When it came time to make the decision to start a family, I was fortunate to be insured and able to set aside dollars in a Flex Savings Account (FSA) to plan for the costs associated with having a baby. I anticipated costs based on information pieced together from our insurance company plan guide and by assumed that I would be paying co-pays for pre-natal visits, the delivery of my son, Niko, and for his newborn care. As the visits continued with increasing frequency leading up to Niko’s birth, I was initially surprised that I did not pay a penny, until I realized that I was going to be billed for everything all at once. My single bill was for the full “episode of care” and included pre-natal care, the delivery itself, and post-natal care I received. While my assessment was correct that I would be paying Niko’s pediatrician separately for newborn care (though the preventive services were covered in full under the ACA), I was NOT correct in assuming that the cost of having a baby would be multiple payments throughout the duration of my care.
In most cases, providers are paid separately for each service they provide, and patients often receive multiple bills for their portion as well. As a consumer, it was so much easier to receive one bill from the hospital for everything related to my pregnancy, delivery and follow-up. Had I realized how I was going to get billed, I could have more accurately predicted my costs and reduced my anxiety around unexpected expenses. I could have also fully maximized the services that were available to me that I did not know were included such as lactation consultant visits and additional testing during pregnancy. Overall, my experience was easier on the billing side, even though I didn’t realize I had additional services I could have accessed.
In the coming weeks CIVHC will be releasing Colorado facility price and quality information estimating full “episode costs” for births, knee and hip replacements, colonoscopies, and other common services. This tool will allow consumers to estimate the total price they can expect to pay (with their insurance company) for the care leading up to, during, and after their procedure. This information will, for the first time, enable Coloradans to plan for the total costs related to what are often very costly services and enable them to shop for facilities with low costs and high quality.
Although most of the services that will be available on the shop for care page of CIVHC’s website are not currently billed on an episode of care basis, more health insurance payers are moving towards bundled payments in an effort to control costs and improve care. In fact, through the Colorado All Payer Claims Database, CIVHC has been able to provide episode costs to payers and providers looking to understand and develop bundled payments. So, while many Coloradans will likely continue to receive multiple bills for the different components of their care in the near future, I’m hopeful that more and more people over time will have the same experience I did.