An increasing number of pregnant patients and new parents are expressing frustration over being asked to make upfront payments for labor and delivery before giving birth.
Typically, patients receive a bill only after insurance has covered its portion, which for pregnant patients usually occurs once the pregnancy is complete. However, some pregnant people have been taking to baby message boards and other social media forums to say their providers are asking them to pay out-of-pocket fees earlier than expected, 19th News reports.
While the practice is legal, patient advocacy groups deem it unethical. Medical providers, however, argue that upfront payment requests help ensure they are compensated for their services. However, upfront payments have been hard for researchers to track since they are considered a private transaction between the provider and the patient.
Patients, medical billing experts, and advocates argue that this billing practice adds unexpected anxiety during an already stressful time. The estimates can sometimes exceed what patients ultimately owe, leading them to fight for refunds in cases of miscarriage or overpayment.
It’s “holding their treatment hostage,” said Caitlin Donovan, a senior director at the Patient Advocate Foundation.
Kathleen Clark, 39, recalls being just 12 weeks pregnant when her doctor’s office in Cleveland, Tennessee, requested an upfront payment of $960, the estimated amount she would owe after delivery. Clark was taken aback by the charge, especially so early in her pregnancy during her second prenatal visit.
“You’re standing there at the window, and there’s people all around, and you’re trying to be really nice,” Clark recalled through tears. “So, I paid it.”
Previously, pregnant patients often faced copayments at each prenatal visit, which sometimes led them to skip essential appointments to save money. However, the Affordable Care Act now mandates that commercial insurers fully cover specific prenatal services.
Additionally, it’s increasingly common for patients to switch providers or receive care from different providers for prenatal visits, labor, and delivery—especially in rural areas where patient transfers are frequent. Some healthcare providers argue that requiring prepayments allows them to spread out costs over the pregnancy, ensuring compensation for care provided, even if they don’t ultimately handle the delivery.
“You have people who, unfortunately, are not getting paid for the work that they do,” said Pamela Boatner, who works as a midwife in a Georgia hospital.
Though the Affordable Care Act mandates insurance coverage for certain prenatal services, it doesn’t prevent providers from billing patients in advance. Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, says that regulating the timing of these payment requests would be politically and logistically difficult for state and federal governments.
Due to the legal gray area, Lacy Marshall, an insurance broker at Rapha Health and Life in Texas, advises clients to check with their insurer about whether they can decline prepayment of their deductible. Some insurance plans prohibit network providers from requiring upfront payments. If clients are allowed to refuse, Marshall recommends they first establish themselves as a patient before declining to ensure they won’t be denied care.
Joy Burkhard, CEO of the Policy Center for Maternal Mental Health, believes asking pregnant patients to prepay “is another gut punch” during an already stressful experience.
“What if you don’t have the money? Do you put it on credit cards and hope your credit card goes through?”
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