Birth Is Stressful Enough — What’s With The Unexpected Bill?

When Bobbi Dempsey’s oldest son was born in 1989, her insurance did not cover the entire cost of the birth—something that was unfortunately common in her small Pennsylvania town. The hospital, accustomed to patients without wads of cash on hand, offered a payment plan that many families eagerly signed up for. Month after month, Dempsey ran into friends at the hospital cashier’s office as they made in-person payments towards the balance of their birth expenses.

“We would just laugh and be like, ‘See ya next month, same time, same place," she recalls. It took two years of eye rolls and jokes with other local moms before their debt was paid. “It seemed wild and ludicrous at the time.”

Walking into a hospital to pay a bill in person these days is rare, but Dempsey’s experience remains shockingly common. According to the Centers for Disease Control, Medicaid funds 41% of births in this country, while private insurance pays for about 52%. The remaining births are either self-pay or become medical debt. Many American families cannot cover a large unexpected expense, but setting up payment plans or negotiating to lower bills is confusing and stressful, leaving parents with more questions than answers. Extenuating circumstances, such as NICU stays, complicate matters and result in astronomical bills that regularly surpass $1 million.

“Medical bills are so confusing because the U.S. healthcare system was never purpose-built; it has grown and mutated over time,” says Chris Severn. He’s the CEO and cofounder of Turquoise Health, a platform focused on bringing transparency to medical pricing for patients—a tricky job. “All of the administrative systems we use today were created in silos, resulting in a disjointed and inefficient healthcare system. As a result, prices vary wildly between hospitals, insurers, and even patients with the same coverage.” Despite his expertise, even Severn and his wife faced unexpected costs after the delivery of their son in 2024.

“My wife and I were fortunate that she had a complication-free delivery of a healthy baby boy, for which you would expect a standard billing process and set of costs,” says Severn. Despite a textbook birth, bills full of codes, jargon, and lists of small charges added stress to an already busy time. “I thought it was ironic that while I have more niche knowledge on the cost of healthcare than most people, it is so complicated that even I struggled to anticipate the costs.”

Severn did negotiate with their insurance company to reduce their costs, and says this should be standard procedure for new parents hit with a surprise bill. They were charged $6,200 for an epidural, though the final negotiated cost was $2,680.

“Ask providers for an itemized bill, and compare prices across hospitals,” says Severn. “Knowing the fair market price for a service is the first step toward avoiding overpayment and holding the system accountable.” If there’s a code on your bill with a price amount attached, Severn says to just Google it—these codes are standard nationwide. Turquoise Health has a database of healthcare costs across the country that can be useful for negotiating, as well. There are other healthcare cost estimators available, such as this resource from Fair Health Consumer.

I’m not the first one – and I won’t be the last – to tell you that the way insurance is set up in this country is fundamentally broken. Private insurance is often tied to employment, while Medicaid eligibility is based on income or disability. This leaves parents relying on a slapdash mashup of programs that may or may not cover the costs associated with adding a new family member—and little clear guidance on where to start.

Louise Norris, a health policy analyst for HealthInsurance.com, says birth expenses are particularly stressful because they are often the first time someone has to battle with insurance. Someone with a chronic illness may be a pro at arguing down the cost of a medical procedure, but that’s often not the case for new parents. “Birth is an example of a perfectly healthy person having their first real experience with significant medical bills and the claims process,” says Norris. “But the nice thing about childbirth is that you have some time to prepare.”

Norris urges parents to contact their insurance well before birth to gain an understanding of their potential out-of-pocket costs. “They cannot give you an exact number, as they can’t predict if you will need a NICU stay or other care, but it’s a starting point.” Parents should also find out if they qualify for Medicaid and apply before birth, even if they have private insurance.

That’s because private insurance plans have complicated deductibles and copays, while Medicaid often covers the bulk of medical services for an individual. The government-backed insurance will function as secondary insurance, covering what private insurance denies and greatly reducing the remaining balance.

The income guidelines for pregnant women and infants are much higher than standard Medicaid thresholds, and many women do not realize they qualify while pregnant. Nationally, the income threshold is 138% of the Federal Poverty Level [FPL], though many states have expanded access—Pennsylvania uses 215% of the FPL as their cutoff, for example.

Norris also warns new parents to pay very close attention to timelines. Missing the enrollment period to add a newborn to private insurance can result in denied claims, and Medicaid will only backdate payments for three months. That timeline is reduced to only two months under the recently passed One Big Beautiful Bill, though that change will not take place until late 2026.

For Jessica Harper*, excitedly anticipating the birth of her twin boys in 2018, million-dollar medical bills were not on her radar. She and her husband were thinking about double strollers, matching onesies, and introducing their young daughter to her two new brothers.

That all shifted quickly when the unimaginable happened—the couple lost one of their sons, and the surviving twin faced significant complications that required a NICU stay. “It was awful,” recalls Harper. They were planning a funeral, grieving, and dealing with their son’s uncertain prognosis. The chaos and grief meant the couple nearly missed the window to add their son to their family’s private employer-sponsored insurance. “We dragged our feet, but it was just like ‘one more thing,’ and it also felt like acknowledging the enormity of what had happened,” she says of that time. “

The Harpers managed to find a few moments to apply before the 30-day cutoff, and their private insurance did cover the nearly seven-figure bill. They also had to apply for Medicaid, which covers ongoing medical costs for their surviving son.

Many children born with complications qualify for Medicaid based on a permanent or temporary disability, even if their family is above the income requirements. This is the most common way large NICU bills are covered in the United States, with Medicaid paying for about half of preterm births annually. “If we did not have Medicaid today, my son would not continue to get the services he needs. His ongoing care is all covered by Medicaid,” says Harper.

The Harpers’ experience is sadly far from uncommon, says Norris. She urges parents to be proactive and contact their insurance carrier, but not panic. “There could be an error; something as simple as a typo can mean the plan does not get processed,” she says. Most hospitals have a social worker on staff, and Norris says these professionals are skilled at breaking charges down into plain language for parents. Many hospitals also offer no-interest payment plans, which often makes sense versus struggling to pay a bill in full. A Biden-era ruling removed medical debt from credit reports, but a recent Trump-era action reversed that protection, so ignored medical bills can affect your credit.

The key, says Norris, is to review everything carefully, seek expert advice when needed, and develop a workable plan (all while recovering from birth and caring for a newborn, of course).

“Don’t ignore a bill and assume it can just be fixed or will disappear, but do not just write a check without asking some questions.”

Meg St-Esprit, M. Ed., is a journalist and essayist based in Pittsburgh, PA. She’s a mom to four kids via adoption as well as a twin mom. She loves to write about parenting, education, trends, and the general hilarity of raising little people.