June 16, 2024

A mom’s hospital bills for her quadruplets’ neonatal intensive care unit stay, totaling over $4 million, is sparking a conversation about the high cost of health care in the United States.

Hanna Castle, a mom of four from the Columbus, Ohio area, shared details of the bills in a TikTok video. In the nearly two-minute clip, Castle revealed after she had her quadruplets in 2021, they all needed to be admitted to the NICU and each of her four babies ended up staying for varying lengths of time between 64 days and 147 days. Overall, their NICU bills totaled over $4 million, for which all of it was covered by Ohio Medicaid.

PHOTO: Hanna Castle and her husband Nic Castle are parents of quadruplets in the Columbus, Ohio area.

Hanna Castle and her husband Nic Castle are parents of quadruplets in the Columbus, Ohio area.

Courtesy of Hanna Castle

Castle’s video post has gone viral since it was first shared in November, gathering over 8 million views and over 23,000 comments.

Some commenters expressed shock and wondered how to respond to the scenario.

“What do you do??? just file for bankruptcy??” asked one commenter.

Other parents chimed in to share their own similar experiences or described how their experiences differed in other countries.

“So glad someone did this!!! The nurses would joke 1/2 million dollar babies and I would laugh and then I got the bill……. No joke 1/2 million,” one wrote.

“I have twins in the NICU right now. They both had to be flown in separate helicopters to the NICU. 144000 per flight 😱,” another parent wrote.

Castle told “Good Morning America” she had her quadruplets – Atlas, Dominic, Magnolia, and Morgan – at 28 weeks and one day via Cesarean section and they first received care at two different NICUs.

PHOTO: Hanna Castle and her husband Nic Castle are parents of quadruplets in the Columbus, Ohio area.

Hanna Castle and her husband Nic Castle are parents of quadruplets in the Columbus, Ohio area.

Courtesy of Hanna Castle

The costs of delivering a baby are on the rise

In anticipation of her quadruplets’ births and knowing that they likely would need further medical care, the 24-year-old mom said she and her husband Nic Castle made major life changes to financially prepare as much as they could, including quitting her job to qualify and enroll in Medicaid and enlisting her mom to help.

“At 16 weeks pregnant, I decided to quit my job to get some of that assistance because there was no other way,” Castle told “GMA” of changing her status to qualify for financial assistance. “I moved my mom in with us to kind of help financially for the first year and see how the kids were going to be.”

“If I would have been able to keep my job I would. I loved my job. I loved the company I worked for,” she added. “I just think people nowadays are feeling like they can’t be prepared, you can’t be prepared. There’s not truly any assistance [in] childcare.”

PHOTO: The Castle quadruplets were treated at the Nationwide Children's Hospital neonatal intensive care unit in Columbus, Ohio.

The Castle quadruplets were treated at the Nationwide Children’s Hospital neonatal intensive care unit in Columbus, Ohio.

Courtesy of Hanna Castle

According to Katie Martin, president and CEO of the nonprofit Health Care Cost Institute, the cost of childbirth has been going up, just like the cost of health care in the last five years.

“Our research shows that for people who get insurance through work, the average cost of having a baby is about $24,000 and that’s from the prenatal period to the postpartum period,” Martin told “GMA,” referencing a May 2023 HCCI study. “For childbirth itself, the average is closer to $13,000, though that varies considerably, whether it’s a vaginal birth or a C-section, that number has gone up over time, not dramatically differently from how healthcare costs in general had been increasing.”

In Ohio, where Castle and her family live, pregnant women, infants, and children may quality for Medicaid but they need to meet a limited income requirement that can range from an income up to 156% to 200% of the federal poverty level, which the U.S. Centers for Medicare & Medicaid Services defines as $41,960 for a family of six in 2024.

For expecting parents, Martin suggested they consider the costs and ask ahead of time.

“It would be nice to not have to think about the financing of it all and, instead, focus fully on welcoming a new member (or members) of the family. But, the expense of childbirth is a reality that families have to deal with,” Martin said.

In Castle’s case, her babies had required additional care in the NICU and Medicaid paid for all of her $4 million hospital bill.

PHOTO: Atlas, Dominic, Magnolia and Morgan all had varying NICU stays – from 64 days to 147 days – until they were healthy enough to go home.

Atlas, Dominic, Magnolia and Morgan all had varying NICU stays – from 64 days to 147 days – until they were healthy enough to go home.

Courtesy of Hanna Castle

“In any instance, NICU care is more expensive than a standard nursery, well baby care that you would get following delivery and there’s just huge variation, even within the NICU about what the cost is, depending on the very specific needs of the baby or babies, in this case,” Martin said. “The price can vary tremendously.”

An HCCI study from 2023 examined NICU use and spending from 2017 to 2021 and found that higher level NICU care per baby has increased to $3,741 per day, triple the cost of general newborn care of about $1,200 per day.

“The average spending per newborn admission for NICU care has gone up…faster, for NICU level four, which is the most complicated care provided than well baby general newborn care,” Martin said, adding that, “Prices are increasing everywhere. There’s no part of the country that is immune from it.”

The high costs of having multiple babies and babies that require NICU care is one Castle said not everyone can fully be ready for.

PHOTO: Hanna Castle said she decided to quit her full-time job and move in with her mom when she was 16 weeks pregnant in order to qualify for financial assistance ahead of her quadruplets’ arrival.

Hanna Castle said she decided to quit her full-time job and move in with her mom when she was 16 weeks pregnant in order to qualify for financial assistance ahead of her quadruplets’ arrival.

Courtesy of Hanna Castle

“I don’t think you can ever truly financially prepare,” Castle said of the financial aspects of starting a family.

“In the United States of America, it’s kind of hard to know, OK, you’re going into this situation, my insurance is not going to cover X, Y, Z, or it has to be this substantial for them to actually cover it,” she said.

Castle said she wished she didn’t have to make major changes in order to make the best financial decisions for her family and is now motivated to advocate for other NICU families by sharing her family’s story.

“At the end of the day, I think as a parent, we’re just out here trying to survive and do what we can to make it day to day,” she said.


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