by Jeroslyn JoVonn

November 13, 2024

Pregnant patients and new parents are speaking out against medical providers who demand upfront payments before giving birth.

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A growing number of pregnant patients and new parents express frustration of having to pay upfront for labor and delivery before delivery.

Typically, patients only receive a bill after insurance has covered its share, which for pregnant patients usually happens after the pregnancy is over. However, some pregnant women have been socket to baby chat rooms and other social media forums to say that their providers are asking them to pay fees early, 19th News reports.

Although this practice is legal, patient advocacy groups consider it unethical. Medical providers, however, say upfront payment requests help ensure they are paid for their services. However, researchers have difficulty tracking upfront payments because they are considered a private transaction between provider and patient.

Patients, medical billing experts and advocates say this billing practice adds unexpected anxiety to an already stressful time. Estimates can sometimes exceed what patients ultimately owe, leading them to fight for reimbursements in the event of a miscarriage or overpayment.

This “holds their treatment hostage,” said Caitlin Donovan, senior director of the Patient Advocate Foundation.

Kathleen Clark, 39, remembers being just 12 weeks pregnant when her doctor’s office in Cleveland, Tennessee, asked for an upfront payment of $960, the estimated amount she would owe after giving birth. Clark was taken aback by this accusation, especially so early in her pregnancy, during her second prenatal visit.

“You’re there by the window, and there’s people all around, and you’re trying to be really nice,” Clark recalled through tears. “So, I paid for it.”

Previously, pregnant patients often had to pay a co-payment at each prenatal visit, sometimes leading them to skip essential appointments to save money. However, the Affordable Care Act now requires commercial insurers to fully cover specific prenatal services.

Additionally, it is increasingly common for patients to change providers or receive care from different providers for prenatal visits, labor, and delivery, particularly in rural areas where patient transfers are common. Some health care providers say requiring advance payments allows them to spread costs across the pregnancy, ensuring compensation for the care provided even if they don’t ultimately handle the delivery.

“There are people who, unfortunately, don’t get paid for the work that they do,” said Pamela Boatner, who works as a midwife at a Georgia hospital.

Although the Affordable Care Act mandates insurance coverage for certain prenatal services, it does not prevent providers from billing patients in advance. Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, says regulating the timing of these payment requests would be politically and logistically difficult for state and federal governments.

Because of the legal gray area, Lacy Marshall, an insurance broker with Rapha Health and Life in Texas, advises her clients to check with their insurer to see if they can opt out of prepaying their deductible. Some insurance plans prohibit in-network providers from requiring upfront payments. If clients are allowed to refuse, Marshall recommends that they first establish themselves as patients before refusing, to ensure they will not be denied care.

Joy Burkhard, CEO of the Policy Center for Maternal Mental Health, believes what to ask pregnant patients must pay in advance “is another gut punch” to an already stressful experience.

“What if you don’t have money?” Do you put it on your credit cards and hope your credit card gets accepted? »

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