Managing Costs for NICU Stay

The Neonatal Intensive Care Unit (NICU) is designed to provide round-the-clock health care for babies born prematurely or with life-threatening health conditions.

A NICU stay can be emotional and stressful for parents and there can be financial setbacks once the medical bills start rolling in. Costs of intensive care for newborns can be significantly higher than standard neonatal care costs. Although your insurance should pay for some of your medical costs, it may not cover everything.

Average cost of NICU stay

The Neonatal Intensive Care Unit provides specialized care for newborns who are born prematurely or are sick. While in the NICU, your baby may be seen by a number of healthcare staff, including a neonatologist, respiratory therapist, neonatal nurse practitioner and dietitian. In general, your baby will receive more intensive care and attention during their NICU stay than they would during a typical hospital stay.

From a cost perspective, this means that you will likely pay more for neonatal intensive care than for standard neonatal care. According to a Michigan Medicine study of nearly 400,000 deliveries requiring hospitalization from 2016 to 2019, the average NICU bill was $4,969. In 9% of cases where neonatal intensive care was needed, the bill exceeded $10,000.

How much you might pay for NICU care can depend on several factors, including:

• Why your baby was transferred to the neonatal unit
• How long they stay in the NICU
• The level of care they receive
• The hospital where the NICU is located

For moderately to late preterm babies, the typical stay in the NICU is about 17 days. Some newborns may go home earlier from the NICU, while others may stay for several weeks or even months, depending on the extent of their care needs. Generally, the longer the stay, the more expensive you can expect a NICU visit to be.

Does insurance cover NICU costs?

That your health insurance will cover some or all of the costs of neonatal intensive care depends on your policy. If your baby is admitted to the NICU, it is important to contact your health insurance company to find out about your coverage. Specifically, you can ask these questions:

• Does my plan pay for neonatal intensive care?
• What costs are included or excluded from coverage?
• What part of the medical expenses am I responsible for?

You will also need to consider how your financial obligation might be affected if your child is covered by more than one health insurance plan. For example, if you are married and you and your spouse both have health insurance through your employer, you will need to know if the coordination of benefits rule applies.

Coordination of benefits is a provision included in most health care plans and provides up to 100% coverage for medical services. Under this rule, your plan is primarily designed to cover you while your spouse’s plan primarily covers them. When you have children, your insurance companies may use the birthday rule to decide which policy should cover the child. The primary plan for the child would be the one owned by the parent whose birthday occurs first in the year.

This means that if your birthday comes first, your child will be covered first by your plan, even if your spouse’s plan offers more generous coverage. You will therefore need to submit NICU bills to your plan as the primary insurer before submitting any claims to secondary insurance, which could increase the amount you will have to pay out of pocket.

How to get help with NICU costs

If your health insurance doesn’t cover newborn intensive care or you don’t have health insurance, there are some things you might be able to do to ease some of the financial burden. You can start by contacting the case manager or NICU social worker at the hospital. They should be able to discuss possible options for covering NICU expenses, including requesting Medical help Where Supplemental Security Income (SSI) advantages.

Newborns born to mothers already covered by Medicaid are automatically covered. In cases where the mother is not eligible for Medicaid, the baby may still be eligible. Eligibility for Medicaid is based on household size, income, and financial resources. You can apply for Medicaid for your newborn or for yourself at your local Department of Social Services office.

Supplemental Security Income can cover babies born with certain conditions that require NICU care. Although SSI does not directly cover health costs, it can provide families with monthly benefits that they can use to pay for medical care or other expenses related to their baby’s stay in the NICU. You will need to apply for SSI benefits through the Social Security Administration (ASS).

If you are not eligible for Medicaid or SSI benefits, you can discuss other options with the hospital. For example, you may be eligible for charitable assistance depending on your income and financial resources. Or the hospital can work with you to negotiate a reduced payment plan. You can contact the hospital billing department to discuss possible solutions for your situation.

Conclusion

Getting your baby through the first few days or weeks of life in neonatal intensive care can be tough enough, without having to worry about astronomical medical bills. Understanding what is likely to be covered by your health insurance and the options you have for obtaining financial assistance can help reduce your stress related to financial issues.