In April, 12 weeks into her pregnancy, Kathleen Clark stood at the reception desk of her obstetrics and gynecology clinic and was asked to pay the $960 the clinic estimated she would be owed after giving birth.
Ms Clark, 39, was shocked to be asked to pay the amount during her second prenatal visit. Typically, patients receive a bill after their insurance is paid, but pregnant women are billed only when their pregnancy ends. It would take months for the office to file a claim with her health insurance company.
Clark said she felt stuck. The obstetrics clinic in Cleveland, Tennessee, was affiliated with the birthing center where she wanted to give birth. Moreover, she and her husband had wanted to have a baby for a long time. And Clark was emotional because his mother had died just a few weeks earlier.
“You’re standing at the window, and there are people around you, and you’re really trying to be nice,” Clark recalled through tears. “So I paid.”
online baby message board others social media forumPregnant women say their health care providers are asking them to pay copays sooner than expected. Although the practice is legal, patient advocacy groups say it is unethical. Health care providers argue that requiring upfront payment ensures they get paid for their services.
It is difficult to track how often this occurs because it is considered a private transaction between a healthcare provider and a patient. Therefore, payments are not recorded in insurance claims data or examined by researchers.
Patients, medical billing experts and patient advocates say the billing practices create unexpected anxiety at a time when stress and financial pressures are already high. Estimates can be higher than what patients ultimately owe, and people can fight for refunds if they miscarry or if they paid more than the final bill.
Upfront payments also pose a hurdle for women who want to change providers if they are not satisfied with their care. In some cases, especially in places where few other obstetric care options exist, women may end up forgoing prenatal care altogether.
“We’re holding their care hostage,” said Caitlin Donovan, the association’s senior director. Patient Advocacy Foundation.
Medical billing and women’s health experts believe that obstetrics and gynecology clinics adopted this practice to control the high costs of maternity care in the United States and how they are billed.
Once your pregnancy ends, your gynecologist typically submits one insurance claim for routine prenatal care, labor, delivery, and often postpartum care. The practice of bundling all maternity care under one billing code began 30 years ago, said Lisa Satterfield, the agency’s senior director of health care and payment policy. American College of Obstetricians and Gynecologists. But such bulk billing is outdated, she says.
Previously, pregnant patients had to pay a co-pay for each prenatal visit and could skip important appointments to save money. But now, the Affordable Care Act requires all private insurance companies to fully cover certain prenatal services. Additionally, it is becoming more common for pregnant women to change healthcare providers or request prenatal care, labor, and delivery to another provider, especially when patient transfers occur frequently. This is true in rural areas.
Some providers say that prepayment allows you to: Spread out one-time payments This is to ensure that they are compensated for the care they provided, even if they ultimately do not deliver the baby.
“Unfortunately, some people are working and not being paid,” said Pamela Bortner, who works as a midwife at a Georgia hospital.
She believes that women should receive care during pregnancy regardless of their ability to pay, but she also understands that some health care providers want to ensure that their claims are not ignored after delivery. Bortner said new parents are burdened by hospital bills and the costs of caring for a newborn child, and can lose income if parents aren’t working.
In America, having a baby can be expensive. According to the report, people with health insurance through a large employer pay an average of nearly $3,000 out-of-pocket for pregnancy, childbirth, and postpartum care. Peterson-KFF Health System Tracker. Additionally, many people have high-deductible health insurance plans, which means they end up paying more. Of the 100 million Americans with health insurance debt, 12% report that at least some of it is due to maternity care. 2022 KFF Poll.
She said families need time to save money for the high costs of pregnancy, childbirth and childcare, especially if paid maternity leave is not available. Joy BurkhardtCEO of the Center for Maternal and Child Mental Health Policy, a policy think tank based in Los Angeles. Asking them to pay upfront is “another gut punch,” she says. “What do you do if you don’t have money? Do you sign up for a credit card and hope it goes through?”
Calculating your final maternity costs will depend on multiple factors, including: timing of pregnancythe benefits of the plan, and the health complications. Erin Duffya health policy researcher at the Schaefer Center for Health Policy and Economics at the University of Southern California. The final amount patients will be billed will not be known until health plans decide how much of their claims will be covered, she said.
However, in some cases, waiting for your insurance company may be taken away from you.
During Jamie Doe’s first pregnancy in 2020, her gynecologist accepted her refusal to pay upfront because Doe wanted to see the final bill. But in 2023, during her second pregnancy, a private midwife in New York told her she was on a high-deductible plan and would owe $2,000 in monthly payments.
Doe, a health policy researcher at Columbia University, gave birth in September 2023 and received a $640 refund check in November of that year for the difference between the estimated and final bill.
“I’m studying health insurance,” she said. “But in real life, as most of us know, it’s very complicated.”
The Affordable Care Act requires insurance companies to cover some prenatal services, but does not prohibit providers from sending final bills to patients early. . He said it would be politically and practically difficult for state and federal governments to try to regulate the timing of payment requests. Sabrina Corlettco-director of the Center for Health Care Reform at Georgetown University. Medical lobbying groups are powerful and contracts between insurance companies and medical providers are exclusive.
Because there is a legal gray area, lacey marshallThe Texas-based insurance broker, Rapha Health & Life, advises customers to ask their insurance companies if they can refuse to pay their deductibles upfront. Some insurance plans prohibit in-network providers from requiring upfront payments.
If an insurance company says they can refuse to pay upfront, Marshall says he tells his clients to familiarize themselves with the procedure before refusing to pay so the insurance company can’t deny the treatment.
Clark said she met her insurance deductible after paying for genetic testing, additional ultrasounds and other services from her medical flexible spending account. She then called her gynecologist and asked for a refund.
“My spine is back,” said Clark, who previously worked for a health insurance company and a doctor’s office. She received a check for about half of the $960 she originally paid.
In August, Clark was taken to the hospital after his blood pressure spiked. A specialist in high-risk pregnancies, not her original gynecologist, delivered her son Peter prematurely at 30 weeks via emergency C-section.
Only after resolving most of the birth-related bills did I receive the remaining refund from another OB-GYN clinic.
The final check was made in October, days after Clark brought Peter home from the hospital and after numerous calls to the office. She said all of this added even more stress to an already stressful time.
“Why should I, as a patient, have to pay that price?” she said. “I’m just trying to have a baby.”
