The Latest Trend In Prenatal Care: Pay Now; Deliver Later

It’s the latest buzz on online baby message boards and other social media forums: Pregnant women share that they are being asked by their doctors and delivery centers to pay upfront. Before their baby is delivered and before health insurance is billed.

Kathleen Clark told KFF Health News that she was shocked when her OB-GYN’s office asked her to pay $960, the total the office estimated she would owe after she delivered. Usually, patients are billed after delivery and after insurance has paid its part.

Clark, 39, was just 12 weeks into her pregnancy and said she felt she had no choice. She paid the bill.

The practice is legal, KFF reports, but patient advocacy groups call it unethical. Doctors and other medical providers say they need to make sure they are compensated for their services. However, many say demands for payment before delivery also create anxiety and financial pressure for expectant parents. Also, estimates can be higher than the ultimate charge and women who miscarry are then forced to fight for their money back.

Having a baby is 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.

Jamie Daw, a health policy researcher at Columbia University, refused to pay in advance during her first pregnancy in 2020. But during her second pregnancy, in 2023, the private midwifery practice she was using told her she must pay $2,000 before delivery.

After she delivered in September 2023, Daw told KFF she got a refund check for $640 covering the difference between the estimate and final bill.

“I study health insurance,” she said. “But, as most of us know, it’s so complicated when you’re really living it.”

Have you been asked to pay for your baby’s delivery months before it happened? Share your story with Voices for Affordable Health.