A TPA and Stop Loss carrier pended payment on a shocking 2.7 million dollar claim for a preterm birth of triplets that were in the NICU for 3-months.
In the U.S., the average cost of an uncomplicated full term hospital childbirth is nearly $19,000 and premature births can be 10 times more costly. Furthermore, multiple births (vs single births) are 7 times more likely to be premature and often require care in the NICU. The level of care depends on the severity of the illness. For these babies, their care was for respiratory and nutritional support until they were healthy enough to go home. There were no significant surgeries, no congenital deformities, or specialized treatment.
The birth of triplets is foreseeably costly, but these triplets were no million dollar babies. According to Ira Weintraub M.D., Chief Medical Officer at WellRithms, "The itemized bill showed the level of care was constantly changing. Yet, according to the medical records, the medical treatment never changed. You simply couldn't match the severity of the illness to the levels of care the hospital was billing."
WellRithms adjusted the 3-month NICU stay daily acuity level to a level 2, denied the charges for daily oxygen, reduced inflated drug prices, and more. The hospital was paid 1.1 million dollars, which was fair and reasonable for the medical treatment the babies received in this case.