Saturday, February 18, 2017

Comprehensive financial cost from pregnancy to birth - Part 3

Finally received the final bill from NUH, so that I can properly blog about the cost of the entire pregnancy and delivery. To be honest, NUH billing is so complex and it's not immediate intuitive to know what the costs are. I received a total of 3 billings, one while in the hospital, one after I've discharged and the last one about 2-3 weeks after we discharged. Why so many bills? I've no idea. From what I observed, the first bill is to let us know the rough figures while the second bill is for us to foot a deposit in cash, because there is a limit to claim from medisave and so the rest had to be footed in cash. Lastly, the final bill received post discharge is after all the medisave claim had been sent, approved (they might not grant you the full medisave claim) and we had to pay the remaining amount due by credit or cheque.


To understand the bills, one would have to understand the events leading to the delivery. There are 3 major stages:

1. Antenatal charges

This is related to the checkups, from the 1st trimester to the 3rd trimester, and includes stuff like consultation with the gynecologist, laboratory screening (for genetical defects etc), ultrasound scanning and swab test. There is also a range of supplements, like essential vitamins, iron, calcium, fish oil and folic acid, to ensure that the mother is well nourished so that the foetus can grow healthily. For new parents, there could be antenatal classes conducted by various hospitals to teach the parents how to prepare for the delivery and also the care taking part.

2. Delivery charges

This is related to the actual delivery cost. Generally there are two ways - natural (or normal) delivery or cesarean delivery, with the latter being much costlier because besides the gynecologist, there is also an anesthetist (that's two doctor fees for you). It takes a longer time for the wound to heal too, so the standard hospital staying duration is 3 days, as opposed to just 1 day or 2 days for normal delivery. Lastly, there are a lot more medications and drugs so there will be more charges on this aspect as well. During antenatal check ups, there is a GSB (group B strep) swap test. If it's tested positive, there will be a need to IV drip antibiotics during delivery. All the charges are also tagged to ward category, but if the father wants to bunk in overnight, it has to be A wards (single bedder).

3. Nursery and laboratory charges

These are charges for the newborn baby to stay at the nursery. On top of that, there is a screening for NENS (I don't know what's that), Galactosemia and Cystic Fibrosis, plus vaccinations (BCG, Hep B etc). There will be daily pediatrician visits to check on the baby too.


It's really hard to make a good judgement of the cost without telling people what we had in the first place. So, here's what we had:

1. 4 consultations with a senior consultant + 1st trimester antenatal screening
2. Antenatal package covering 8 consultations with the doctor and some screening
3. GBS screening
4. Supplements
5. No antenatal classes (about $200)

NUH antenatal package. We opt for the senior consultant, highlighted above

1. Natural birth
2. 1 day hospital stay at A1 ward (single bedder)
3. No painkillers like epidural
4. GBS positive - so antibiotics given
5. 18 hours labour

NUH delivery package. We have a normal delivery @ 1 bedder ward, highlighted above

Nursery and lab:
1. No jaundice
2. All standard vaccinations
3. All screening test (NENS, Galactosemia, Cystic Fibrosis)
3. 2 day nursery

I'll present the final bills here:

The total bill works out to be $6,862.21. (Update on 22nd Feb 2017: I checked my CPF-MA and realised there is another deduction of $361.87. I have no idea where it came from - I told you NUH bills is really confusing) Of the Antenatal and delivery charges, $2100 can be claimed under CPF Medisave account (MA), while the entire sum of $457.97 under the Nursery and lab charges can be claimed under MA. In other words, we paid $3,946.37 in cash. But that's just the final sum after all the claims had been done. What's more important is the cash out flow i.e exactly when do you have to pay this or that fees?

Here's my hand drawn time schedule of all the cash payment:

My hand drawn diagram of the cash outlay schedule. I would like to do this digitally, but nah, time is precious to me these days. Essence is more important than form.

Antenatal charges is spread over the entire pregnancy over 3 trimesters. The entire $2,090.29 is paid by us first, then we can claim from MA after delivery. Supplements is paid throughout the entire 9 months. The first 4 consultations and 1st trimester test (B+C) amounting to $800.70 is paid over 2 trimesters. Thereafter, once the antenatal package of $898.80 is paid in advance, there's not much money to be paid for check ups anymore other than the supplements and some minor tests.

Delivery charges is first paid on the day of discharge. They will calculate how much you paid for the antenatal charges, add in the delivery fees and minus off the medisave claimable amount. You pay in cash/credit immediately. That is $1855.55 straight away for us.

Nursery and lab charges are claimable from medisave straight away, so there's no need for any cash outlay for that one.

After 3-4 weeks, when the final bill is in, we owe them $0.50 (you did not read wrongly). So, either a cheque or a credit card bill statement had to be sent back to them and that will be all.


Is it costly to give birth in Singapore? I think a lot depends on our expectations. With the baby bonus of $14k, $8k of which is paid out in cash over several months, this will more than offset the cash outlay of the entire pregnancy journey. I'm showing both the final bill and the actual cash outlay schedule hoping to reassure new parents that it's not a shocking bill at the end of the whole thing. You'll have 9 months to save up, and even then, all can be paid for by the baby bonus. Of course, care-taking is another big tap where money gets drained out fast.

That is another story, another day. In the meantime, I have a baby boy to cuddle and love :)

Part 1: My fatherhood journey
Part 2: Her motherhood journey


Rolf Suey said...

Hi LP,

My baby will be due soon. And this time round unlike the past, there are so many more tests prior to delivery.

Fortunately for us, we choose to ignore and skip all the tests, after we seen the truth in this world. It's a long story...

Its a joy to have a newborn! Congrats!

FuzzyView said...

You'll get double doctor charges as well for natural with epidural as that is administered by the anesthetist. :)

Rena said...

Hi LP,

I notice you paid for 3 consultations and 1 1st-trimester scan prior to the maternity package.Is it 'cuz for NUH, you can only sign on packages after 1st trimester?



la papillion said...

Hi Rolf,

Wah, you really enlightened being now :) Happy for you!

la papillion said...

Hi Fuzzyview,

Yes, you're right :) I heard anesthetist is even more impt than gynae. I've heard many horror stories lol

la papillion said...

Hi Rena,

You're pretty observant :) Yup, you're right. The package can only be signed on after 22nd weeks. I think it's only for NUH and not applicable for other hospitals.

brattz said...

first of all, gong xi gong xi!! :D :D :D

baby boy yeah! :P

life suddenly has gotten more meaningful than just dollars and sense! :D

jia you! please go for 2nd/3rd babies!! :P

Rena said...

Hi LP, curious. How did you and your wife split the cost?

la papillion said...

Hi Rena,

She was paying for all the antenatal checkups and supplements while I footed the delivery cost in cash and all the rest of the medisave charges. The split is about 35:65, with me footing more. We haven't really talked about splitting up the cost equally, so likely I'll just leave it at that.

la papillion said...

Hi Brattz,

Haha, thanks :) 2nd or 3rd?! LOL, that will have to wait a while!

Unknown said...
This comment has been removed by a blog administrator.
Anonymous said...

Sign up cord blood banking?

la papillion said...

Hi anonymous,

We donated it to public cord blood bank. I think it's better this way, rather than to keep for ourselves. The use of the cord blood to save lives will be widened tremendously through their network than just to use for us. Let that be the first good thing our son do for the rest of the world.

simplefolk said...

this definitely too complex for me!!!
i think still pretty high for low income family though they could probably choose more affordable options.

how about harvesting dental stem cells for future use?

la papillion said...

Hi simplefolk,

I think there are folks from my fb feeds who mentioned that they paid zero dollars (all from cpf medisave) from the same hospital, so it definitely could be cheaper. I think the main thing is that they didn't choose any particular doctor, so it's public subsidised rates, and secondly the father didn't choose to stay with the mum during the hospital stay, so it's B ward and below. It can definitely be more affordable. Either way, the baby bonus should be more than enough to foot all the hospital bills. It's the time and energy needed to care for the baby that's difficult haha

Wah, simi dental stem cells? Didn't even know they exist :)

simplefolk said...

google "Dental Stem Cells Banking" ... interesting but looks pretty complex to me. i think idea same as cord blood banking.

Marcus said...

Hi thanks for the detailed info!

Noticed that you mentioned credit card is allowed to be used for delivery payment ? Can i confirm this, if yes then i would confirm with the bank if i am entitled for any cash back =D

la papillion said...

Hi Marcus,

Yup, I remembered I used credit card for it, so definitely can be used. Can save some money, why not? Call your banks haha

Katie said...

Hi, thank you for the detailed info provided! I thought that annetal charges are charged on the day itself during the consult or would it be tagged on to the hospital bill as shown in your post? Also, was the $1855 amt paid the deposit needed prior to delivery? Therefore, was your total delivery bill about $4k plus that can be claimed via Medisave with a total of $1642? Sorry, don’t really understand why amount due after discharge was so much despite claimable amount from Medisave and amount paid prior

la papillion said...

Hi Katie,

The antenatal charges is an ongoing charge. Meaning that every time you visit the gynae for checkups, you pay it straight away. We signed up for a package, which pays up front first for x sessions, but it's still essential paid by us first. If I didn't rmb wrongly, you pay first, after which some part of it (because it's capped) can be claimed from the medisave later.

The $1855 can be considered a deposit, but it's not prior to delivery. Once my wife is in the ward after delivery, they asked us to pay it already. But I guess it could vary from hospital to hospital.

The total delivery charge is $3956.08, so it's about 4k. Some are paid in cash, some claimed from medisave though. Also, it's been too long, can't rmb the exact details now haha

Hope it still helps.

Anonymous said...

Hi LP, may I check the supplements that your wife paid were from doctor's prescription or bought from pharmacy outlet? Thanks

la papillion said...

Hi Leroy,

It's from doc prescription. But it costs the same as pharmacy elsewhere so there's not discount or anything. We also did not buy any extra supplements not prescribed by doc.

Anonymous said...

Hi. Did u pay any additional consultation fees after u signed up for the 22 weeks above antenatal package? I understood only first visit will have additional cost.. but i just received a tax invoice for my 2nd visit, theyre charging me 102 bucks for consultation fees and i wonder why. I thought thr package covers this already.

Missymins said...

Hi! May I know for the first 4 consultations, are ultrasounds included each time? And what does the first trimester screening consist of? Is it the detailed scan? Did you all take the Oscar test for Down syndrome?


la papillion said...

Hi anonymous,

Hmm, you might have to check with them. I don't recall paying anything except for medication. All in already.

la papillion said...

Hi missymins,

Yup, I believe they are included. I don't recall paying for them. But it's been a while so I might have forgotten...but I really don't think I paid them separately.

I'm not sure what's meant by detailed...Oscar test, yup, it's done.

Missymins said...

Hi! Thanks for the reply! Do you mean the Oscar test is included in the first trimester screening?

la papillion said...

Hi missymins,

I really really can't rmb. Anyway, the situation might have changed since the last visit, so it's best to call them up to check :) Sorry couldn't be of much help!