Tracy Hollis was thrilled, but also a little discouraged, when she discovered she was pregnant with twins.
But the first-time mother from Hampton Roads, Virginia, quickly went into shock when she was asked making a deposit for her entire pregnancy, birth and postnatal care following her first scan at just six weeks.
The $3,600 amount was demanded in one lump sum by her practice, and Hollis was told she would not be able to book any further appointments until it was paid.
“So I sat there in tears because I couldn’t set up care,” Hollis told DailyMail.com. ‘I felt like I couldn’t go on at all.’
And she is certainly not alone. Pregnant women are increasingly being asked to pay their entire healthcare bill up front – before giving birth.
Providers add up the expected costs for prenatal care and birth care that would be due after a baby is delivered. Normally, patients receive the bill after the insurance company has paid its share, which for pregnant women usually only happens when the pregnancy ends.
Although this is legal, families and patient advocacy groups have hit back at the practice, calling it unethical and a source of unnecessary stress at a vulnerable time.
According to them, the policy has many difficulties, namely that many families are overwhelmed and do not have the money in advance.
Tracy Hollis was asked to pay $3,600 upfront for her entire pregnancy, birth and postnatal care after her first scan at just six weeks
It also causes anxiety at a financially stressful time.
In addition, estimates for care not yet provided may be incorrect, resulting in higher costs that must then be challenged and recovered by patients at a later date.
This can be especially painful if the pregnant patient experiences a miscarriage and does not require the full expected care package.
Hollis was told that if she miscarried and did not require the full care she paid for, the money would be held by the healthcare provider for three to six months before a refund would be issued.
The 41-year-old asked the biller if she could split the payments or use the money in her Health Savings Account (HSA) to help fund the total.
However, both requests were denied and the biller was “very unfriendly,” she said.
“Looking back on it,” she remembers, “it makes me really sad. When you’re newly pregnant, you’re vulnerable and excited, but then you’re told, “Sorry, you’re out of luck, give me this money, otherwise we don’t care.” It was devastating.”
While this practice appears to be increasing anecdotally, it is difficult to audit billing in advance because payments are not recorded in insurance claim data for researchers.
It is instead considered a private transaction between individual patients and their healthcare providers.
Although upfront billing is legal, families and patient advocacy groups have hit back at the practice, calling it unethical and a source of unnecessary stress at a vulnerable time.
Prepaying for care also complicates matters for women who want to switch providers during their pregnancy.
This can lead to women who are unhappy with their care missing out on antenatal appointments altogether, especially in areas where there are few other options for maternity care.
‘The biggest impact on patients is financial. Not only does it force patients to pay up front, but it forces them to pay a lot of money for care they haven’t received and may never receive,” Caitlin Donovan of the Patient Advocate Foundation told DailyMail.com.
Although the practice is completely legal, Donovan states that it is “based on what makes a medical practice the most money, and not on what is best for the patient.”
“It can be very difficult to see a new doctor once you have started care, and relocation practices can lead to incorrect or overbilling,” she explained.
‘It is indicative of healthcare as a whole.’
Hollis eventually filed a complaint against the practice that asked for the bill up front and left for another provider, but the billing nightmare didn’t end there.
The new provider did not ask Hollis to prepay for the care. However, her insurance company paid the bill after her birth, but then withdrew the payment due to an administrative issue because the babies were twins.
“Then they told me I owed $144,000 and it would take me two and a half years to resolve the problem,” she said.
‘It was a nightmare, a lot of stress and I must have spent hundreds of hours on the phone.’
Nonprofit worker Emily Brown, who also lives in Virginia, was also asked to pay upfront for her care.
Brown, who now has two-year-old twins, had her first ultrasound and was able to make progress toward future care.
However, she then received a message through her OBGYN’s online patient portal asking her to pay $1,704.86 in estimated costs for her upcoming pregnancy care.
Nonprofit worker Emily Brown, who also lives in Virginia, was also asked to pay for her care upfront (photo: her twins who are now two years old)
Asking women to pay for care upfront could cause women who are unhappy with their care to miss out on prenatal appointments altogether, especially in areas where there are few other maternity care options
According to the release, this would include three routine ultrasounds, routine obstetric exams, a vaginal delivery and one postpartum exam.
It was then determined that the patient had to be willing to pay the full amount after the first visit. If this was not possible, the practice could offer a three-month repayment plan.
“That would still be $600 for three months straight and it also stated that it would not include additional services such as non-routine issues, OB visits, nurse visits, any additional ultrasounds, non-stress testing, C-sections and others,” Brown explained. .
Brown was nervous about the suggestion of other additional costs because she knew having twins could pose more challenges.
Brown paid the full amount up front and was able to use money from her HSA for the bill.
However, after giving birth, she was bounced a check because she had paid too much for the care.
“No one has contacted me to let me know that there was an overpayment, or that there was even a chance that this could happen. This check just showed up at my house,” she said.
“There was no overview of what I had overpaid for or how it happened.”
‘The biggest impact on patients is financial. Not only does it force patients to pay upfront, but it also forces them to pay a lot of money for care they didn’t receive and may never receive,” said Caitlin Donovan of the Patient Advocate Foundation.
The typical billing practice for maternity care is done by a gynecologist who files a single insurance claim for the combined care they provide during pregnancy, including prenatal care, labor, delivery and postpartum.
This combined policy started about thirty years ago, says Lisa Satterfield of the American College of Obstetricians and Gynecologists. CBS News.
However, Satterfield said the practice has been made obsolete by changes such as the Affordable Care Act.
Before the 2010 bill was signed into law, pregnant women had to pay a co-pay for each individual appointment, leading some to skip crucial visits to save money.
Obama-era legislation required all commercial insurers to fully cover a wide range of prenatal services in the future.
It has also become increasingly common for pregnant women to have different providers for prenatal care, labor and delivery, or to switch providers completely during the process.
Some providers say such shifts in the way health care is delivered have led to a change in billing.