By Lindsey Konchar, as told to Jesse King
When I checked into the hospital to deliver my son in 2022, I was very nervous. At the time, I was still reeling from an ectopic pregnancy a year earlier, and before that, I’d had a difficult time delivering my daughter. So while I trusted my doctor, I was anxious. Luckily, when it was time to start pushing, I had a wonderfully easy delivery. After a couple of days in the hospital, my husband and I brought our son home, elated. And then, about six weeks later, we got a bill that was more than $20,000.
The average out-of-pocket cost of giving birth in the U.S. is $2,854.[1] So clearly, something was wrong. But as a licensed social worker and financial coach, I tried not to panic. I had already been in the practice of negotiating my medical bills for a few years, as part of a personal journey to gain control over my finances. After some quick phone calls, I was able to correct an issue with my insurance and get a new bill from the hospital for about $2,500 — and then I convinced them to shave another $500 off that. Here’s how I did it.
Step one: Verify your bill
To be honest, part of me wasn’t surprised by my bill. It’s not uncommon for medical bills to have errors.[2] The first thing I did was comb through my bill and double-check that my charges were correct. My bill was already itemized, but if yours isn’t, you can call the hospital billing department to request an itemized statement.
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Reading through the charges was confusing at first, as they were listed by something called CPT codes. Think of a CPT code like a barcode at the grocery store: each five-digit number represents a specific service, from items like “vaginal delivery” to individual medications you might have received. To figure out what each code meant, I simply Googled it: “CPT code XXXXX.”
Once you know what you’re being billed for, compare it to your experience. Do you remember getting that epidural? I did — but when you’re hours into labor, you’re probably not taking meticulous notes on everything your nurse or doctor does. Luckily, they are: If you’re unsure about a CPT code, or think you’re being charged for care you didn’t receive, you can call the hospital’s medical records department and ask them to check your doctor’s notes.
If you find an error, then it’s time to call the billing department and ask for a correction. This might take time, as the clerk will likely check with other offices internally (including medical records) before making the fix. I’ve found persistence is key. If a clerk tells you they will “check and get back to you” on something, always ask for an expected response date, and follow up as needed. Sometimes, the clerk may set up a conference call with a medical records representative, so the three of you can review the potential error together.
It’s important to note that some hospitals might bill your care and your baby’s care separately. In my case, everything was combined into one bill, but depending on your provider, you might have to keep an eye out for two separate invoices, and be prepared to go through this process twice.
Step two: Verify your insurance
In my case, all of my CPT codes checked out, and things had gone wrong with my insurance. My insurer hadn’t paid anything toward my bill, which turned out to be the fault of the hospital billing department. Someone had mistyped my insurer’s group number. Luckily, this was an easy fix, and after a quick call to the hospital billing department, they resubmitted a claim to my insurance company and mailed me a corrected bill. With my insurance now in play, my out-of-pocket balance was a little under $2,500. A huge difference for such a small mistake!
At this step, it’s important to understand what your insurance provider does and doesn’t cover. If you have any questions about your bill, or feel like you’re missing coverage, you can call your insurance company’s customer service line and ask someone to explain your bill. Some companies (including mine) have patient advocates that can walk you through your bill in detail.
Step three: Negotiate for a discount
Finally, I made one last call to the hospital billing department to see if they would agree to a pay-in-full discount (meaning I would pay the entire amount that day). Not every medical office will say yes to this request, but many hospitals do, as it ensures they get paid as soon as possible (whereas some payment plans can stretch for years). In my own experience negotiating, and from helping others with their bills, I’ve seen discounts from 10 to 20%. Before dialing, I did the math on a sheet of paper. A 10% discount would bring me down to about $2,250, while a 20% discount would equal roughly $2,000. I wanted that 20%.
When I called to negotiate, I started with the same framework I always use: “Hello, I’ve received our bill. I see that the total for my delivery on [date] is [dollar amount]. My family has been under some financial stress, and we can’t pay that right now. What is your pay-in-full cash discount?” That’s it! While asking for a “favor” felt nerve wracking, I resisted the urge to over-explain or apologize. The clerk quickly offered me 10% — which is great — but since I knew I could get more, I pushed a little further: “Thank you. My family is able to pay $2,000. Is that doable?” The clerk put me on hold briefly to run some calculations, and ultimately agreed. In less than 10 minutes on the phone, I had saved $500.
The kicker about these discounts is they require you to have cash up front. My husband and I always keep an emergency fund, so this worked for us. But if you don’t have the money on hand, there are other things you can do. I’ve found many hospitals will offer an interest-free payment plan based on what you can afford — of course, you won’t get a discount, but you will have the flexibility to work within your budget and take as long as you need to pay your bill. Some hospitals also have financial aid programs that you can apply for. You'll just want to ask your hospital billing department about your options.
My tips for when the negotiation process gets tough
Correcting and negotiating my delivery bill took just two phone calls, a bit of Google research…and a lot of patience. While the phone calls were brief, the time it took for the hospital to mail my bills brought the whole process to about three months — which is admittedly a long time to feel like bills are hanging over your head, especially when you’re juggling a newborn and potentially other children at home.
I’m someone who doesn’t enjoy confrontation, so negotiating is always the most intimidating part for me. Here are my tips for parents who might be nervous about this part:
Keep a positive attitude. It’s important to remember that the clerk you’re negotiating with isn’t out to get you — they are just doing their job. People are also more likely to work with you when you’re nice to them. I always keep the conversation friendly and polite (even though the whole ordeal is understandably frustrating).
If you know a hospital has offered discounts in the past, use that to your advantage. In my case, I knew my hospital was open to discounts because I had negotiated one after the birth of my daughter a couple years earlier. While I didn’t need to, I was prepared to cite that when making the same negotiation for my son.
If at first you don’t succeed, try again. I’ve heard of a few people who asked for a pay-in-full discount and were turned down. There are a lot of reasons why this might happen: perhaps the clerk you spoke with is new and unaware of any discount; perhaps they’ve been instructed not to negotiate for the time being; or perhaps they’re just having a bad day. The negotiation process can be a little subjective. If you’re told, “No,” I suggest you respond with, “Thank you. I will discuss this with my partner.” Then simply call back another day. You might get a different clerk and find circumstances have changed. If you don’t, then it’s worth asking to speak to a manager before giving up.
You can also reduce your risk of sticker-shock by researching your hospital’s prices before giving birth. Just as you might tour a hospital or interview your doctor during prenatal visits, call the billing department to ask about their average delivery costs. Not all hospitals will be forthcoming, but if you get a price list to run by your insurance provider, you’ll have a better idea of what to expect. It might also help you choose between hospitals and birthing centers, if you have multiple options nearby.
In the years since my son’s birth, I have continued to negotiate my medical bills — and help other moms do the same. While every person’s situation is different, and not all medical offices are willing to play, I’ve had enough success to know that it’s worth a try, especially if it can save you a few hundred bucks in the end. For me, every bit of savings counts, and negotiating has helped me feel a better sense of control over my family’s finances.
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