About the author: I am an award-winning investigative journalist who worked at Greenville, SC’s WYFF News 4 from 1999 to 2005. Everything you read below is objectively true.

Summary: Below is a long and detailed account of paying to have my second child delivered at St. Francis Hospital in Greenville, SC. It is a story of broken promises, misinformation, and billing practices that have been reported to state and federal regulators. It serves as a warning to people seeking to self-pay for the cost of having a baby at St. Francis Hospital. No matter what you may be told, no matter what you may pay in advance, no matter how many receipts showing zero balances you have, you will never know when the hospital billing will stop. St. Francis Hospital can charge you whatever it wants to deliver your baby, and it will charge you much more than it promises in advance. Although the healthcare professionals there are magnificent and are beyond reproach, the billing office should give you pause. Do your homework before choosing St. Francis to deliver your baby. If you have questions about this report, feel free to use the contact box at the top of the page to send me a message.

Market Price

All we wanted to know was, “How much is it going to cost?”

Our second son was on the way and there was no stopping him. The calendar had just flipped to 2009 and we were going to have a baby in May, no matter what.

Frankly, our question seemed like an easy one. Every item has value and every service has a price. Go to almost any business, and the man behind the counter will gladly tell you how much he is going to charge. We wanted to know, “How much is it going to cost to have a baby at St. Francis Hospital in Greenville, SC?”

And the hospital wouldn’t tell us.

It wasn’t for a lack of asking. I called St. Francis and left several messages. My wife did the same. We searched the web site. We sent e-mails. It seemed like a simple question that should have a ready answer.

Of course, we weren’t expecting an exact price. No birth is the same. The duration of delivery, emergencies, and any number of things can change how much a delivery would cost. However, there are dozens of people who work for that hospital who know the average cost of a birth at St. Francis. We simply wanted a ballpark number. Finding someone who would tell us that estimate was nearly impossible.

The price was important to us. We have private insurance for which we pay a $934 monthly premium. It would cost more, but we decided five years ago to save several hundred dollars a month in insurance premiums by not carrying maternity coverage. It’s what our insurance agent recommended and seemed to be the most logical course of action. Instead of giving thousands more dollars per year to an insurance company, we put the money in the bank with the intention of using it to pay for the birth of our second son. All we needed to know was an estimate of how much it would cost.

In a logical business environment, it should be easy to calculate. Hospital rooms cost X per night, nurses cost X per hour, drugs cost X per dose. All we wanted was, if you don’t mind the metaphor, the hospital’s menu. Instead, hospital finance workers routinely presented us with the medical equivalent of steak and lobster served at “Market Price.” That is, the hospital would only tell us the final cost when it was all over. It’s standard practice, we were told. In fact, my wife’s OB-GYN office was in constant search of the same information so it could provide it for its patients. The people there begged my wife to uncover the schedule of charges so they could help other mothers plan for the costs.

Ultimately, my wife marched down to the hospital and pleaded for guidance. How were we supposed to plan for our family if we had no idea how much to save for the birth of our son? She finally found a woman who said she could help. St. Francis, the billing officer said, offered a pre-pay option for people without maternity coverage. We could pay for everything in advance and get a small discount for putting the money up front. No muss, no fuss, no worries about big unexpected bills later.

Of course, we were suspicious. The hospital wouldn’t provide a printed contract. We couldn’t get the menu we wanted. In fact, the best my wife could wrestle from the billing officer was a Post-It note.

The note was white with three tilted apples at the bottom. At the top, the woman scrawled “2 day Vag Del” (two-day vaginal delivery) and the amount we could pre-pay. We were told that was the average amount charged for a routine St. Francis birth. Below that, the woman wrote “Well baby” and the amount it would cost for the hospital to care for our son immediately after he was born. Finally, the woman wrote the phone number for Palmetto Anesthesia, the local provider for the hospital and the company that would provide my wife’s pain management service. We were told we could pre-pay there as well.

We breathed a sigh of relief. Finally, we found someone who could help us plan for the cost of having a baby. We wrote a check for $6,224.77 to St. Francis hospital with the verbal assurance that if nothing went wrong with the birth, we wouldn’t have to pay any more money and may even be due a refund. That same week, we pre-paid $900 to Palmetto Anesthesia and were told we were square with them, too. That was in addition to the check we gave the OB-GYN office for around $2,000. In all we’d submitted more than $9,000 in payments. It was a lot of money, but it was money we’d saved for just that purpose. Even better, we were working on the assurance we wouldn’t have to worry about spending any more of our savings if we had a routine delivery.

We would soon learn a very tough lesson: St. Francis didn’t want to give us a price because every birth costs a different amount. Even routine births that are exactly the same can have different prices. It depends on whether you have insurance, whether you can pay in advance, and, most importantly, however the numbers can be worked such that the hospital makes as much money as possible.

That is a long way of saying, there is no way of knowing how much it will cost to have a baby at St. Francis hospital until the last bill arrives—and you never know when that will be.

Paranoia strikes Dad

In the months leading up our son’s birth, the nervousness rose up in my throat. I found myself awake at night worrying about the typical paternal fears. What if something went wrong? What if the baby was sick? What if something happened to my wife?

I bolted out of bed one night and said, perhaps a little too excitedly, “What happens if you need a C-section?”

It was the one thing we hadn’t considered in the medical billing process. We knew we’d paid for everything related to gestation, labor, and delivery. I didn’t remember, however, how we would be billed if my wife ended up in surgery.

The next day, I calmed myself and sat in front of the phone. I didn’t want to talk to the insurance company again. The calls were almost always adversarial and I always felt like there was a guy standing at my bank ready to withdraw $1,000 just because I’d made the mistake of calling.

When I got somebody on the phone, however, I was uncharacteristically reassured. Unless my wife elected to have a C-section, our insurance would cover it. That is, if it was an emergency procedure, we were covered.

Every base, we believed, was covered. My wife’s doctors had been paid in full. The anesthesia company had been paid in full. The hospital had been paid in full. In the event my wife had to undergo an emergency Caesarean section, the insurance company would cover it. We were prepared as we could be.

With that, we sat back and waited on a baby.

Did you pack our attorney?

Women know.

Instinct takes over and in the blink of an eye they can determine, “This is the day I’m having a baby.”

One nice day in May, the look in my wife’s eye changed. She called her doctor, we went into the office, and they said, “You’re having a baby.” My wife nodded. Another spot-on medical opinion.

Rather than spend more time and money than necessary at the hospital, we went home. Understand, we were doing all we could to make sure we didn’t overshoot the amount of money we already pre-paid. My wife packed newborn diapers for the baby and a bottle of Ibuprofen for herself. We were leaving nothing to chance. Again, we were told that if everything was routine, we would not owe a penny more. Moreover, we hoped for that possible refund.

My wife sat at home for another three or four hours until the pain made it evident that our second son was going to be born soon.

It was a calmer drive than the first time we’d had a baby. We’d done it all before. We knew the way to the hospital. We knew the protocol when we got there. It was, we were sure, going to go smoothly.

“We pre-registered,” my wife said to the lady at the front desk.

In between contractions, my wife was a reasonable and put-together woman. She’d spent months writing checks, signing papers, and making sure we were not going to end up with one of those medical billing horror stories. Now, with those final words to the front desk, she was free to writhe in a pain that only mothers can comprehend.

If the ladies in the St. Francis Hospital billing office are to be believed, this is the moment I should’ve consulted an attorney. This moment in which my wife is doubled over in pain and being led away from me by a stone-faced nurse? This moment in which all I want to do is be beside her and make sure nothing goes wrong?

This is the point in my adult life in which I should pay very close attention to the fine print.

It is of no matter that we began preparing for the logistics and protocol of our son’s delivery when he was still a peanut-sized fetus. It is of no matter that we, in good faith, paid every bill in advance and were assured that only in the event of an extraordinary deviation from the norm would we end up owing more than we’d paid. It was of no matter that my wife’s face was a mask of pain and that we were at our most vulnerable.

No, this was the moment I was apparently supposed to grab the registration documents and run down to my lawyer’s office.

Remember this moment.

This is the moment St. Francis would get paid.

Defining routine

We had every reason to be happy. The labor could not have been much shorter. The delivery almost seemed easy. Within less than four hours of arriving at the hospital, we were alone in our room with our new baby boy. In short, if you needed a definition for “routine birth,” you only needed to look at us.

We felt confident that we would owe no more money. In fact, we even spoke that night about the possibility of getting some of our money back because everything was so quick and easy. My wife felt so good and healthy that she declined drug after drug, and service after service designed to make her more comfortable. If we’d kept going at that rate, St. Francis should’ve been cutting us a nice check.

The doctor, the mother, the baby,and the nurse defining routine birth

The bills started almost immediately upon our arrival home.

Despite our repeated protestations that we had no maternity coverage, and despite notes on our account specifically stating that we had no maternity coverage, St. Francis submitted all the bills to our insurance company anyway.

A reasonable person would ask, “Well, if you had already paid for everything, why would the hospital submit the bills to the insurance company?”

There is no clear or fair answer. The hospital would likely say it was a mistake or that, in a moment of altruism, it was trying to save us money. Someone else might assume the hospital thought it might be able to get paid a little more. There is no way of knowing for sure.

Know this, however: when our insurance company mistakenly paid the hospital thousands of dollars for coverage we didn’t have, St. Francis Hospital neither tried to give that money back to the insurance company, nor did it try to give us back the money we had paid in advance. It was only after Blue Cross/Blue Shield had discovered its error and demanded the money back that St. Francis returned the cash to the insurance company. And then the hospital started billing us again.

It took three months of fighting with the St. Francis billing office and being told that we, in no uncertain terms, owed money to the hospital before we finally snapped. We literally picked up our baby and stormed the hospital. We demanded to speak to someone in person. We were settling it that day.

By some quirk of fate, we ended up across the desk from the lady with the tilted apple Post-It notes. We shoved a thick file folder across a desk, showed her the note with her handwriting on it, and said, “Fix this today.”

She hemmed and hawed. She scrunched up her face and looked deeply into our account. Finally she said, “This is a mistake.”

This woman again appeared to be our savior. After hours of waiting on the phone and fighting with the heavies in the central business office, we’d found the woman who had, in essence, entered into a verbal contract with us seven months before. This was the woman who had promised us that, if everything went smoothly, we’d never have to worry about paying another bill.

She called her supervisor, Angie Pittman, into the office. Pittman looked across the desk at us and shook her head like we were the two most pitiful people in the world. It must have been a sight. My wife and I are educated people. We have no debt except our home mortgage. We pay off our credit cards every month. We have a perfect credit score. For the past several weeks, however, we’d been treated like deadbeats. We were frustrated almost to the point of tears. It strained our relationship and we were at the end of the rope.

Pittman comforted us, complimented our baby’s pudgy cheeks, and then did what we wanted all along. She gave us two receipts showing zero balances on our St. Francis accounts. She signed her name and the date and told us we owed nothing else.

I remember all of this with a particular clarity. The day we finally had signed receipts showing a zero balance was the moment we knew we were free from everything and could get on with enjoying our new baby. There would be no more bills. There would be no more fear that the money we had saved for vacations and holidays would have to be spent paying for hospital bills we had already paid.

And just because I wasn’t sure any moment could be so good, I recorded it all on a digital voice recorder. It was a conversation I’d listen to several times over the next few months and wonder, “Did that really happen?”

For the services of Maria Claxton

That is where the story should end. That is where I could shake my head and tell you ruefully about how St. Francis overcharged us and manipulated the bill such that the cost of our son’s birth met the exact amount we paid in advance. This is where I could tell you about getting charged for drugs my wife was never given and nursery visits my son never made. This is where we could talk about how I was simply ready for it all to be over. This is where we would talk about how the healthcare industry is verging on corrupt.

There was no time for those conversations, because three months later we got another bill in the mail.

For anyone who has never been through such a Kafkaesque experience, this is the moment you want to cry. This is the moment you stand in the middle of the kitchen with your head bowed and wonder what you did to deserve such an endless cycle of frustration. This is the point at which you wonder if you are the victim of a very ugly joke, or worse, a very well-calculated crime.

The bill was $1,541 and arrived almost five months to the day after my son was born. It had obviously been recently submitted to our insurance company and had understandably been denied. The $1,541 was ostensibly meant to cover the cost of a Certified Registered Nurse Anesthetist (CRNA) named Maria Claxton, a woman with a North Carolina personal address and a South Carolina business address who neither works for St. Francis, nor Palmetto Anesthesia, the two companies with which we contracted and had been given zero-balance receipts.

My wife and I barely remember this woman. If she is who we believe her to be, she is the lady who followed the anesthesiologist into the delivery room when he gave my wife her epidural. The American Association of Nurse Anesthetists proudly proclaims that its members “enjoy a high degree of autonomy and professional respect” and that they are “the main provider of anesthesia to expectant mothers and to men and women serving in the U.S. Armed Forces.”

In our case, the woman we believe to be Claxton was there for less than half an hour and her duties seemed to be along the lines of standing there, handing the doctor things, and then monitoring my wife for a few minutes to make sure she wasn’t going to have a negative reaction. For this service we were being charged somewhere between $50 and $100 per minute.

Bear in mind here, we pre-paid Palmetto Anesthesia $900 for the entire cost of the epidural and doctor’s services. Now we were being charged more than $1,500 for the doctor’s assistant, a freelancer with whom we had never contracted. She was working for St. Francis Hospital, the company that told us that if we paid our bill in advance and settled up with Palmetto Anesthesia in advance that we would owe no more.

We called the number on the bill, which took us to the Jackson, Michigan-based Anesthesia Business Consultants (ABC). Over the course of three or four phone calls totaling nearly two hours, we began to recognize the sound in the background of poorly-trained call-center workers with fake names like “Jason B.” and “Steven No-Last Name.” Each time, they told us they couldn’t help us. Each time they told us it was a bill from St. Francis. So, we called St. Francis, who told us that we needed to call ABC. The strategy on both sides was clear—pass the caller along until he gets tired and gives up.

Over the next four weeks of phone calls and frustration, my wife took copious notes. We called the hospital patient relations line. We educated ourselves. It eventually became clear that St. Francis Hospital contracts with private CRNAs through the giant nationwide Anesthesia Business Consultants clearinghouse. We have no way of knowing how much Nurse Claxton received for her services, how much St. Francis scraped off the top, or what kind of kickbacks went to ABC. All we know is that for less than half an hour of service, we were being charged more than $1,500.

After four weeks, we’d gotten nowhere. It was affecting our relationship. It was affecting our family. What we believed was over had started again and we didn’t know what to do.

So, we did what we’d done every time before. I went back to the lady with the tilted apple Post-it notes. And this time she could do nothing for us. She shrugged her shoulders in a way that suggested we’d finally realized how inextricably stuck we were in a situation over which we had no control.

I left that office depressed, angry, and vowing to fight until there was no more fight to be had. Insurance companies had teams of lawyers. Rich folks have enough money to pay without thinking about it. We were just middle class people trying to make a living and we were being milked for every penny the hospital could squeeze out of us.

We hit the phones again. The call-center workers in Jackson, Michigan promised three times to have a supervisor call us back. A supervisor never called.

St. Francis business office workers refused to do anything to help or even explain why we owed the money. Finally I got someone to give me the name “Terri Gibson,” the top dog in charge of St. Francis billing. I vowed to speak to her and settle it once and for all. I vowed to explain how St. Francis had entered into a verbal contract (and one on a Post-It note, as I saw it), how St. Francis had given me two receipts showing zero balances, how we had not only paid in advance, but had been overcharged for services we didn’t receive.

Gibson refused to speak to me. The call ended up with a woman named Patty. I quickly determined that she was the heavy at the office. It’s her job to imply we are deadbeats who don’t want to honor our contractual obligations. It’s her job to suggest that if we don’t pay the bill, our account will be turned over to a collection agent. It’s her job to ignore my pleas that I have a zero balance with a St Francis employee’s signature on it. It’s not her job to be friendly, and she was not. That is a long way of saying, when St. Francis does a commercial advertising its top notch patient care, Patty will be kept far away from the camera.

Despite the great healthcare we received from the hospital and its staff, we had finally found the person at St. Francis who not only didn’t care about us, but was paid to not care about us. Her only job was to make sure we paid a bill, and it didn’t matter how insulting she had to be to make that happen. Her job was to get the money.

I protested. I told her about my receipts. I told her I had a zero balance.

And that’s when she started talking about that moment.

You remember it, right? My wife is on the brink of having a child. I’ve paid all my bills in advance. A nurse is wheeling my pained lover of 13 years away from me. I can’t see my wife anymore and I won’t be able to until I…sign my name to the admittance papers.

That’s the moment the hospital asserts I consented to paying whatever it might want to charge for a freelance CRNA. I’ve never seen this document, save perhaps the moment I tried to find the line to sign so I could be with my wife. The hospital tells me that I gave them full right to charge me whatever it saw fit for a freelance nurse anesthetist.

It doesn’t matter that we were told we had paid everything in full in advance.

It doesn’t matter that the hospital had told us multiple times we owed them no more money.

It doesn’t matter that we didn’t complain when they charged us for services and drugs we never received.

It doesn’t matter that we’re being charged between $50-$100 per minute for a freelance CRNA to stand in the hospital room.

It doesn’t matter that the actual anesthesiologist and pain management procedure cost far less than the nurse who observed it.

That was it. Pay or be turned over to a collection agent. Pay or have a damaged credit score. There are no more appeals. We middle class parents who have now battled with a corporate giant for more than six months have three choices. We can hire an attorney, try to fight it ourselves, or pay up.

There were no more options.

I am not proud to admit that we folded. We gave up. We wrote the check. We mailed it. We protected our perfect credit. We let St. Francis Hospital get by with a billing practice that borders on criminal.

And we have no way of knowing that another bill won’t arrive tomorrow.