Pregnant? You Could Be Asked To Prepay As Doctors Change Billing Policies

Having a baby can be pretty expensive, with the national average in the United States running close to $20k in 2023.

Fortunately, most people won’t pay that entire amount out of pocket. Instead, they’ll rely on insurance to cover the majority. They’ll pay regular premiums to their insurance company, along with covering deductibles and copays.

That could be changing, though, as some women are being asked to pay their out-of-pocket costs upfront.

How Much Will Your Pregnancy Cost You?

Your obstetrician probably estimates your total cost after prenatal care and delivery, but that number could change significantly over time.

You might have an extra ultrasound that wasn’t in the original estimate if your OB is worried about your baby’s measurements. Additional hospital visits may occur for preterm labor or, unexpected bleeding, or any number of other complications that could turn out to be minor or severe. You could need extra procedures, up to and including an emergency C-section.

In other cases, a pregnancy may end in a miscarriage, eliminating several of the visits and procedures that were originally figured into that estimate.

Though an estimate may be available, there’s no sure answer to your total pregnancy and labor care costs until your treatment is complete.

What Might Billing Look Like?

According to the Health Resources & Services Administration, if you have an insurance plan through the marketplace established by the Affordable Care Act, you should not have copays. The legislation required certain preventative care needs, including prenatal care and mammograms, to be provided without cost-sharing by any qualified insurance plan.

You could still have to pay for any services deemed medically necessary (such as if you seek a 3D or 4D ultrasound for keepsakes) or if you have a healthcare plan that does not follow the ACA’s marketplace regulations. If you have no insurance, your entire cost is out of pocket.

If you have copays, they may be due at the time of each appointment. Depending on the specific office pricing and any procedures or testing, the full cost of an appointment out-of-pocket could run under $100 or as much as a few hundred dollars. For your hospital stay and care, you could expect to be billed after the fact.

Some Women Are Being Asked To Prepay In Advance

For pregnancy, insurance is most commonly billed after care is complete—that is, after the baby is born—and the patient can expect a bill afterward if there are any out-of-pocket costs.

To bill in advance is legal, but not the standard practice, and advocates argue that it’s unethical since it could prevent a patient from seeking prenatal care or make it difficult to change providers. Even worse, that sudden bill for the entire cost of your pregnancy may be presented without warning.

One such patient, Kathleen Clark, told CBS News that she was checking in for her second prenatal appointment when she was informed that she owed $960. She described receiving this bill unexpectedly in a waiting room in front of other patients and feeling pressured to fork over the money, regardless of whether it seemed right.

She said she felt “stuck.”

Providers Are Defending The Practice

Obstetric offices have defended the practice, saying that sometimes they don’t get paid since a new parent is also juggling the costs of a newborn, hospital and other bills, and reduced income while the new mom remains out on maternity leave.

They say that charging in advance is a way to make sure they get their fees paid.

On the other hand, if a patient decides to change providers, or has a miscarriage, or otherwise doesn’t fully use the services that are being billed in advance, she has to consider how much work and time will be involved in getting her money back.

Advance Billing For Delivery Costs

Last year, another mom shared a similar experience. Instead of being asked to pay nearly a thousand dollars in one payment at her second visit, though, she was directed to pay $200 per month throughout her pregnancy to decrease the final bill for delivery.

One of her big worries was the money being tied up if she didn’t make it to a delivery room. She has already had one miscarriage and had just finished paying off the bills for treatment. She describes the experience so many pregnant women share of heading into the doctor’s office to confirm that her baby-to-be is “real.” Writing for Parents, she says:

She shares the story of another mom, too, who wanted to change providers after a bad experience with a doctor. She described being afraid that she wouldn’t be able to get her money back from the first practice in order to pay another provider, and ultimately having a C-section performed by the doctor she’d wanted to leave — what she calls her “worst-case scenario.”

What Can Pregnant Women Do About This?

Simply being aware that different doctors and practices may have different billing plans will help prevent a surprise, so that’s the first step.

If possible, having good insurance is a great choice since it will even cover massive or disastrous outcomes, and pregnant women who may qualify for Medicaid or a similar program should apply for those benefits. (Each state operates its own Medicaid program, but American Pregnancy has general information you can use to check whether you’re likely to be eligible.)

If you will be paying out of pocket, check with your provider in advance for an estimate of costs and their payment schedule. If it doesn’t work for you, it’s better to know before you’re handed a bill!

If you decide to work with a provider who charges in advance, ask questions early to find out how to get any refunds you may be eligible for if you choose to change doctors or have other circumstances.