For Hannah Castle, an Ohio mom of premature quadruplets, the reality of the U.S. healthcare system was laid bare in a $4.04 million hospital stay.
In a TikTok post against a backdrop of itemized bills, Castle details how long each of her four babies — Atlas, Magnolia, Morgan and Dominic — stayed in the hospital's neonatal intensive care unit (NICU) and the cost for each child.
"This is not including the delivery," Castle said.
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The quadruplets’ hospital stays ranged from 64 days to 147 days, with costs ranging from $714,747 to $1.6 million for each baby.
"Take the cost just to stay in the NICU and the 27 pages of god knows what else he needed, and you get this," Castle said, gesturing to the $976,415.69 total just for her son Morgan.
Her viral TikTok post ignited a firestorm of comments, with many people expressing horror and sharing their own experiences with crushing medical debt.
"I've actually never been more shocked and horrified by anything ever," a TikTok user named Beth commented.
Another TikTok user named Kristin Magill wrote, "So all in all I just need to go on a vacation in another country around the time I go into labor."
Many commenters shared similar stories of premature babies racking up millions of dollars in debt for their hospital stays.
"I have identical twin boys, and we owe $2 million to the children's hospital," TikTok user Grace Middleton posted.
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Ty Webb said that in the two days before he died, his son had surgeries and blood transfusions. "I got his bill. It was $1 million and some change," he posted.
While Castle's bill is extreme, it’s an example of a widespread problem. Preterm babies often require weeks or months of specialized care, including ventilators, feeding tubes and round-the-clock nursing.
Her story also sheds light on the reality of health insurance. The "sticker price" of hospital services is rarely what a patient pays, as insurance companies negotiate significant discounts. Still, families are left with deductibles, co-pays, and out-of-network charges that can add up to tens of thousands of dollars, which is enough to drain savings and push a household into debt.
A 2021 report from the Commonwealth Fund, a private foundation that aims to improve the U.S. healthcare system, estimated that pregnancy and delivery complications would cost the nation $32.3 billion, including $13.7 billion for preterm births, from conception through age 5 for babies born in 2019.
With the rise of high-deductible health plans, families are shouldering a greater share of the financial burden. In 2021, 55.7% of private-sector workers were enrolled in high-deductible plans, with deductibles ranging from $5,000 to $6,000, according to Progeny Health, a company specializing in maternity healthcare and NICU management.
The out-of-pocket costs for a NICU stay can be thousands of dollars, a financial blow that can lead to medical debt and long-term financial instability.
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Newborns who are admitted to an NICU have five times more healthcare costs in their first 18 to 24 months than those who are not, according to Peterson-KFF, a health research nonprofit.
Even normal births can take their toll on a family's economic well-being. Pregnancy, childbirth and post-partum care cost an average of $20,416, including $2,743 in out-of-pocket expenses for women who have employer-sponsored insurance coverage, according to Peterson-KFF.
Giving birth is expensive, but other medical expenses can also take a toll on a family's financial well-being.
In 2022, about four in 10 U.S. adults had medical or dental debt, which was often owed to credit cards, collection agencies, or family and friends, and many with employer-sponsored or Marketplace health plans rated their coverage as "fair" or "poor" because of high premiums and out-of-pocket costs for doctor visits, according to health news and research site KFF.
Castle's story exposes a widespread issue in the U.S. healthcare system. Faced with high deductibles and rising out-of-pocket costs, families can face life-altering financial burdens from unexpected medical events.
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