Managing Costs for a NICU Stay

The neonatal intensive care unit (NICU) is designed to provide around-the-clock healthcare for babies who are born prematurely or with life-threatening health conditions.

A NICU stay can be emotional and stressful for parents, and there may be financial aftershocks once medical bills begin arriving. Newborn intensive care costs can be significantly higher than standard newborn care costs. While your insurance should pay for some of these medical expenses, it may not cover everything, so it’s important to know how to manage them.

Key Takeaways

• A neonatal intensive care unit (NICU) provides around-the-clock care for prematurely born babies and newborns with certain health conditions.
• If your baby has to go to the NICU shortly after birth, it’s important to add your newborn to your health insurance policy as soon as possible.
• Health insurance may cover some, though not all, of the costs associated with neonatal intensive care.
• Parents whose insurance does not cover the full cost of a NICU for their infant or who are uninsured may qualify for financial aid through the hospital or their state’s Medicaid program.

Average Cost of a NICU Stay

The NICU provides specialized care to newborns who are born early or are sick. While in the NICU, your baby might be seen by a number of healthcare staff, including a neonatologist, a respiratory therapist, a neonatal nurse practitioner, and a dietitian, among others. In general, your baby will receive more intensive care and attention during their NICU stay than during a typical hospital stay.

From a cost perspective, this means that you’ll likely pay more for neonatal intensive care than you would for standard newborn care. According to a Michigan Medicine study of nearly 400,000 deliveries that required 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.

$3,000 to $20,000

The price range of a NICU stay per day as of 2023.

The amount that you might pay for NICU care can depend on several factors, including:

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

A 2023 study in Frontiers in Pediatrics found that the cost of neonatal care significantly increases when tiny infants have health issues common to prematurity; the five most frequent problems cost roughly $18,000 to nearly $57,000 to treat.

For moderate to late preterm babies, the typical NICU stay 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 health issues and care needs. Generally, the longer preterm infants stay, the more you can expect a NICU visit to cost.

Important

In addition to NICU stay costs, new parents may also need to consider the possibility of other added costs if the mother requires specialized care to deal with complications stemming from the birth.

Does Insurance Cover NICU Costs?

Whether 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’s important to contact your health insurance company to ask about your coverage. Specifically, you should ask these questions:

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

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

Coordination of benefits is a provision that’s included in most healthcare 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 can use the birthday rule to decide which policy should cover the child. The child’s primary plan would be the one that belongs to the parent whose birthday comes first in the year.

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

Note

Once your child is born, you’ll need to contact your health insurance company to add them to your policy before any NICU costs can be covered.

How to Get Help With NICU Costs

If your health insurance doesn’t cover newborn intensive care, or if you don’t have health insurance, there are a few things you might be able to do to lighten some of the load financially. You can start by contacting the hospital’s NICU case manager or social worker. They should be able to discuss possible options for covering NICU expenses, including applying for Medicaid or Supplemental Security Income (SSI) benefits.

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

All babies that meet the low birth weight (LBW) requirements qualify for SSI. A baby is considered LBW if they weighed 1,200 grams or less at birth, or if they weighed 2,000 grams or less at birth and are less than the 3rd percentile of size for their age. Babies that are non-LBW may still qualify for SSI if they have certain conditions that may affect them for a year or more.

While SSI does not directly cover healthcare costs, qualifying for SSI automatically makes your baby eligible for Medicaid in 35 states, and applying for SSI is an important first step in the process. SSI only pays $30 per month while your baby is in the hospital, but can pay up to $943 per month when your baby comes home if your family is exceptionally low income. Most hospitals have social workers who furnish paperwork to the Social Security Administration (SSA) to qualify for SSI. If yours does not, you can file online at ssa.gov and an SSA employee will contact you to complete the application.

You could talk to the hospital about other options if you’re not eligible for Medicaid or SSI benefits. For example, you may be eligible for charity assistance based on your income and financial resources. Or the hospital may work with you to negotiate a discounted payment plan. You can contact the hospital’s billing department to discuss possible solutions to fit your situation.

Tip

Thoroughly review any medical bills you receive from the hospital or specific providers to look for errors or charges that you don’t understand, then contact the biller to have those issues addressed.

Can Neonatal Intensive Care Unit (NICU) Babies Get Supplemental Security Income (SSI)?

Newborns who have certain disabling conditions may be eligible to receive Supplemental Security Income (SSI) benefits. To qualify, your child must meet the LBW requirements outlined above, or have a condition that’s expected to seriously limit their activities for a period of 12 months or more.

How Much Is a Week’s Stay in the NICU?

The cost of a weeklong stay in the NICU can vary by hospital. For example, Nationwide Children’s Hospital typically charges $8,600 per day for NICU level 2 care. Based on those numbers, you could pay as much as $60,200 for a seven-day NICU stay. If your baby has to go to the neonatal unit, ask for an itemized bills so you can see what you are being charged for.

Does Insurance Cover Premature Birth?

Health insurance plans can cover premature birth and NICU costs if neonatal care is necessary. If you anticipate any complications that might result in a NICU stay for your newborn, it’s important to ask your insurer what will be covered and what won’t. If you’re married, you can also check your spouse’s coverage, since the baby will be eligible for both health plans.

The Bottom Line

Having your baby spend the first days or weeks of its life in neonatal intensive care can be strenuous enough without having to worry about staggering medical bills. Understanding what’s likely to be covered by your health insurance and what options you have for getting financial assistance can help reduce your stress.

Read the original article on Investopedia.