Surprise bills for childbirth

The study found that among privately insured families with in-network deliveries in 2019, nearly 1 in 5 potentially received a surprise bill for maternal and/or newborn care, averaging $744.

“Childbirth is the most common reason for hospitalization,” said principal investigator Kao-Ping Chua, MD, PhD, an assistant professor of pediatrics at the University of Michigan Medical School in Ann Arbor. Chua also is an assistant professor of health management and policy. “Although older studies have estimated the frequency of surprise bills for deliveries, no recent studies have estimated the frequency of surprise bills for both deliveries and newborn hospitalizations.”

Kao-Ping Chua, MD, PHD

The authors analyzed 2019 data from Optum’s de-identified Clinformatics Data Mart, which includes 12 million privately insured enrollees from all states.

Potential surprise bills occurred in 15.5% of newborn hospitalizations with neonatal intensive care, for a median liability of $1,282, and in 8.9% of newborn hospitalizations without neonatal intensive care, for a median liability of $262.

Neonatal intensive care accounted for 19.4% of surprise bills for newborn hospitalizations, the highest share of any service.

“We found that anesthesia for vaginal birth, such as epidural placement, was the No. 1 reason for potential surprise bills related to the maternal delivery,” Chua told Contemporary OB/GYN®. “We also discovered that surprise bills were more common with Cesarean section. This suggests that families may be able to decrease their risk of receiving a surprise bill by planning for a delivery with fewer interventions when possible.”

Study results are not unexpected because other studies also have found a high frequency of surprise bills related to hospitalization, according to Chua. “Nonetheless, I believe some of our findings are quite sobering,” he said. “For example, we found that potential surprise bills were common when babies need intensive care. Families are already stressed out enough in those situations, and they already will face large bills for the intensive care unit stay in the absence of surprise bills. To add surprise bills on top of all this seems particularly unfair.”

Starting January 1, 2022, the No Surprises Act will begin protecting families from most surprise bills. “For privately insured mothers who are expecting before this date, it is important to understand that there is a significant chance of receiving a surprise bill, even if the delivery and newborn hospitalization occur at an in-network facility,” Chua said. “Those surprise bills will be in addition to the roughly $3,000 that privately insured families pay out-of-pocket on average for deliveries and newborn hospitalizations.”

Hence, families need to save as much money as they can before the delivery, according to Chua, “so that they have the funds to pay both the hospital bill and any surprise bills.”

After January 1, 2022, privately insured mothers who are expecting should not receive bills from out-of-network providers after this date. “But families might still receive these bills if there are problems implementing the federal ban,” Chua said. “If this happens, families should contest these bills.”

The high frequency of potential surprise bills in the study suggests that childbirth might currently be the most common source of hospitalization-related surprise bills. “Therefore, it is particularly important for policymakers to ensure that the new ban on surprise bills is appropriately implemented in the case of childbirth,” Chua said. “Otherwise, a large number of families could still receive surprise bills in error.”

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Disclosure

Chua reports no relevant financial disclosures.

Reference

1. Chua KP, Fendrick AM, Conti RM, et al. Prevalence and magnitude of potential surprise bills for childbirth. Published online July 2, 2021. JAMAHealth Forum. 2021;2(7):e211460. doi:10.1001/jamahealthforum.2021.1460