{"id":1667,"date":"2024-11-20T11:45:26","date_gmt":"2024-11-20T11:45:26","guid":{"rendered":"https:\/\/retirednurseblog.com\/index.php\/2024\/11\/20\/pay-first-deliver-later-some-women-are-being-asked-to-prepay-for-their-baby\/"},"modified":"2024-11-20T11:45:26","modified_gmt":"2024-11-20T11:45:26","slug":"pay-first-deliver-later-some-women-are-being-asked-to-prepay-for-their-baby","status":"publish","type":"post","link":"https:\/\/retirednurseblog.com\/index.php\/2024\/11\/20\/pay-first-deliver-later-some-women-are-being-asked-to-prepay-for-their-baby\/","title":{"rendered":"Pay first, deliver later: Some women are being asked to prepay for their baby"},"content":{"rendered":"

In April, just 12 weeks into her pregnancy, Kathleen Clark was standing at the receptionist window of her OB-GYN\u2019s office when she was asked to pay $960, the total the office estimated she would owe after she delivered. <\/p>\n

Clark, 39, was shocked that she was asked to pay that amount during this second prenatal visit. Normally, patients receive the bill after insurance has paid its part, and for pregnant women that\u2019s usually only when the pregnancy ends. It would be months before the office filed the claim with her health insurer. <\/p>\n

Clark said she felt stuck. The Cleveland, Tennessee, obstetrics practice was affiliated with a birthing center where she wanted to deliver. Plus, she and her husband had been wanting to have a baby for a long time. And Clark was emotional, because just weeks earlier her mother had died. <\/p>\n

\u201cYou\u2019re standing there at the window, and there\u2019s people all around, and you\u2019re trying to be really nice,\u201d recalled Clark, through tears. \u201cSo, I paid it.\u201d <\/p>\n

On online baby message boards and other social media forums, pregnant women say they are being asked by their providers to pay out-of-pocket fees earlier than expected. The practice is legal, but patient advocacy groups call it unethical. Medical providers argue that asking for payment up front ensures they get compensated for their services. <\/p>\n

How frequently this happens is hard to track because it is considered a private transaction between the provider and the patient. Therefore, the payments are not recorded in insurance claims data and are not studied by researchers. <\/p>\n

Patients, medical billing experts, and patient advocates say the billing practice causes unexpected anxiety at a time of already heightened stress and financial pressure. Estimates can sometimes be higher than what a patient might ultimately owe and force people to fight for refunds if they miscarry or the amount paid was higher than the final bill. <\/p>\n

Up-front payments also create hurdles for women who may want to switch providers if they are unhappy with their care. In some cases, they may cause women to forgo prenatal care altogether, especially in places where few other maternity care options exist. <\/p>\n

It\u2019s \u201cholding their treatment hostage,\u201d said Caitlin Donovan, a senior director at the Patient Advocate Foundation. <\/p>\n

Medical billing and women\u2019s health experts believe OB-GYN offices adopted the practice to manage the high cost of maternity care and the way it is billed for in the U.S. <\/p>\n

When a pregnancy ends, OB-GYNs typically file a single insurance claim for routine prenatal care, labor, delivery, and, often, postpartum care. That practice of bundling all maternity care into one billing code began three decades ago, said Lisa Satterfield, senior director of health and payment policy at the American College of Obstetricians and Gynecologists. But such bundled billing has become outdated, she said. <\/p>\n

Previously, pregnant patients had been subject to copayments for each prenatal visit, which might lead them to skip crucial appointments to save money. But the Affordable Care Act now requires all commercial insurers to fully cover certain prenatal services. Plus, it\u2019s become more common for pregnant women to switch providers, or have different providers handle prenatal care, labor, and delivery \u2014 especially in rural areas where patient transfers are common. <\/p>\n

Some providers say prepayments allow them to spread out one-time payments over the course of the pregnancy to ensure that they are compensated for the care they do provide, even if they don\u2019t ultimately deliver the baby. <\/p>\n

\u201cYou have people who, unfortunately, are not getting paid for the work that they do,\u201d said Pamela Boatner, who works as a midwife in a Georgia hospital. <\/p>\n

While she believes women should receive pregnancy care regardless of their ability to pay, she also understands that some providers want to make sure their bill isn\u2019t ignored after the baby is delivered. New parents might be overloaded with hospital bills and the costs of caring for a new child, and they may lack income if a parent isn\u2019t working, Boatner said. <\/p>\n

In the U.S., having a baby can be expensive. People who obtain health insurance through large employers pay an average of nearly $3,000 out-of-pocket for pregnancy, childbirth, and postpartum care, according to the Peterson-KFF Health System Tracker. In addition, many people are opting for high-deductible health insurance plans, leaving them to shoulder a larger share of the costs. Of the 100 million U.S. people with health care debt, 12% attribute at least some of it to maternity care, according to a 2022 KFF poll. <\/p>\n

Families need time to save money for the high costs of pregnancy, childbirth, and child care, especially if they lack paid maternity leave, said Joy Burkhard, CEO of the Policy Center for Maternal Mental Health, a Los Angeles-based policy think tank. Asking them to prepay \u201cis another gut punch,\u201d she said. \u201cWhat if you don\u2019t have the money? Do you put it on credit cards and hope your credit card goes through?\u201d <\/p>\n

Calculating the final costs of childbirth depends on multiple factors, such as the timing of the pregnancy, plan benefits, and health complications, said Erin Duffy, a health policy researcher at the University of Southern California\u2019s Schaeffer Center for Health Policy and Economics. The final bill for the patient is unclear until a health plan decides how much of the claim it will cover, she said. <\/p>\n

But sometimes the option to wait for the insurer is taken away. <\/p>\n

During Jamie Daw\u2019s first pregnancy in 2020, her OB-GYN accepted her refusal to pay in advance because Daw wanted to see the final bill. But in 2023, during her second pregnancy, a private midwifery practice in New York told her that since she had a high-deductible plan, it was mandatory to pay $2,000 spread out with monthly payments. <\/p>\n

Daw, a health policy researcher at Columbia University, delivered in September 2023 and got a refund check that November for $640 to cover the difference between the estimate and the final bill. <\/p>\n

\u201cI study health insurance,\u201d she said. \u201cBut, as most of us know, it\u2019s so complicated when you\u2019re really living it.\u201d <\/p>\n

While the Affordable Care Act requires insurers to cover some prenatal services, it doesn\u2019t prohibit providers from sending their final bill to patients early. It would be a challenge politically and practically for state and federal governments to attempt to regulate the timing of the payment request, said Sabrina Corlette, a co-director of the Center on Health Insurance Reforms at Georgetown University. Medical lobbying groups are powerful and contracts between insurers and medical providers are proprietary. <\/p>\n

Because of the legal gray area, Lacy Marshall, an insurance broker at Rapha Health and Life in Texas, advises clients to ask their insurer if they can refuse to prepay their deductible. Some insurance plans prohibit providers in their network from requiring payment up front. <\/p>\n

If the insurer says they can refuse to pay up front, Marshall said, she tells clients to get established with a practice before declining to pay, so that the provider can\u2019t refuse treatment. <\/p>\n

Clark said she met her insurance deductible after paying for genetic testing, extra ultrasounds, and other services out of her health care flexible spending account. Then she called her OB-GYN\u2019s office and asked for a refund. <\/p>\n

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