Cost for Alta Bates delivery with Blue Shield/PPO

Our second child was born last month at Alta Bates in a straightforward delivery. We have a Blue Shield PPO policy with 20% coinsurance.

The hospital bill was $19k and the physician's bill was $8k.

Blue Shield made almost no adjustments to these bills and apparently paid over $20k.

Our responsibility is about $5k.

Does anyone else have a similar experience? Is it normal for Blue Shield to pay the full billed amount, rather than having a better negotiated rate (which would reduce our coinsurance)?

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I had the same experience in 2019. Same hospital and insurance, straightforward delivery. We paid 5k out of pocket without negotiating. :(

Call your insurance to find out what your out of pocket max is for the year. I delivered at UCSF with anthem PPO and paid about $5000 unfortunately.

This was what it was like for us with our first kid. We were able to work out a payment plan with Alta Bates and paid off the amount over several years. 

Same situation as you but probably different insurance plan (though we also have a BlueShield PPO). Hospital bill was $27K, physician's bill was $8K. The EOB only lists the amount billed and they paid all of the hospital bill. It doesn't list an Amount Allowed or BlueShield Responsibility, etc, which seemed weird to me - I also expected there would be a negotiated rate. 

In the end we were responsible for about $1K to the physician. TBH I don't totally understand how this was all calculated but was happy to pay the physician and be done with it. I hope you're able to get to the bottom of this without too much annoyance... and congrats on the new baby.

I had vaginal birth, no interventions or medication beyond motrin and stayed a total of 30 hours from intake to discharge at Alta Bates in late 2020 and have UnitedHealthcare PPO. Here is a very loose breakdown based on claim summaries I just skimmed:

Alta Bates - billed $15k, the plan discounted $1k, insurance paid $13k and we paid $1k

Delivering Dr - billed $7.5k, plan discounted $0, insurance paid $6.5k and we paid $1k

Baby Drs - billed $1.5k, plan discounted $0, insurance paid $500 and we paid $1k

I have heard that you can call the hospital and negotiate down the amount you owe, but it's not something I've personally tried to do. I hope this helps!

I have worked in provider contracting in other markets and I’ve found the discounts on Sutter’s rates horrendous across insurers in no cal. They’re essentially a monopoly in many places and no one seems to be getting good discounts from them. I paid double for an anatomy scan at Sutter what I did at a teaching hospital in Boston. It seems like a systematic problem. No advice just confirming your read of the situation. 

It depends on the contracts in place behind the scenes.  Is Alta Bates a preferred provider for your insurance?

If not, the limit for each billable item may be limited by BlueCross's interpretation of "usual and custom ary".  Call the customer service department of BC, or get a person from your employer's liaison engaged to have a fully itemized bill shared with you, and then an explanation for all the reimbursements.