Tracy Hollis was delighted, but a little daunted, to find out she was pregnant with twins. However, the first-time mother from Hampton Roads, Virginia, was soon left in a state of shock when she was asked to make an upfront payment for her entire pregnancy, birth and post-natal care after her first scan at just six weeks.
The $3,600 figure was demanded by her practice in one payment, 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 establish care," Hollis told DailyMail.com. "I felt like I couldn't move forward at all."
And she is by no means alone. Pregnant women are increasingly being asked to foot their entire healthcare bill upfront - before giving birth.
Providers total up the expected costs of prenatal and birth care, which would be owed after a baby is delivered. Typically, patients would receive the bill after insurance has paid its part, which for pregnant women is usually only 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.
"The biggest impact on patients is financial. It not only forces patients to pay upfront but it forces them to pay a lot of money for care they haven't received and may never receive," Caitlin Donovan from the Patient Advocate Foundation told DailyMail.com.
This policy causes anxiety at a financially stressful moment. Estimates for care not yet administered can be wrong, resulting in higher charges that then have to be challenged and clawed back by patients later.
"Looking back on it," Tracy recalled. "It really makes me sad. When you're newly pregnant you're vulnerable and excited but then to be told 'sorry you're out of luck give me this money or else we don't care'. It was devastating."
While this practice appears to be on the rise anecdotally, it is hard to monitor upfront billing because payments are not recorded in insurance claims data for researchers. It is instead considered a private transaction between individual patients and their healthcare providers.
The Impact of Upfront Billing
Paying for care upfront also complicates matters for women who wish to swap providers during their pregnancy. This can result in women who are unhappy with their care missing out on prenatal appointments altogether especially in areas where there are few other maternity care options.
"It can be very difficult to see a new physician once you have started care and moving practices can trigger incorrect billing or over-billing," Donovan explained.
A Personal Struggle
Hollis ended up filing a complaint against the practice that asked for the upfront bill and left for another care provider but faced further issues when her insurance company retracted payment due to an administrative glitch related to her twins' birth resulting in significant stress over resolving a $144 000 bill over two-and-a-half years.