Kathleen Clark, just 12 weeks into her pregnancy, was taken aback when her OB-GYN’s office asked for $960 upfront to cover her projected bill, according to CNN.
Normally, these payments aren’t due until after delivery. Although Clark was assured any discrepancies would be adjusted later, the unexpected expense added stress to an already challenging time.
Stepping Out of Network
Most people with employer-sponsored or marketplace plans stick with in-network providers to save money.
Clark, however, opted for an out-of-network birthing center, and her husband’s health care-sharing plan only partially covered pregnancy costs. Clark’s practice charged a “global fee” upfront to secure their fees, covering all OB-GYN services through postpartum care. That made her first visit particularly costly.
Unplanned Financial Strain
While Clark did get some of her payment refunded when a specialist, not her OB-GYN, delivered her baby, many on pregnancy forums have shared similar stories of financial surprises.
Caitlin Donovan of the Patient Advocate Foundation mentioned that upfront charges help providers guard against nonpayment if patients change doctors or move. However, according to the Peterson Health System Tracker, these fees often fall heavily on patients, with maternity and newborn care averaging $18,865, as of 2020.
Barriers to Switching Providers
Once patients have paid these upfront fees, changing providers can be tough. Financial burdens or the need for ongoing care can make switching impractical, leaving expectant parents feeling trapped.
Donovan highlighted that these unexpected costs are especially challenging when parents budget for items like strollers and nursery essentials.
New Approaches to Billing
There’s been talk about breaking bundled services into separate billing codes for better transparency.
But even with this change, providers may still bill patients before insurance can approve coverage. Donovan pointed out that meaningful policy changes are unlikely due to the political clout of hospitals and insurers.
The Balance Between Provider and Patient Needs
Donovan noted that billing prenatal services separately could spare patients steep upfront costs.
Still, many providers prefer prepaid bundled billing as it helps them manage financial stability and limit surprise charges.
Stay Informed and Prepared
To protect themselves, expectant parents should ask for itemized bills and make sure they understand their insurance terms before any services begin.
Donovan emphasized that being proactive and communicating with healthcare providers about billing expectations is essential to avoid unwanted surprises.
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