Pregnant patients forced to pay in advance before giving birth

An increasing variety of pregnant patients and recent parents are expressing frustration with having to pay in advance for labor and delivery before giving birth.

Typically, patients receive the bill only after their insurance covers a part of it, which in the case of pregnant patients often occurs after the top of the pregnancy. However, this was the case for some pregnant people taking in to kid’s message boards and other social media forums to report that their providers are asking them to pay ongoing fees sooner than expected, the report said.

Although this practice is legal, patient advocacy groups consider it unethical. However, healthcare providers say requests for upfront payment help ensure they’re paid for his or her services. However, it was difficult for researchers to track upfront payments because they’re considered a personal transaction between the provider and the patient.

Patients, medical billing experts and advocates say this billing practice is causing unexpected anxiety during an already stressful time. The estimates can sometimes exceed what patients ultimately owe, leading them to fight to get their a reimbursement in the event of a miscarriage or overpayment.

It’s “holding them hostage,” said Caitlin Donovan, senior director on the Patient Advocate Foundation.

Kathleen Clark, 39, recalls that she was 12 weeks pregnant when her doctor’s office in Cleveland, Tennessee, demanded an upfront payment of $960, the estimated amount she would owe after giving birth. Clark was surprised by the accusation, especially early in her pregnancy, during her second prenatal visit.

“You stand by the window, there’s a lot of people around, and you try to be really nice,” Clark recalled through tears. “So I paid.”

Previously, pregnant patients often had to pay extra for every prenatal visit, which sometimes led to them skipping needed visits to lower your expenses. However, the Affordable Care Act now requires industrial insurers to fully cover certain prenatal services.

Additionally, it’s increasingly common for patients to change providers or receive care from different providers for prenatal visits, labor and delivery – especially in rural areas where patient transfers are common. Some providers argue that requiring prepayments allows them to spread costs over your entire pregnancy, ensuring they’re compensated for the care they supply even in the event that they don’t ultimately manage the delivery.

“There are people who, unfortunately, are not paid for their work,” said Pamela Boatner, who works as a midwife at a hospital in Georgia.

Although the Affordable Care Act requires insurance for some prenatal services, it doesn’t prevent providers from billing patients in advance. Sabrina Corlette, co-director of the Center for Health Insurance Reform at Georgetown University, says it will be politically and logistically difficult for state and federal governments to schedule these payment claims.

Because of the legal gray area, Lacy Marshall, an insurance broker at Rapha Health and Life in Texas, advises clients to check with their insurer to see in the event that they can decline to prepay their deductible. Some insurance coverage prohibit network providers from requiring upfront payment. If clients may refuse, Marshall recommends that they first acknowledge themselves as a patient after which refuse to ensure they aren’t denied care.

Joy Burkhard, executive director of the Policy Center for Maternal Mental Health, says asking pregnant patients to prepay is “another punch in the gut” during an already stressful experience.

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