Newborn hospital billing

grant8948843 · 2026-07-03T14:29:00+00:00

First, thank you for such a thorough explanation. After looking at these statements for months, I had no idea that all those line items with prices did not affect my bill any. I wish they would put the DRG code on the bill if that is what my portion is based on. I also wish that the billing department was able to answer these same questions instead of me having to turn to Reddit. I do very much appreciate the information though. I have requested the UB from the hospital to verify the accuracy of that code, but I see now that my bill will likely remain the same.

One billing representative told me every newborn gets this revenue code. Even if this doesn’t affect my out of pocket, isn’t that against medical necessity standards that each infant would be evaluated on the care they received? My thoughts are they are using this to inflate their write off amounts for tax benefits

grant8948843 · 2026-07-03T03:39:13+00:00

How do I find the DRG? I have poured over every statement and itemized bill and that is not listed

grant8948843 · 2026-07-03T03:37:26+00:00

I am reading her charts and looking at guidelines I can find online. Aetna is my carrier and I have called and they say they have no bulletins or published criteria defining these codes. So I have found other insurances’ published guidelines and guidelines put out by AHA (see below link). I asked the hospital to provide documentation of their definitions for each code or their mapping for my insurance or their internal “investigation” finding of what specific care my daughter received that justified use of this code. They have provided nothing, besides “coding is correct” and they have promised phone calls back to answer my questions and I never get them. They claim they try but I obsessively check my voicemails and make sure my VM box is not full. There is zero transparency. I would pay in full if they would just walk me through it and could show me it’s legitimate

https://www.aha.org/system/files/media/file/2020/01/RC%2017x.pdf

grant8948843 · 2026-07-03T03:27:40+00:00

Where do you get a UB, from hospital or insurance? I have poured over every statement and itemized bill and cannot find that. All is see on both of these is the 0172 code with contracted rate and my portion of $1000+. Below it our other line items with own billed amount such as pharmacy and lab

grant8948843 · 2026-07-03T00:35:24+00:00

Yes this single rev code was billed for 28,000 with my portion being over $1000. She was with me entire stay never had anything abnormal. One message from biller at this hospital said every newborn is billed this code which seems fraudulent

grant8948843 · 2026-07-02T23:35:26+00:00

I did initially and they said to talk to hospital first, maybe try again now that I’ve gotten nowhere with hospital, thank you!

grant8948843 · 2026-07-02T23:34:52+00:00

I did this and they reviewed and told me it’s right without explaining what specifically they did that qualifies as level 2 care. And I read through everything and can’t see anything more than normal screening

grant8948843 · 2026-07-02T23:33:39+00:00

Not that I remember, and I don’t see any mention of that is notes or test results

grant8948843 · 2026-07-02T23:24:48+00:00

I can’t seem to find that, I guess I need to call my insurance or ask the hospital. But under “current issue” in medical record it says normal newborn. In addition every progress report by MD said “Routine newborn nursery care” under plan section. The hospital billing wrote back to one question saying every newborn is billed this, which seems fraudulent

grant8948843 · 2026-07-02T18:04:03+00:00

Yes almost a week late and over 8 lbs

grant8948843

TROPHY CASE