Just days after I saw two pink lines on a pregnancy test, after months of trying to conceive my rainbow baby, I visited the OBGYN to confirm it was real. Turns out it was so real, that they were ready to start billing me for the birth that hadn't even happened yet. I was exactly four weeks pregnant.
I don't think the billing office got the notice that 10-25% of pregnancies end in miscarriage. I also don't think they were much concerned with the fact that I'd just finished monthly payments on the D&C surgery from my miscarriage when they slid the payment plan requirements across the desk.
Their ask? I should pay around $200 per month for the entirety of my pregnancy to offset the over $3000 potential charges for just the doctor's prenatal care and the actual birth (not including the hospital and newborn bills). If I declined, I had to sign on the big scary line that basically said, "Ok then. You owe all this within 10 days of the delivery. Good luck." (At least that's how it read to me).
Related: Hospital Births Are Expensive—Here's What to Expect
Another mom, Audrey Chamber in Geneva, Ill. has a 2-month-old, and recalls getting a similar prepayment request. She thought, Is this a scam? Is this real? She recalls wondering if this was an option or a mandate, and tells Parents that she "didn't know better, being it was my first kid."
While some may consider a request to prepay to offset planned birth costs a helpful service, for other pregnant people it can range from shocking to inappropriate to downright deceptive and disturbing. Here are the reasons we must stop pressuring families with this ridiculous request.
Money gets tied up, limiting options
Exiting the OB office, my excitement started to wane a bit. The money meeting put a damper on my newfound excitement about my rainbow baby coming. Bad thoughts started to spiral: What if this baby isn't even ever born? If I lose this one too, what happens to my $200—times however many months it's been? I started doing math, adding up my current D&C medical bills with this amount, and considering my options—other than that seriously hefty monthly payment for babies (whether they were still living in or already passed out of my body).
Psychotherapist Haley Neidich, LCSW, a Tampa, Fla. based therapist treating patients online, went through this situation herself. "Something about it felt off to me and I found myself checking with friends who had given birth…I was shocked to learn how common it is," she says. "Particularly given that my pregnancy was complicated, I recall wondering why I would pay for a birth that I wasn't sure I'd have or for a type of birth that I didn't ultimately end up being able to experience." Towards the end of her pregnancy, after an "alarming" visit with her current provider, she decided to switch practices, but realized the money was tied up in the payment plan the office had asked her to do. The inability to transfer money ultimately prevented her from switching providers.
Related: We Need to Talk About the Financial Toll of Miscarriage
"I ended up having to have that same doctor perform my C-section, which had been my worst-case scenario. While I have a happy, healthy 3-year-old, it took a much longer time for me to emotionally recover because of having to deal with that doctor," she says. "I believe that if our finances hadn't been tied up in that practice that I would have left and felt safer and less anxious with another doctor."
Neidich has had clients herself with similar experiences; they couldn't switch to a preferred provider without having to then start paying the new provider's plan as well. "Most people don't have an extra few hundred dollars lying around each time they go to the doctor, especially while planning for baby," Neidich says.
Counting your chickens before they hatch?
For me, being pregnant again after a miscarriage was fraught with superstition, spiritual warfare, and mental health preservation. I found out what my triggers were—those that would set me into a fit of anxiety, convinced this baby would die too—and avoided them like the plague. Anything that involved presuming this child would make it to a live, healthy birth when the last one hadn't felt like tempting fate and provoking the gods, or something.
So, the idea that I should prepay for a service and birth that hadn't even happened yet? That seemed presumptuous at the least and wildly insensitive at worst.
Emily Edelmann, a mom of a 2-year-old and a 7-week-old in Chelsea, Mich. got a letter in the mail from her provider requesting prepayment as well. It even included a line that said if she didn't make the down payment of $450 then, they wouldn't be able to provide prenatal care to her and her child.
"The thought that they are billing me five months before [the birth] happened was insane to me," Edelmann tells Parents. As a medical billing professional at a doctor's office by profession, Edelmann was shocked and found the whole thing inappropriate.
Related: All About Pregnancy After Miscarriage
"My other thought was, What if I miscarried? How traumatic would it be to have to go ask for my money back?" Edelmann explains. "You go to the grocery; then, you pay for your groceries. You don't pay and then get the groceries in two months." Edelmann ignored both letters asking her to prepay, and talked to her midwife—who confirmed they would still provide care regardless of payment.
Neidich explains that asking for anything that requires a deeper connection to the outcome before the baby makes it to term can cause issues. "Whether it's a family member gifting a baby blanket, daydreaming about the nursery, or being asked to pay in advance for the birth, anxiety will come up," she says. She also has a family member who struggled to pay for a D&C for a miscarriage while awaiting for those prepaid baby care funds to be returned. "Not only did she have to deal with the bill in the mail for the D&C, but she shared that the day she received that refund check was one of the worst days of her life."
Psychologist Dr. Helena Vissing, Psy.D, also a Certified Perinatal Mental Health Professional (PMH-C), says deep and important emotional work goes on during pregnancy and delivery; for that reason, many pregnant people feel that "acting like you are taking it for granted that you will have your baby feels unsafe on a spiritual level," Dr. Vissing tells Parents. "That it is a way of honoring life for them to not take it for granted. The question of not taking things for granted is also heavy during pregnancy after loss."
Vissing herself recalls the devastation of receiving a "congratulations on your pregnancy" letter after she prepaid for procedures and then miscarried. "It was devastating. I knew it was some algorithm that had prompted it, but that was also the hurtful thing; the reminder of how we become numbers and data points in the system."
Insurance changes, procedure changes
Two of my three pregnancies and births have involved a major insurance plan change right in the middle of care. This resulted in two separate bills for prenatal and birth care for anything that bridged the time span between those two plans. So the baby born a few hours before midnight? Half an OBGYN bill in the previous year with old insurance, and a half in the next year. The result was a logistical nightmare, complicated by the concept of prepaying for care. In fact, final bills weren't sorted out in all of the chaos for that New Year's baby until the following Halloween.
This level of complexity in the insurance and billing process is the opposite of what a brand new parent needs. "And how about the uncertainty of delivery?" Vissing asks. "What does the prepayment cover, and how will you know if you are under or overpaid? Right after having a baby is probably the time of your life with the least energy and time for scrutinizing bills and double-checking charges against deductibles, let alone disputing issues or errors."
Edelmann, too, recalls being concerned, as someone who suffered from Hyperemesis Gravidarum both pregnancies, that she might not only hit her deductible before the birth but also be prepaying at the same time (paying twice).
Trauma-informed practices increase access to care
If you couldn't pay, would you keep showing up at your prenatal appointments? Neidich is worried that upfront costs may deter people from getting the care they need.
"Families [may be] avoiding proper OB care during pregnancy due to the fear of facing this financial stressor that they simply cannot manage," Neidich explains. "Not only is this concerning because of the health of the mom and baby, but these parents may be reported to [child and family protective services] if they show up to the hospital to birth without established OB care, further compounding their stress and sense of insecurity."
Vissing also has concerns that this system is the opposite of a trauma-sensitive environment and may "exacerbate" mental health conditions. "Especially in relation to trauma, we are wired to become less trusting of others when our nervous system is in high alert. Building trust requires that the surroundings are sensitive, respectful, gentle, honest, and transparent. These are not usual characteristics of the healthcare payment process."
If you are worried that not being able to prepay will prevent you from obtaining medical care, speak to your provider directly—and challenge any notion that you are required to prepay for procedures you have not yet had. It's time for pregnant people to regain control of their own money, avoid funds being locked in the healthcare system limbo, and be able to advocate to get the care they want from providers they trust.