Imagine this: At just your second prenatal visit, a moment brimming with hope and excitement about your growing baby, you’re handed an unexpected bill. The amount? Hundreds—maybe even thousands—of dollars, demanded before your little one has even arrived. It’s a gut-punch at a time when you’re already juggling excitement and the unknown.
For many families, this scenario isn’t hypothetical. It’s a harsh reality of modern maternity care. Last year, I experienced it myself, facing a required prepayment of nearly $9,000 before giving birth to my fifth child. And while some parents note that prepay policies in hospital delivery settings aren’t entirely new, they are gaining fresh attention as the costs of maternity care climb and the financial burden on families continues to grow.
Why prepayments are in the spotlight
Prepayment requests in maternity care aren’t unheard of, but here’s why they feel more pressing now than ever. As the 19th News recently reported, the rise of high-deductible health plans—where patients shoulder more upfront costs—has made these policies more common.
At the same time, maternity care costs have reached staggering heights. A 2022 Kaiser Family Foundation study found that the average cost of giving birth in the U.S. is over $18,865 with insurance—and families are increasingly paying a significant share of this upfront.
According to the 19th, the trend reflects a broader shift in how hospitals handle billing, often asking for upfront payments to guarantee revenue. But for expectant parents, it raises important questions: Is prepay legit? Is it even allowed by my insurance plan? In my case, it was excruciating to prepay nearly $10,000 for my hospital delivery, only to wait months after giving birth for partial reimbursement from my insurance company.
Related: The cost of giving birth is getting more expensive—and some families are getting hit with childbirth debt
Why are providers asking for prepayments?
Prepayments are a common practice in other areas of healthcare, such as elective surgeries, but maternity care presents unique challenges. Unlike a one-time surgery, hospital deliveries and stays at birthing centers involve months of unpredictability. From miscarriages to premature births, these uncertainties make prepayment policies feel particularly insensitive.
From a provider’s perspective, however, prepayments offer financial security. Hospitals argue that these policies help ensure they’re compensated, especially if a patient switches providers or fails to pay their bill after delivery. In my case, my midwives explained that prepayment was necessary to guarantee their availability over the months of my pregnancy. While I understood their reasoning, it didn’t make the process any easier to accept.
Still, many advocates question the ethics of requiring upfront payments for such a fundamental healthcare service. They argue that these policies disproportionately burden families, especially those already struggling to make ends meet, and may deter some from seeking essential prenatal care altogether.
The emotional and financial toll
For many families, the financial strain of prepayment policies adds stress during what should be a joyful time. Pregnancy is already a physically and emotionally demanding experience, and unexpected bills can exacerbate feelings of anxiety.
Take Kathleen Clark, for example, whose story was featured in the 19th. After a high-risk delivery, Kathleen fought for months to receive a refund for the prepayments she’d made. Her experience is an all-too-common reminder of how prepay policies for hospital deliveries can overshadow a time meant for healing and bonding.
And unlike other forms of prepayment in healthcare, maternity care stands apart due to the uncertainty of its outcomes. A premature delivery, miscarriage, or other complication can leave families paying for services they didn’t receive—or worse, grieving while fighting for refunds.
Related: Where to give birth: Here are your labor and delivery options
Practical advice for expectant parents
If you’re facing a prepayment request, here’s how you can protect yourself:
1. Ask the Right Questions:
– Can your insurance company refuse to allow prepayments?
– Will I be refunded if my pregnancy doesn’t go as planned or if my circumstances change?
2. Know Your Rights:
– Some insurance plans prohibit upfront payments. Call your insurer to confirm what’s allowed.
3. Plan Ahead:
– Leverage tools like HSAs (Health Savings Accounts) or FSAs (Flexible Spending Accounts) to save for unexpected costs.
While prepayments may feel inevitable, preparation can help ease the financial strain.
So, what’s next? Families deserve clearer policies, more affordable insurance options, and a system that prioritizes care for mothers and families over profit. Expecting a child should be a time of joy and anticipation—not one marked by financial fear. It’s time to rethink how we support mothers during one of life’s most significant journeys. No family should have to choose between their finances and their health.
