AMA Plans Significant Changes to Pregnancy Billing
The American Medical Association (AMA) is set to revamp how doctors charge for pregnancy care. Families should pay attention to this, as it may impact them significantly.
The AMA claims that this new approach will enhance billing accuracy and modernize care. It’s a nice idea in theory, but for many American families already feeling the pinch of rising expenses, it seems like a change that could add to the burden of having children.
Starting January 1, 2027, the existing global maternity code will be replaced with a more intricate billing system for pregnancy, labor, delivery, and postnatal services. This means healthcare providers will bill for each visit and service individually, rather than treating pregnancy as a cohesive experience.
However, pregnancy isn’t as straightforward as picking items off a menu. It’s a holistic journey that requires careful coordination. Bundled payment systems, where care is packaged together, actually encourage healthcare providers to deliver services efficiently and effectively. In contrast, this new unbundled model could incentivize billing for every single service, regardless of necessity.
For many prospective parents, the question has shifted from “Do we want kids?” to “Can we afford them?” Indeed, one of life’s significant expenses could become even more daunting.
The AMA manages the billing codes that patients see on medical bills—those five-digit numbers that specify what services were provided. By moving from a bundled code to multiple individual codes for pregnancy, obstetric care could slide toward a fee-for-service model, which often leads to higher quantities of billed services and, inevitably, fees.
Federal watchdogs have previously cautioned that fragmented billing opens doors for abuse. The Department of Health and Human Services Office of Inspector General frequently examines billing practices and often uncovers inconsistencies in coding and billing.
In one audit, it was revealed that Medicare had made potentially inappropriate payments of up to $17.8 million linked to complex coding and billing problems in opioid treatment. Different specialties, yet the same crucial lesson arises: Disjointed and poorly managed payment systems contribute to waste, fraud, and abuses.
Many patient advocates are already stating that this new billing framework could lead to higher out-of-pocket costs for families.
Some policymakers advocate for a lump sum payment model, arguing it could lower costs while enhancing care quality. Bundled payments can inhibit unnecessary C-sections, which are notably more expensive and carry increased risks compared to vaginal births, as well as requiring lengthier recovery periods.
When the incentives are skewed toward providing more services rather than ensuring better outcomes, families can expect to grapple with escalating medical bills, extended recovery times, and additional childcare expenses.
The real policy dilemma lies not in whether providers will misuse the system, but whether lawmakers should tolerate a setup that makes such misuse easier and life for families more expensive.
This shift in billing codes arrives at a particularly inopportune moment. By 2024, projections indicate that the birth rate in the U.S. will hit an all-time low. If conservative policymakers genuinely care about supporting family growth, they must resist allowing the AMA to complicate and escalate the costs associated with one of life’s significant and stressful experiences.
As a father of several children, I understand that raising a family in the U.S. isn’t an easy feat. Every new child is a joy, but every parent knows the bills will inevitably follow.
It’s crucial for policymakers to safeguard the existing healthcare framework rather than letting it deteriorate for the sake of families. Ordinary Americans might find themselves facing heftier bills alongside disorganized care plans. As families pay more for the opportunity to welcome children into the world and pursue their dreams, we cannot let an elite institution label this as progress.
