MARY LOUISE KELLY, HOST:
Nitrous oxide is the gas you may know from your dentist's office - laughing gas. It's also used to help women with pain during childbirth, and it is generating some crazy bills. One of them is our May Bill of the Month. Dr. Elisabeth Rosenthal, editor-in-chief of our partner, Kaiser Health News, is here to talk about it. Dr. Rosenthal, welcome.
ELISABETH ROSENTHAL: Great to be here.
KELLY: Tell me who we're going to meet today.
ROSENTHAL: We're going to meet Karli-Rae Kerrschneider, a nurse midwife, and she had some really clear ideas about what she wanted for the birth of her second child.
KELLY: OK. And I know she shared her story with our colleague, Mark Zdechlik of Minnesota Public Radio. He went to visit her. We'll share that story, and then I want to ask you some questions about it.
MARK ZDECHLIK, BYLINE: Karli-Rae Kerrschneider is feeding 4-month-old Leviathan, Levi for short. They're cuddled in a stuffed chair in her sunny living room and appear enamored with one another. And he's got a lot to say.
KARLI-RAE KERRSCHNEIDER: Hi, pumpkin.
ZDECHLIK: We're in western Wisconsin in the quiet town of Baldwin about an hour from Minneapolis. Karli-Rae works as a midwife and couldn't have been happier with the people who helped her deliver Levi.
KERRSCHNEIDER: They took care of me amazingly. The nurses were incredible. The midwives were spectacular. Like, I have - I told - after this birth experience, I told my husband - I said I don't want to give birth anywhere else.
ZDECHLIK: Levi is Karli-Rae and Christopher Kerrschneider's second child. When his sister, Eleanor, was born a couple of years ago, Karli-Rae got an epidural to help with the pain. She wanted something different for Levi's birth, something that would leave her more in control. She opted to have Levi in a hospital bathtub using nitrous oxide to help her relax.
KERRSCHNEIDER: I was so much more empowered. I was able to get into the different positions I wanted. I didn't have to be - I wasn't hooked up to anything.
ZDECHLIK: It took about 11 hours, but everything went great. She inhaled the laughing gas whenever she wanted some relief.
KERRSCHNEIDER: It really helped take the edge off, and it feels a little bit like a buzzed sort of feeling maybe is, like, the best way to describe it.
ZDECHLIK: Several weeks later, Karli-Rae could have used another hit of laughing gas to help her come to terms with her newly arrived hospital bill. It detailed it almost $5,000 price tag for the nitrous oxide alone.
KERRSCHNEIDER: I was shocked when I saw the itemized charges, and at first, I thought there was a mistake.
ZDECHLIK: Remember, Karli-Rae makes a living helping other women give birth, and her facility charges a flat fee of about $100 for laughing gas.
KERRSCHNEIDER: Working in health care, I have always tried to be proactive about finding out how much things would cost before going into them. With the nitrous, I never even asked because I had never conceived that someone would bill it so high. I knew many places that provided the service for free.
ZDECHLIK: Karli-Rae says she and her husband have a lot of student loans and carefully spend their money.
KERRSCHNEIDER: We try to be very, very wise about where our money is going.
ZDECHLIK: Her health insurance company was on the hook for most of the bill. Still, she thought it was ridiculous and didn't want anyone overcharged, but her insurance company didn't seem to mind.
KERRSCHNEIDER: They said, well, since it's part of the global fee, we don't really care. It's just - it is what it is, and we're not going to worry about looking into it.
ZDECHLIK: Karli-Rae gave in and paid her share of the bill even though she thought she was being overcharged.
KERRSCHNEIDER: At that point with a new baby and a toddler and my own job, you know, looking forward to going back to, I just didn't - the hassle was just too much, and I didn't want to fight them on it anymore.
KELLY: That was Karli-Rae Kerrschneider explaining the bill she got for laughing gas to Mark Zdechlik of Minnesota Public Radio. And, Elisabeth Rosenthal, let me bring you back in here - $5,000 bill for that laughing gas at the hospital even though, as we heard, her facility charges a hundred bucks, flat fee. How do you explain that huge difference?
ROSENTHAL: Well, when we examined Karli-Rae's bill, we saw that her hospital had gotten to $5,000 by charging her - get this - by the minute. She was billed over $100 for every 15 minutes that tank was in her room, and it didn't matter that she was only taking hits of the gas now and again. She would have been billed that much just for it sitting by the bedside. It's kind of like if you rent a car for the day, you're paying for 24 hours even if you're only driving for an hour.
KELLY: Even if you never drive it a mile.
ROSENTHAL: It's crazy.
KELLY: Is that common, to bill by the minute or by the hour?
ROSENTHAL: Well, unfortunately, more and more because it's very lucrative to do so. So you can charge surgical suites by the minute. You can charge recovery room time by the minute. It's a dubious but kind of legal way to bill. For example, in that recovery room case - right? - you're sitting there for three hours. Well, it may not be for a medical reason but because your surgeon is making rounds or dealing with another patient or just can't find a parking space. By the way, the thing that really shocked me is that when we ask the hospital, well, what would you charge for an epidural, the charge was $1,500, so a third of what having that tank sitting in the room costs.
KELLY: Wow, and doing it in a bathtub with no epidural. So what's - are there lessons here that we should take away from the Kerrschneiders' experience?
ROSENTHAL: You know, the first thing is always ask for an itemized bill. And if you see something that doesn't make sense, like this $5,000 charge that was listed as anesthesia - you know, she said, whoa, what's that about? Asking those questions got the charge dropped for her to about $500. So for me, the takeaway is, you know, we tend to look at these bills and go, whoa, what's that, I don't know - ask, make a fuss. It may make a difference, both for you and for your insurer.
KELLY: So they did ask. They did make a fuss. How much - what did their total bill end up being for the birth of this child?
ROSENTHAL: They paid about $3,600. That was their high-deductible copay for a birth that cost about $12,000. You know, that's a lot for a birth in a bathtub without anesthesia.
KELLY: Elisabeth Rosenthal - she's editor-in-chief of Kaiser Health News - thank you so much.
ROSENTHAL: Thanks for having me.
KELLY: And if you have a medical bill that you want us to investigate, you can go to NPR's Shots blog.
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