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When Ohio mom Hannah Castle saw the hospital charges for her premature quadruplets, the total was staggering: $4.04 million.
Her TikTok post [1] about the bills — four babies, each needing treatment from a neonatal intensive care unit (NICU) — exploded with more than 22,000 comments, most of them echoing Castle’s own disbelief. One commenter said they were “horrified.” Other moms said the post resonated with them, following their own massive NICU bills.
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The bills are extreme, but they’re also a window into how fragile American healthcare financing has become for anyone facing a crisis. Here’s what happened, and what you can do to protect yourself from a medical debt.
How hospital bills leave families drowning in debt
Castle delivered her quadruplets — Atlas, Dominic, Magnolia and Morgan — at just over 28 weeks, with the babies cycling through two different NICUs.
After discovering she was pregnant, the 24-year-old and her husband tried to prepare as best they could for the financial strain ahead. Castle quit her job mid-pregnancy to qualify for Medicaid. She told ABC’s Good Morning America [2], “I loved my job,” but she says the move was necessary to get help. Her mother also moved in to provide support during the first year.
Premature infants often need weeks or months in neonatal intensive care, with ventilators, feeding tubes and round-the-clock nursing. Those miracles of modern medicine carry staggering price tags.
A 2023 study by Frontiers in Pediatrics [3] found the median NICU cost for one premature baby’s admission was about $77,000. Multiply that by four, add surgical procedures, extended hospitalizations and post-discharge care, and Castle’s seven-figure bill comes into focus.
Most families don’t face quadruplet-level numbers, but even a single complicated birth can leave lasting financial scars. The Kaiser Family Foundation [4] says over 100 million Americans — about 41% of adults — carry medical debt they can’t pay, and maternity-related expenses are major contributors.
Read more: Warren Buffett used 8 simple money rules to turn $9,800 into a stunning $150B — start using them today to get rich (and then stay rich)
Insurance softens the blow
Castle’s viral bill illustrates an important point: The “sticker price” in U.S. hospitals isn’t always what patients pay. Insurance companies negotiate discounts and cover much of the cost, but families are still left with deductibles, co-pays and out-of-network charges.
That can add up to tens of thousands of dollars, enough to drain savings or push households into debt. And those bills may come at the worst possible time, such as when exhausted parents are caring for fragile newborns.
That’s why it’s so important to find the best health insurance plan for your circumstances and health conditions. If you’re not sure where to start, U65 Health Insurance can help you find a plan if you’re under the age of 65 (including those who might have pre-existing health conditions). It enables you to quickly compare and access multiple health insurance offers at once, for free.
Just input your ZIP code, age range and household income, and U65 Health Insurance will sort through insurance companies in your area to find you the best options. You can choose from providers including United Health, Kaiser, Anthem, Cigna, Oscar Health, Aetna, Molina Health, Blue Shield of California, eHealth and Select Quote. Once you review and pick your preferred coverage, you’re good to go.
How to protect yourself from medical debt
No parent can plan for a $4 million hospital bill, but there are ways to limit the financial fallout from a medical crisis:
- Check your coverage closely: Make sure you understand your policy’s deductibles, out-of-pocket maximums and what counts as “in-network” before a medical event forces you to find out the hard way.
- Ask about itemized bills: Mistakes happen. Healthcare communications company Dialog Health says up to 80% of medical bills in the U.S. contain errors [6]. Always request an itemized statement and challenge duplicate charges or unexplained fees.
- Negotiate and apply for aid: Many hospitals have financial assistance programs, even for insured families. Ask about charity care and payment plans.
- Consider supplemental insurance: Policies for critical illness or hospital stays can provide cash benefits to help with non-medical costs like rent and childcare.
Saving up for unexpected expenses
Castle’s viral TikTok didn’t just resonate because of its jaw-dropping number. It struck a nerve because millions of Americans see themselves in her shoes — being just one accident, one diagnosis, one complicated birth away from financial disaster.
One way to protect yourself from a staggering, surprising medical bill is to bolster your savings. A high-yield account is an easy way to put your money to work, while ensuring it’s still readily accessible for any emergencies.
You can start your search for the best high-yiels acocunt with the help of Moneywise’s Top Savings Accounts.
For instance, with SoFi, you can get fee-free banking on your checking account. So, no fees, no monthly maintenance costs and no minimum balance requirements.
You can earn 4.50% APY on savings balances and 0.50% APY on checking balances with direct deposit or qualifying deposits too. When you set up a direct deposit, new account holders can even get a cash bonus up to $300.
Similarly, certificates of deposit (CD) can offer higher interest rates than top savings accounts. They can also be more liquid than traditional investments, though the trade-off for this higher rate is your money staying locked for a set period — typically between a few months and a few years.
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[1]. @HannaCastle. "TikTok post on Nov. 23, 2023"
[2]. ABC News. "Mom’s $4M bill for quadruplets’ care sparks conversation on high health care costs"
[3]. National Library of Medicine. "The price of neonatal intensive care outcomes – in-hospital costs of morbidities related to preterm birth"
[4]. KFF. "Diagnosis: Debt"
[5]. KFF. "Their First Baby Came With Medical Debt. These Illinois Parents Won’t Have Another."
[6]. Dialog Health. "70+ Medical Billing Statistics: From Errors to Economic Impact"
This article provides information only and should not be construed as advice. It is provided without warranty of any kind.