[USER]

I recently had a baby via elective/ planned csection (due to factors that put me at risk for postpartum bleeding but not complications with baby). All went well and baby was healthy and did not require any special cares during our hospital stay.

That said, we were billed for level 2 nursery cares which of course made our bill much higher.

When I questioned the billing dept after reviewing her chart and not finding any of the special cares listed as applicable to the higher level of care code they used, they informed me it was billed that way because the hospital needed to prepare for the possibility of complications due to the c-section and reserve a level 2/nicu bed for that possibility.

Is this normal procedure?

Can I really be charged for the possibility of complications/care that we did not need?

[Jessica]

I worked in labor and delivery for years and I’m currently an obgyn nurse practitioner who happens to do billing at the office.

I’m not 100% sure how billing works in the hospital, however I do know that the nicu aprn or neonatologist needs to be present at the c/section and they also care for the baby for 24 hrs afterwards.

After the 24hrs, the pediatrician takes over. By “care” I mean that they are considered the primary physician for the baby and would handle any orders, calls, and problems with the baby during that time period.

This might be their way of billing this. Do you know the cpt code that was used?

[Dawn]

I have had 3 cs all “planned” to some extent. All have nicu staff ready just in case.

CS due to breach babies. Non were emergencies.

[Rebekah]

I’m a Nicu nurse, so I can only speak from that side of things. It’s pretty common for NICU staff to attend c-sections, elective or otherwise.

So there probably was someone from the nursery in attendance at your delivery. However, we don’t “reserve a bed” unless it’s for a known admit (prematurity, syphilis treatment, known congenital defects requiring treatment, etc).

We always know where we are going to admit to, in case a baby ends up needing care, but if we billed for that, then every family having a baby would receive a bill, vaginal or c-section delivery.

Because every baby has the potential to be admitted for *something.* You definitely need to call and speak to someone else about this.

You can not be billed for services not rendered. Congratulations on your bundle!

[Michelle]

Level 2 is not NICU care. Late preterm infants, those who are on blood sugar protocol or need phototherapy for high bilirubin (jaundice) all are considered level 2 care.

Ask for an itemized bill including what diagnosis codes were used.

You are absolutely justified in asking these questions!

[Angela]

Did the hospital provide you upfront cost info for the level 2 nursery when being admitted?

If not, that goes against the “no surprises act” which is a federal law since 2022 (I believe) that requires hospitals to disclose the fee of services when scheduling and/or before procedure.

Look into this in case you did not sign anything saying you would possibly need this care.

[Bridget]

I would call back and talk to someone else. I doubt they held a nicu bed.

I had twins via c section. One twin went to the nicu and one went to the reg nursery on the mother/baby floor.

We were only charged for special care for the baby that went to the nicu

[Nancy]

You cannot be charged for services you did not receive. It’s like you coming in for a broken arm and they hold a bed in icu just in case they find something seriously wrong and you collapse.

[Shelby]

The only thing I can think of is if the NICU team was present at your delivery? As a NICU provider I charge every delivery I go to where I put my hands on the baby to assess them, even if I let baby stay with mom.

However, I don’t think it would show up as a NICU charge completely.

We don’t even typically attend planned C-sections to be honest and definitely don’t reserve a bed for them (although it is true they’re more likely to have respiratory distress).

[Cara]

You should ask your insurance company to investigate this charge for waste or abuse charges. They’ll know what you are talking about.

Also, you can tell the hospital that you are asking the insurance company to investigate for waste or abuse and see if they change their charges.

If they are found to be “over charging” for waste or abuse, they can lose their status with insurance carriers.

[Adrienne]

I’m a CRNA that does a lot of OB. It’s standard for NICU to be present for all sections if there is any chance of complications (baby or to mom before baby comes out).

This is not optional for care, it is a requirement. I think billing is misinformed of the reason.

The level of care was the NICU team assessing baby after delivery and making sure everything was good.

Congrats on the little babe and I hope everyone is settling in nicely.

[Korey]

Yeah, because the people have to stand there to be sure, then they leave if you don’t need them.

[Author]

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