenatal doctor visits if I have health insurance?

A: If your plan is like most, you should pay somewhere between $15 and $35 per visit. It's possible you'll pay more or less than that, though. What you pay for your prenatal doctor visits depends on your plan and the copayments it charges. So check your policy or contact your insurer for specific details on how your plan deals with these important check-ups.

Q: How much will I pay for prenatal doctor visits if I don't have health insurance?

A: Without insurance, you'll likely pay between $100 and $200 each time you go to see your physician or obstetrician while you're pregnant. Again, you may pay more or less than this amount. The only way to know for sure what you'll pay in this kind of situation is to call clinics and care providers directly.

Q: Does health insurance usually cover amniocentesis?

A: Most health plans do cover amniocentesis--if the procedure is considered medically necessary. If it's not, you may have to pick up the tab. Don't just shrug that off, though; amniocentesis can cost thousands of dollars. As such, make sure you know how your plan treats amniocentesis before you agree to or schedule one.

Q: How many ultrasounds will my health plan pay for during my pregnancy?

A: Almost all health plans cover at least one ultrasound during a woman's pregnancy. Many cover more than that, though--especially if the additional ultrasounds are medically necessary. As is so often the case, check with your insurance company for the full story on how many ultrasounds your plan covers and what copays or co-insurance costs you'll be charged when you have them done.

Q: Does health insurance pay for breast pumps?

A: In most cases, yes, your health plan should cover the cost of a breast pump. This isn't true for some "grandfathered" plans, though, so review your particular policy or check with your insurer if don't know how your plan treats these products. Actually, that's good advice no matter what situation you're in, as some plans cover breast pumps differently than others. An example: yours may only pay for a rental. Or it may only pay for certain pumps.

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