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In April, just 12 weeks into her pregnancy, Kathleen Clark stood at the receptionist's window at her ob-gyn's office when she was asked to pay $960, which the entire office estimated she would owe after giving birth.
Clark, 39, was shocked to be asked to pay that amount during this second prenatal visit. Typically, patients receive the bill only after the insurance has paid its share, and for pregnant women, this is usually only when the pregnancy is over. It could be months before the office submits the claim to her health insurer.
Clark said she felt stuck. The Cleveland, Tennessee, obstetrics practice was affiliated with the birthing center where she wanted to give birth. Also, she and her husband wanted to have a child for a long time. And Clarke was emotional because her mother died a few weeks ago.
“You're standing there at the window, and there's people all around, and you're trying to be pretty,” Clark said through tears. “So I paid for it.”
Online Baby message boards And so on. Social media platformsPregnant women report being asked by their providers to pay out-of-pocket earlier than expected. The practice is legal, but patient advocacy groups call it unethical. Medical providers argue that requiring payment up front ensures that they receive compensation for their services.
It is difficult to track how often this happens because it is considered a private transaction between the provider and the patient. Therefore, the payments were not recorded in insurance claims and were not studied by researchers.
Patients, medical billers and patient advocates say the billing experience adds unexpected stress to an already high stress and financial burden. Estimates can sometimes be more than a patient can ultimately pay and can force people to fight for a refund if they screw up or if the bill is higher than the final bill.
Prepayment also creates a barrier for women who want to change providers if they are unhappy with their care. In some cases, it causes women to forego prenatal care altogether, especially in places where there are few other prenatal care options.
“Their treatment is hostage,” said Kathleen Donovan, a senior director on the case. Patient Advocacy Foundation.
Medical billing and women's health experts believe that OB-GYN offices have adopted this practice to control the cost of maternity care and the way it is paid for in the US.
When a pregnancy ends, OB-GYNs file a single insurance claim for routine prenatal care, labor, delivery, and often, postpartum care. That practice of consolidating all maternity care into one billing code began three decades ago, said Lisa Satterfield, senior director of health and payment policy. American College of Obstetricians and Gynecologists. But such bundled billing is outdated, she said.
In the past, pregnant patients were charged extra for each prenatal visit, which could lead them to skip important appointments to save money. But the Affordable Care Act now requires all commercial insurers to fully cover certain prenatal services. Additionally, it is becoming more common for pregnant women to switch providers, or have different providers handle prenatal care, labor, and delivery—patient transfers are common, especially in rural areas.
Some suppliers say they allow prepayment Spread the one-time payments during pregnancy to ensure that they are compensated for the care they provide during pregnancy, even if they do not ultimately deliver the baby.
“Unfortunately, you have people who don't get paid for what they do,” said Pamela Boettner, a midwife at a Georgia hospital.
Although she believes women should have access to prenatal care regardless of their ability to pay, she understands that some providers want to make sure their bills aren't neglected after the baby is born. New parents can be overwhelmed with hospital bills and the costs of caring for a new baby, and if the parent doesn't work, they may not have an income, Boatner said.
Having a baby in the US can be expensive. People with health insurance through large employers pay an average of nearly $3,000 more out-of-pocket for pregnancy, birth and postpartum care. Peterson-KFF health system tracker. Additionally, more people are opting for high-deductible health insurance plans, leaving them to bear the brunt of the costs. of the 100 million people of America At least 12 percent of the health care debt goes to maternal care 2022 KFF poll.
Families need time to save up for the high costs of pregnancy, childbirth, and childcare, especially if they don't have maternity leave. Joey BurkhardtCEO of the Maternal Mental Health Policy Center, a Los Angeles-based policy think tank. Asking them to pay up front is “another gut punch,” she said. “What if you don't have the money? Do you put it on credit cards and hope your credit card goes through?
Calculating the final costs of childbirth depends on several factors, e.g Pregnancy periodsaid the plan benefits and health problems Erin DaffyHealth Policy Researcher at the Schaefer Center for Health Policy and Economics at the University of Southern California. The final bill is not clear to the patient until the health plan decides how much it will cover the claim, she said.
But sometimes the option of waiting for the insurer is taken.
In the year But in the year In 2023, during her second pregnancy, a private midwifery practice in New York told her she was obligated to pay $2,000 spread over monthly payments because she had a high-deductible plan.
Dow, a health policy researcher at Columbia University, filed in September 2023 and received a $640 refund check that November to cover the difference between the estimate and the final bill.
“I study health insurance,” she said. But, as most of us know, it's more complicated when you live.
While the Affordable Care Act requires insurers to cover some prenatal services, it doesn't prevent providers from sending patients their final bills in advance. Trying to control the timing of payment requests for state and federal governments is a political and practical challenge, he said Sabrina CorletteAssociate Director of the Center for Health Insurance Reform at Georgetown University. Medical lobby groups are powerful and proprietary contracts between insurers and medical providers.
In the legal gray area, Lacy MarshallAt Rapha Health & Life, an insurance broker in Texas, he advises clients to ask their insurer if they refuse to pay a deductible early. Some insurance plans prohibit providers in their network from requiring upfront payments.
If the insurer says they can refuse to pay up front, Marshall said, she tells her clients to put up with the practice of refusing to pay so the provider can't deny treatment.
Clark said she got her insurance deductible after paying for genetic testing, additional ultrasounds and other services from her health care variable spending account. She then called the OB-GYN's office and asked for a refund.
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“I got my spine back,” said Clark, who previously worked in health insurance and a medical office. She got her first check for about half of the $960 she originally paid.
In August, Clark was sent to the hospital after her blood pressure spiked. A high-risk pregnancy specialist — not her first OB-GYN practice — delivered her son Peter prematurely by emergency cesarean at 30 weeks.
She got the rest of her refund from another OB-GYN practice after settling most of the bills from the birth.
This last check came in October, just days after Clark brought Peter home from the hospital and several calls to the office. All of this, she said, added stress to what was already a stressful time.
“Why should I pay the price as a patient?” she said “I'm trying to have a baby.”
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