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She had an uncomplicated birth at an Idaho hospital. This is what it cost her

Angela Palermo, Idaho Statesman on

Published in Health & Fitness

BOISE, Idaho — Josie Last arrived at the hospital at 7 a.m. nearly 41 weeks pregnant and scheduled for an induced labor. That evening, at about 11:30 p.m. on March 26, she gave birth to her first baby, a boy named Luca, at Saint Alphonsus Regional Medical Center in West Boise.

Everything went smoothly, she said. Last delivered him without any complications, and afterward the infant underwent some routine screenings. Two days later, they were discharged.

“Obviously, I received amazing care,” the 35-year-old said. “The doctors, the nurses, everyone there was incredible. I was treated with so much respect. I would deliver a baby there again in a heartbeat. It was an awesome experience.”

“I just couldn’t believe the billing.”

Despite careful planning, she and her husband were stunned by the cost: $6,000 out of pocket. It was double what their insurer had estimated and included two separate room and board charges, even though she and her newborn shared the same room. When she questioned the duplicate fees, the hospital’s billing department assured her it was correct.

Their experience is hardly unique — about one in five new parents in America receive a “surprise bill” after childbirth. But it raises questions about hospital billing practices, transparency from health insurers and the sheer cost of a routine delivery.

Couple saves up for childbirth

When Last became pregnant last year, the couple did everything they could to determine how much the delivery would cost.

She planned to give birth at Saint Alphonsus because it was in-network with their insurance provider, Select Health, the insurance arm of Intermountain Health, a nonprofit hospital-and-clinic system based in Salt lake City.

“I’ve always known that giving birth was going to be expensive, and that’s why we tried to do our best with calling the insurance company and finding out how much we would owe so we could prepare for it,” Last told the Idaho Statesman in an interview. (Last is her maiden name. For privacy, she asked to be identified by that instead of her married surname.)

She said Select Health told her by phone that she would likely owe $3,000, her out-of-pocket maximum, according to insurance documents she shared with the Statesman.

Plus, according to an example scenario on a summary of benefits and coverage sheet for her health plan, the Select Health SAHA Silver Copay Plan (SAHA stands for Saint Alphonsus Health Alliance), having a baby, including nine months of in-network prenatal care and a hospital delivery, would cost $3,560.

So she budgeted for that amount in her health savings account, or HSA, where money withdrawn for medical expenses is not taxed.

First bill arrives, then another

In April, a couple of weeks after giving birth, she got a bill. It had her son’s name on it.

“TOTAL MEMBER RESPONSIBILITY: $3,000,” it said.

The hospital had charged her insurer $5,844.95, including $4,910 for room and board for two nights ($2,455 per night), $323 for a vaginal delivery, $481 for lab tests, $42.95 for medications and $88 for one vaccine, according to an explanation of benefits. Select Health covered $2,844.95, leaving her outstanding balance at $3,000.

“We were all ready to receive that bill,” Last said. “That’s the bill we had budgeted for. That’s what I assumed we were paying.”

Then, about four weeks later, they got another bill. This one had her name on it.

“TOTAL MEMBER RESPONSIBILITY: $3,000,” it said.

The second bill showed an additional spate of charges. Saint Alphonsus had charged her insurer $11,516.70, including $6,852 for room and board for two nights ($3,426 per night), $145 for less than two hours of lactation assistance, $571.70 for medications, $516 for lab tests and $3,432 for the delivery. Select Health paid $9,027.65, leaving the amount she owed at $3,000.

‘Charged twice’ for the same room

Last said they were blindsided by the two bills. Even more perplexing were the duplicate room and board charges. She went through the documents line by line to try to make sense of it.

“I assumed that my baby and I would be one bill, because I was going in to give birth to the baby,” she said. “It was never mentioned to me that both of us would be treated and billed separately for being in the same room. That just seems crazy.”

She called the hospital’s billing department to see if there might have been an error.

“The woman I spoke to was lovely,” Last said. “She was like, ‘Oh, that sounds weird. I’ll submit a claim to the revenue integrity board and they’ll review it.’”

A few weeks later the hospital called her back. The board determined the room charges were billed correctly. An employee explained that, once the infant was placed in the plastic bassinet by her hospital bed, that triggered the start of his own room and board charges, since her son was considered another patient.

Last said the only time her baby wasn’t with her was when he was taken for screenings, circumcision and an immunization.

“I was told that even though they’re in the same room with you, you still get charged twice for the room fees,” she said. “I would understand if they took the baby to a nursery, and they were taking care of the baby for me in there, but the baby was with me. Everything was very easy, very normal.”

She and her husband dipped into their savings to pay the unexpected bill.

Saint Alphonsus Health System told the Statesman in a statement that it follows standard hospital billing practices and “like other hospitals nationally and locally, includes a nursery charge for the care it provides to the newborn patient.”

 

Dr. David Pate, a retired physician and the former CEO of St. Luke’s Health System, the largest health system in Idaho, told the Statesman by phone that nursery charges can cover the overall care and resources dedicated to a newborn, not just the physical occupancy of a specific room.

“Even if the baby is in the same room, the nursery nurses still have to do regular assessments and all that,” Pate said. “That’s my guess as to the explanation.”

Doctor’s recommendation at odds with cost

Last said that if she had known how much the hospital was going to charge for the room, she would have asked to be discharged sooner, even if that meant going against the recommendation of her doctor, who advised she stay two nights so she and her baby could rest and be monitored.

Most women in the U.S. stay an average of 48 hours for a vaginal birth, according to the National Center for Biotechnology Information. That allows hospital staff to watch for potential issues like excessive bleeding, infection or postpartum preeclampsia, a life-threatening condition that can develop soon after birth. Federal law requires that most insurance companies cover a postdelivery hospital stay of 48 hours for vaginal birth and 96 hours for cesarean section.

Last said the sheer cost of her uncomplicated delivery made her question whether she would have another child, and if she did, whether she would ask to be discharged from the hospital immediately after giving birth.

“I’m happy to pay the doctor’s fee, I’m happy to pay for any screenings, medications, the care that we received there, absolutely, because the people working there were excellent,” Last said. “But I’m not happy to pay an exorbitant out-of-pocket fee for us to stay in the hospital.”

She said that, in a country with declining birth rates, where families are told they need to have more children, women shouldn’t have to decide whether or not they can afford it.

The second most common contributing factor to maternal deaths in Idaho is “lack of access/financial resources,” according to the latest available data reported by the state’s Maternal Mortality Review Committee in 2021. That is the last year the committee published an annual report on maternal deaths. It does not include a breakdown by birth setting (hospital versus home).

“There’s no way I would not want to give birth in a hospital with doctors who know what they’re doing, because there’s so many things that can go wrong, but it really discourages a lot of people from doing that,” Last said. “I don’t know if I’ll do it again, and that’s sad because I would love to have another baby. I just don’t think it should cost thousands and thousands of dollars to do so.”

Expert calls benefits explanation ‘very misleading’

On the summary of benefits and coverage document for her health plan, where Select Health outlines in a chart what patients will pay for common medical events, like giving birth, the co-pay is listed as a flat $1,500 a day for “childbirth/delivery facility services.”

Or in her case, $3,000 for two nights. That’s what an insurance representative had told Last she would owe.

But what Select Health didn’t say, or otherwise make clear, is that the $1,500 a day would just be for her, and that her infant would be subject to the same copay in addition.

“While the Select Health document seems clear and is not technically incorrect in how they handled the benefits, and I can tell this as someone knowledgeable about hospitals, I think it is very misleading and would give the average person the same impression as (Last),” Pate said after reviewing redacted copies of her records and health plan details.

Since the hospital considered Last and her baby two separate patients, and billed them both accordingly, her insurance provider did so too. But nothing in her coverage document implies as much. It says “if you are pregnant” ... “you will pay” $1,500 a day to give birth at an in-network facility. That amount is represented as the total cost.

Select Health did not respond to detailed questions or a request for comment for this story, citing federal privacy regulations.

The insurance provider said in a statement sent by email that it’s committed to helping its members understand their benefits and coverage.

“Health insurance benefits are outlined in standard documents that provide detailed explanations of coverage for each member covered by the plan,” Select Health said. “We encourage individuals to work with a licensed insurance agent when selecting a plan, as agents can help ensure the coverage aligns with their needs and provide guidance on how benefits are applied.”

Pate said that if an insurance agent told Last it would be $3,000 and it turned out to be $6,000, they should work with her in some manner for service recovery.

“That’s not how you treat clients,” he said. “I bet no woman has ever asked that question: What it would cost for only her and not the baby. It’s such a common practice that everybody needs to be transparent — hospitals, insurance companies, everybody.”

It’s unclear whether the charges violate the federal No Surprises Act that took effect in 2022 or the state’s Idaho Patient Act, which took effect in 2020 and prohibits unfair debt-collection practices and excessive attorneys’ fees in hospital-bill collection lawsuits.

The No Surprises Act protects patients from unexpected bills by out-of-network providers, but it doesn’t regulate what in-network hospitals can charge or how they bill for services.

What if you’ve been overbilled?

If you think you’ve been overcharged, ask the hospital for an itemized bill with each billing code listed.

As Last did, check for duplicate charges, services you didn’t receive or unclear fees. About 80% of medical bills contain an error, according to Patient Rights Advocate.

Then, call the hospital’s billing office to ask for explanations about any confusing or questionable charges, as Last did. Sometimes errors can be corrected just by calling or by requesting an internal review from the hospital. If you still believe you’ve been overcharged, you can file a formal dispute with the hospital, your insurance company or both. Keep detailed records of every communication.

Other options, which Last has not yet taken but has not ruled out: Consider filing a consumer complaint with the Idaho Department of Insurance or contacting the Idaho Attorney General’s consumer protection division, which enforces various laws intended to protect consumers from unfair practices. You can also consult a lawyer about suing.

Last said she and her husband have already paid the bills, and aren’t convinced the cost of pursing legal action would be worth it.

“Next time, I think I’ll be a lot smarter with the billing or at least ask the right questions up front, and I probably will leave the hospital sooner,” she said. “But it’s totally out of my financial control now.”


©2025 Idaho Statesman. Visit at idahostatesman.com. Distributed by Tribune Content Agency, LLC.

 

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