We Need to Talk About the Financial Toll of Miscarriage
Of women who know they're pregnant, about 10 to 15 percent of pregnancies end in miscarriage. And it's no surprise that the experience of losing a baby is a deeply emotional one—but it can also be an expensive one.
While insurance usually covers costs associated with miscarriage, there are often large co-pays and other expenses that come with pregnancy loss, not to mention high deductibles to meet, that aren't covered. Physical exams, ultrasound(s), blood work, medications, anesthesia, potentially surgery—it all adds up. And that's without considering missed time from work, the cost of at-home recovery essentials, and—of course—the profound sadness and grief of miscarriage.
Medical cost site Healthcare Bluebook estimates that, before insurance, costs for a procedure called a dilation and curettage (D&C)—which surgically clears the uterine lining after a first trimester miscarriage—can range anywhere from $2,400 to upwards of $7,500.
Worse? "Many women receive the bills for these procedures separately. For example, one bill for the ER visit and another from the anesthesiologist," says Annette Attolini-Fertuck, Ph.D., a perinatal psychologist based in New York. "Getting these bills is a constant reminder of the painful loss they have endured."
Miscarriage tends to be a silent loss, she adds. "Most women mourn their lost pregnancy with very little emotional and financial support."
The True Costs of Miscarriage
Major organizations, such as the American College of Obstetricians and Gynecologists, don't list out the cost of miscarriage, but all experts interviewed in this piece confirmed that cost really does come down to what kind of insurance you have—and that usually, costs of procedures like a D&C are, at least to some extent, covered.
But miscarriage can still be expensive, says Dr. Attolini-Fertuck.
Costs depend on treatment, and there are typically three forms of it:
Waiting things out to see if you miscarry naturally. Usually, this happens in a few days' or weeks' time. If you're able to pass all of the pregnancy tissue, you won't need surgical intervention, though you'll still need a follow-up appointment to confirm that you did indeed miscarry on your own.
Medication, which can be taken by mouth or inserted vaginally. This can bring on contractions and help your body expel a pregnancy.
Surgery. A D&C or a dilation and evacuation (D&E), which is performed in the second trimester, are surgical interventions that remove a pregnancy depending on how far along you are and can be done in the office or in the hospital.
While waiting things out is often always the most affordable option, it also comes with an emotional toll of, well, waiting. Depending on your situation, it also isn't a viable option for everyone.
Costs—even comparing the same two procedures—can also vary dramatically depending on where you live, what facility the surgery takes place in, and other factors. Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University, notes that even a simple D&C can cost thousands.
For the overwhelming majority of people with insurance, though, the cost of miscarriage comes down to one thing: what your insurance deductible is.
For Arden Cartrette, a blogger based in Pittsboro, North Carolina who experienced two miscarriages—one that happened naturally and one where, after complications from taking the medication Cytotec to induce miscarriage, she wound up in the ER needing a D&C—that meant shelling out $10,000.
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"The cost of our second miscarriage was devastating to us," she says. "We both have good jobs, work full time, and have a normal amount of debt for homeowners, but having roughly $10,000 in medical bills was devastating—especially having to spend so much money and not getting to bring home your child."
Jordan Marlow, a 29-year-old based in Boston who had a miscarriage and a D&C at 10 weeks in June of 2018, says that her bills started showing up in batches a month later and totaled close to $4,000. "We were both floored at the cost and brought back to that awful day that our lives were forever altered," she says.
There are other unexpected costs associated with miscarriage too, like having to take time off of work, says Dr. Streicher. Other unexpected expenses might include recovery essentials like maxi pads or adult diapers for bleeding, says Cartrette.
But really, all costs associated with miscarriage can seem shocking. After all, says Dr. Streicher: "No one's expecting to have a miscarriage."
What Needs to Change
When Winifred Mak, M.D., Ph.D., an assistant professor in the department of women's health at Dell Medical School at The University of Texas, sees patients who experience a miscarriage, she doesn't offer any treatments there and then. "I tell them, 'Go home; grieve.'" When her patients are ready, she discusses treatment options with them.
Assuming you're not in need of immediate medical care, that's an important approach. "After a miscarriage, women are left with deep grief, fear of the unknown, and hopelessness," says Dr. Attolini-Fertuck. "OB-GYNs need to be more aware of how emotionally difficult having a miscarriage is for a woman."
That's unfortunately not how all women get care though. "When the doctors were explaining our options, they were empathic but explained the procedures in medical lingo and wanted an answer right then and there," says Marlow of her experience. "I think having the time to process what is happening and what decision needs to be made is necessary."
When their bills started showing up, Marlow and her husband even started questioning the integrity of the health care system in general. "We were wondering if the doctors had pushed the D&C because of the cost associated with it."
Cartrette says that when she called her hospital to set up payments, they were unwilling to work with her to find an affordable option. "That made it all the more stressful during a hard time. It's difficult to mourn the loss of a pregnancy and worry about the financial burden."
What to Do If You Experience Miscarriage
Unfortunately, sometimes facing financial hurdles associated with miscarriage involves being an informed patient—and taking things into your own hands.
Ask for all of your options—and for time. "I encourage women to ask their doctors about other, less expensive options beyond a D&C," says Dr. Attolini-Fertuck. "Do not be afraid to challenge your doctor about different treatment or procedure options." Once you have all of your options on the table, you can discuss them with your partner and/or doctor.
Don't blindly pay a bill you're unsure of. "Insurance companies bank on the fact that when they give you that big whopping bill, you pay it," says Dr. Streicher. "Sometimes, it does help to fight it." If you think something is unfair or should be covered, open a claim with your insurance company.
Be upfront with your doctor and insurance company. If you don't have insurance or are concerned about cost, ask questions and voice your concerns. Sometimes costs can be different depending on where surgery is done (like in an office versus in the hospital, or vice versa), notes Dr. Streicher. And sometimes your doctor might be able to do work at both places. Having conversations beforehand could save you money. One 2007 study out of the University of Michigan Medical School found that the cost of a D&C done at a hospital was almost twice the cost of having the procedure done in a doctor's office.
Find out if anesthesiologists are covered by insurance. It's not something you should have to think about, but knowing that all doctors involved in your care are in-network will save you money. "A lot of operating room facilities have anesthesiologists who aren't part of the network," says Mary Jane Minkin, M.D., a board-certified OB-GYN and a clinical professor at Yale University School of Medicine.
Have a list of good resources. Cartrette suggests that women going through miscarriage check out resolve.org (a resource for infertility and pregnancy loss that includes support groups), fertilityiq.com (great for information on advocating for yourself), and pregnantish.com (a digital resource for women going through infertility and miscarriage). She also blogs about her own experience with pregnancy loss at hello-warrior.com.
Ultimately though, finances aside, if you've experienced miscarriage, it is crucial to take time to heal, says Dr. Minkin. She, for one, counsels all of her patients that miscarriage, in general, is based on something that happened when that sperm and that egg got together. She reminds patients that it has nothing to do with anything that they did.