Childbirth Costs Shift: Doctors Get Paid Per Visit

Starting in January, the U.S. will see a major change in how maternity care is billed, transitioning from bundled payments to a fee-for-service model where doctors charge for each visit and service.

This shift is strongly backed by the American College of Obstetricians & Gynecologists, who believe it will more accurately represent the diverse and complex care needs of modern expectant mothers. The new codes aim to accommodate varying numbers of visits and services based on individual patient requirements.

However, this move raises concerns among patient advocates and employers about potential increases in patient costs. With more line items on bills, especially for those with high-deductible health plans, out-of-pocket expenses could rise significantly, depending on how insurance payers implement the new system.

While the U.S. has struggled with high C-section rates and maternal mortality, proponents hope the new codes will allow better tracking of services and lead to improved postpartum care. Experts note that about 41% of births are covered by Medicaid, which is not financially impacted by these changes, while others may face increased premiums due to higher overall healthcare spending.

The American Medical Association, which developed the codes, is educating providers and payers, but the federal Centers for Medicare & Medicaid Services must still review and approve reimbursement rates. Insurers are concerned about the rapid implementation timeline required for these substantial operational changes.