TABLE 1.
Out-of-Pocket Spending for Childbirth Episodes Among Privately Insured Families, 2016–2019 Optum Clinformatics Data Mart
| All Childbirth Episodes | Episodes With Cesarean Birtha | Episodes With Neonatal Intensive Careb | |
|---|---|---|---|
| Sample size | |||
| No. episodesc | 397 410 | 136 571 | 23 360 |
| No. newborn hospitalizations linked to deliveries | 404 449 | 141 996 | 25 491 |
| Mean out-of-pocket spending for delivery (SD), $ | |||
| Total | 2281 (1706) | 2351 (1826) | 2038 (1872) |
| Deductible | 1042 (1363) | 962 (1330) | 795 (1236) |
| Coinsurance | 1177 (1109) | 1322 (1260) | 1171 (1360) |
| Copayment | 61 (242) | 67 (263) | 72 (269) |
| Mean out-of-pocket spending for newborn hospitalization(s) (SD), $ | |||
| Total | 788 (1654) | 1038 (1984) | 2931 (4968) |
| Deductible | 249 (636) | 325 (742) | 1124 (1424) |
| Coinsurance | 534 (1446) | 705 (1732) | 1760 (4709) |
| Copayment | 5 (77) | 7 (97) | 47 (250) |
| Mean total out-of-pocket spending (SD), $ | |||
| Total | 3068 (2579) | 3389 (2957) | 4969 (5871) |
| Deductible | 1292 (1577) | 1288 (1607) | 1919 (2266) |
| Coinsurance | 1711 (2049) | 2027 (2441) | 2931 (5377) |
| Copayment | 66 (269) | 74 (302) | 119 (465) |
| No. episodes with total out-of-pocket spending exceeding $5000 (%) | 67 792 (17.1) | 30 939 (22.7) | 10 253 (43.9) |
| No. episodes with total out-of-pocket spending exceeding $10 000 (%) | 4052 (1.0) | 2265 (1.7) | 2052 (8.8) |
Defined as episodes in which the delivery was associated with at least 1 claim for cesarean delivery (those with Current Procedural Terminology (CPT) codes 01961, 01963, 01968, 01969, 58611, 59510, 59514, 59515, 59525, 59618, 59620, 59622, or 99360; and those with ICD-10-CM procedure codes 10D00Z0-10D00Z2).
Defined as episodes in which the linked newborn hospitalization(s) was associated with at least 1 claim for neonatal intensive care (those with revenue code 0174 or CPT codes 96468-96469).
A childbirth episode comprised the delivery and 1 or more linked newborn hospitalizations. Deliveries and newborn hospitalizations that began in 2019 could end in 2020. To identify deliveries, we used a modified list of birth-related diagnosis and procedure codes included in a published algorithm,3 as well as labor and delivery revenue codes. Birth-related ICD-10-CM diagnosis codes were O1002, O1012, O1022, O1032, O1042, O1092, O114, O1204, O1214, O1224, O134, O1404, O1414, O1424, O1494, O164, O2402, O2412, O2432, O24420-O24429, O2482, O2492, O252, O2662, O2672, O4202, O4212, O4292, O601xxx-O602xxx, O61xxxx-O82xxxx, O8802, O8812, O8822, O8832, O8882, O9802, O9812, O9822, O9832, O9842, O9852, O9862, O9872, O9882, O9892, O9902, O9912, O99214, O99214, O99284, O99314, O99324, O99334, O99344, O99354, O9942, O9952, O9962, O9972, O99814, O99824, O99834, O99844, O9A12, O9A22, O9A32, O9A42, O9A52, Z37xx-Z38xx (except Z371, Z374, Z377). CPT codes were 01960, 01961, 01962, 01963, 01967, 01968, 01969, 58611, 59300, 59400, 59409, 59410, 59414, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622. ICD-10-CM procedure codes were 0Q820ZZ, 0Q823ZZ, 0Q824ZZ, 0Q830ZZ, 0Q833ZZ, 0Q834ZZ, 0U7C7ZZ, 0U7C8DZ, 0W8NXZZ, 10900ZA, 10900ZC, 10903ZA, 10903ZC, 10904ZA, 10904ZC, 10907ZA, 10907ZC, 10908ZA, 10908ZC, 10D00Z0-10D00Z8, 10D17Z9, 10DA7ZZ, 10D18Z9, 10DA8ZZ, 10E0XZZ, 10S07ZZ, 10S0XZZ. Revenue codes were 0720-0722, 0724, 0729. To identify newborn hospitalizations, we used ICD-10-CM diagnosis codes Z37xx-Z38xx (except Z371, Z374, Z377); CPT codes 99360, 99460-99465, 99468-99469, 99477-99480; and revenue codes 0170-0174.