They are middle class and have insurance. The delivery still left them with a crippling debt.

Hospital Sisters Health System, which operates the hospital where Jessica was born, says it is not talking about specific patients but is “committed to the transparency and accuracy of our billing practices.”

SIU Medicine, a medical provider that works with the hospital, reduced Jessica’s bills by about $3,700 after NBC News reached out. The SIU said a discount equal to the amount of financial aid Jessica received from the hospital was given.

“Patients can qualify for financial assistance, regardless of whether they have insurance or not, and eligibility depends on family income and family size,” Lauren Crocks, director of communications for SUI Medicine, said. said in an email.

In order to cover their medical expenses, day care expenses and Jessica’s reduced income due to not working at the end of the pregnancy, the Hurleys started making minimum payments on their credit cards, which causing them to add up to $18,000 in credit card debt. twins are born.

Better than Medicaid

Employer-insured people pay about $3,600 out-of-pocket, on average, for maternity, labor and delivery services, according to data provided to NBC News by the Health Care Cost Institute. But for about a quarter of the births screened, the cost is more than $5,000.

Medicaid, on the other hand, generally has no out-of-pocket costs, as the program limits cost-sharing, including deductibles, for pregnancy-related services for 60 days after giving birth.

Pregnant women nationwide are eligible for Medicaid if their income is at or below 138% of the poverty level – up to $36,000 annually for a family of three. But 34 states and Washington, DC, have set coverage limits through Medicaid or the Children’s Health Insurance Program at or above 200%, according to KFF, a nonprofit health think tank. And all but two states have adopted Medicaid coverage that lasts one year after birth.

Becky Munge, a mother of three in Morton, Illinois, was on Medicaid when she gave birth to her first two children and doesn’t remember paying a single bill for the health care she received in time. that.

But that was not the case when she had her daughter Jovie in 2021. After a life-threatening delivery, Becky suffered a heart attack and suffered internal bleeding after the removal of her placenta, which was embedded in the wall of the uterus. He was stabbed and underwent multiple surgeries. When her organs began to fail, doctors said goodbye to her husband, Cole, and older children, Gavin and Ava.

Jovie was in the NICU, but the doctors allowed him to see his mother.

“They wanted him to at least be able to make skin and skin if I died,” Becky said.

Becky recovered, and she and Jovie were released from the hospital after one day alone. But while in the hospital, Becky developed osteoporosis that would eventually require surgery on nine hands.

The Munges pay $1,300-a-month premiums for the insurance policy with a $3,000 in-network deductible and a $12,500 out-of-pocket maximum.

For Jovie’s complicated delivery and NICU stay, they ended up paying the hospital $8,000, after insurance covered nearly $1 million in medical expenses.

Separately, Becky received treatment for her bone infection at the Mayo Clinic in Rochester, Minnesota; they still face about $4,000 in debt for that after paying $1,000 so far.

The Mayo Clinic said it has no control over insurance decisions. In a statement, Blue Cross and Blue Shield of Illinois, the couple’s insurance provider, said, “we work directly with members and do not discuss their cases publicly.”

By prioritizing their medical expenses over other expenses, the Munges have accumulated nearly $55,000 in credit card debt and debt in their retirement accounts.

“If we can’t manage the debt, from now on, we will have to pay the debt,” Becky said. “That’s a big threat on our shoulders.”

Like the Hurleys, the Munges are a solid medium. Cole is an independent insurance agent. Before her health problems prevented her from working, Becky was an orthopedic assistant. The family lives in a three-bedroom, ranch-style house.

“We’re not poor, but we’re not rich by any means, and we’re still struggling,” Becky said. “I wish I was making less money so I could get more benefits, because actually I owe a lot.”

The challenge of reducing capital

Of all the reasons a family can face medical debt from childbirth, high deductibles are one of the most common.

“Many workers had nondeductible health care plans, but that’s not true today. Most employer-provided health insurance plans have deductibles. in general,” said Dr. Adam Gaffney, a critical care physician at Cambridge Health Alliance in Massachusetts who researches medical debt. In the early 1980s, his research shows, only 30% of private insurance plans had a deductible for hospital stays.

Wesley Bruce and Ashley Perez’s insurance plan had a $7,000 deductible and a $13,000 out-of-pocket limit when she became pregnant. They knew that giving birth would cost a lot of money, so they set aside money in a health savings account.

But they had no idea how difficult their medical needs would be. Their twins, Isla and Juno, were born prematurely in June, each with a hole in their heart, and spent about a month in the NICU. The couple’s insurance did not cover special care during Perez’s pregnancy, and they were off the hook for more than $10,000 in total.

Bruce, a mental health consultant, and Perez, Ph.D. candidate in psychology, are still paying off student loans.

I said: ‘What can we do? We have no choice,” Perez said. “I can’t pay all of our debt, so add the hospital debt to it. I don’t even know how to collect it.”

The couple exhausted their health savings and asked for donations from family members to cover their medical expenses.

But in September, there was luck: Perez qualified for financial assistance from the hospital system, Sanford Health, and their balance dropped to zero. NBC News reached out to Sanford Health this month, and the couple was refunded about $7,000 they had already paid.

“We are committed to ensuring that patients receive high-quality care regardless of their ability to pay and to provide financial assistance to those who need it most,” said Nick Olson, Sanford’s chief financial officer. Health, he said in a statement.

Nonprofit hospitals like those operated by Sanford Health are required by law to provide “charity care” in the form of discounted or waived costs. Eligibility varies by hospital, but most require that patients have incomes at or below 400% of the poverty level. Since some of those patients are on Medicaid, it is unclear how many people benefit from the policies.

Becker called the system the “Wild West.”

Establishing a government requirement for hospitals to provide limited access to financial assistance could make births easier, he said. Another policy on his wish list: require employers to offer insurance plans with coverage that varies based on people’s incomes.

“In fact, we can fix this problem if we as a community decide that this is a problem we want to fix,” he said.

But other changes, like eliminating deductibles entirely or even creating universal health care, feel unlikely, if not impossible. And any changes would come too late for families already burdened with debt.