Another hit to the pocket! Change in insurance billing could make pregnancy more expensive
Despite some potential benefits to the billing change, there are fears that the approach could incentivize unnecessary testing and increase costs.
In case maternal care and hospitalization is no longer expensive in the United States, the implementation of new billing codes starting in January 2026 will mean that these services, previously billed globally, will be charged individually. This change seeks to more accurately reflect the care provided, although it raises concerns about costs to patients.
As expected, obstetricians and gynecologists support the new structure, arguing that it allows the number of visits and care to be adapted according to individual needs. They argue that, for example, the number of prenatal visits could be increased, which is currently set at 13, a figure they consider quite low, reports KFF Health News, cited by CBS.
However, patient advocates warn that the change could result in higher out-of-pocket bills, especially for those with high-deductible health plans. “I'm always concerned about anything that further fragments our health care system,” said Caitlin Donovan, senior director of the Patient Advocate Foundation, a nonprofit that provides case management services for sick people in the U.S.
Financial implications
The concern revolves around how insurers will implement these new codes and whether this will result in increased insurance premiums.
The American Medical Association (AMA) plans to educate providers and payers about the new structure, while the Medicaid system may not be affected for a significant percentage of deliveries.
Supposed improvement in postpartum care
The new codes will allow doctors to charge for the long-term follow-up needed after childbirth, addressing crucial medical issues in the postpartum period.
Despite the potential benefits, there are fears that the per-service approach could incentivize unnecessary testing and increase costs.
This new billing will mark a turning point in maternity care in the United States, and its impact will be monitored by health experts and policymakers.
Prenatal and postpartum care alternatives
There are several alternatives in the United States for women facing high costs for prenatal and postpartum care:
Charity programs and hospitals with help
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