Birthing Costs: Unraveling The Insurance Billing Process For New Mothers

The cost of childbirth and postnatal care can be a significant expense for new parents, and understanding how insurance coverage works for newborns is essential. In the US, the Newborns' and Mothers' Health Protection Act (NMHPA) of 1996 ensures that mothers and newborns are covered for a minimum period following childbirth. This federal law applies to group health plans and health insurance issuers, guaranteeing coverage for at least 48 hours after a vaginal delivery or 96 hours after a C-section. Beyond this, the billing practices for newborns can vary depending on the hospital, insurance company, and state laws.

In most cases, the mother or the mother's insurance is initially billed for delivery and related care, and the newborn is then added to the mother's insurance policy. However, there have been instances where newborns have received separate bills for their care, leading to unexpected costs for parents.

The Newborns' and Mothers' Health Protection Act (NMHPA)

The NMHPA has a few unique rules. Firstly, health insurance companies cannot provide incentives to the mother in exchange for not accepting all the benefits under the NMHPA. They cannot incentivize health care providers to discharge mothers before the time is up. Pre-authorisation for pregnant women is not necessary under the NMHPA.

The NMHPA affects the amount of time a mother and her newborn child are covered for a hospital stay following childbirth. The type of coverage provided by the plan (insured vs. self-insured) and state law will determine whether the NMHPA applies to a mother’s or a newborn’s coverage. Self-insured coverage is subject to the NMHPA.

The Act applies to two types of health insurance: group health plans (through an employer or union) and individual health insurance plans (self-insured). The U.S. Department of Labor regulates private employer group health plans. The Centers for Medicare & Medicaid Services (CMS) regulates state and local government plans. A State's insurance department handles group health plans.

The Act and its regulations prohibit incentives (either positive or negative) that could encourage less than the minimum protections under the Act as described above. A mother cannot be encouraged to accept less than the minimum protections available to her under the Act and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery.

The birthday rule

There are some exceptions to the birthday rule. For instance, if both parents share the same birthday, the parent who has been covered by their plan for longer provides the primary coverage. In the case of divorce or separation, the plan of the parent with custody generally provides primary coverage. An exception is also made if one parent has insurance through their employer, while the other has coverage through a former employer. In this case, the insurance of the currently employed parent is primary.

Adding a newborn to your insurance

Understanding the Timeline:

You have a limited window of time to add your newborn to your insurance. In most cases, you will need to enrol your baby within 30 to 60 days after their birth. This period is known as the "special enrollment period." It's important to note that the policy will be retroactive, covering your child's care from the date of birth, even if you enrol them a few weeks after they are born.

Contact Your Insurance Provider:

Get in touch with your insurance provider as soon as possible after your baby is born to initiate the enrolment process. If you have employer-based insurance, contact your company's human resources department, and they will guide you through the steps. If you have individual insurance, reach out to your insurance company directly.

Gather Necessary Paperwork:

You will typically need to provide documentation of your baby's birth, such as a birth certificate or hospital records. In some cases, you may also need your baby's Social Security Number (SSN). However, if your newborn doesn't have an SSN yet, don't worry; you can enrol them without it and update the information later.

Compare Plan Options:

If both parents have insurance, take the time to compare the plans. Consider factors such as premium costs, copays, coverage details, and the network of doctors, hospitals, and medications included in each plan. Choose the option that best suits your family's needs and provides comprehensive coverage for your newborn.

Understand Coverage Details:

Review the specifics of what is covered and the extent of coverage under your chosen plan. Commonly covered services for newborns include well-baby checkups, vaccinations, hospitalization, emergency care, specialist care, and prescription medications. However, the benefits and extent of coverage can vary depending on the plan.

Explore Government Programs:

If you are facing financial challenges, consider exploring government programs like Medicaid and the Children's Health Insurance Program (CHIP). These programs provide free or low-cost health coverage for pregnant women and newborns, and you can apply at any time, as there is no restricted enrollment period.

Seek Assistance:

If you have any questions or need help during the enrolment process, don't hesitate to reach out. You can seek guidance from insurance brokers, your employer's human resources department, or customer service representatives from your insurance provider or the insurance marketplace.

Plan for Future Expenses:

Keep in mind that adding a newborn to your insurance may increase your premium. Additionally, as your baby grows, you may need to meet with specialists and cover the costs of extra appointments and procedures. Regular well-baby checkups and immunizations are essential for your child's health and development, so ensure you have a clear understanding of your coverage and any out-of-pocket expenses.

Postnatal care

The birth of a child is considered a "qualifying life event", which means that parents don't have to wait until the end of the year to make changes to their insurance policy. In the US, the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) is a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth. Typically, group health plans and health insurance issuers may not restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a C-section.

According to the World Health Organization (WHO), women and newborns require support and careful monitoring after birth. Most maternal and infant deaths occur in the first six weeks after delivery, yet this remains the most neglected phase in the provision of quality maternal and newborn care. WHO provides technical guidance for skilled health personnel and community health workers who support women and newborns after birth. Basic care for newborns should include promoting and supporting early and exclusive breastfeeding, keeping the baby warm, increasing handwashing, and providing hygienic umbilical cord and skin care.

WHO also recommends that a woman should not be discharged from the hospital before 24 hours after birth. It is important that someone accompanies the woman and newborn for the first 24 hours after birth to respond to any changes in their condition. Many complications can occur during this time. Following childbirth at home, it is important that the mother and baby receive a postnatal examination as early as possible, preferably within 24 hours of birth. If the birth was at a facility, mother and baby should receive a postnatal examination before discharge.

The first few weeks with a new baby are very demanding, physically and emotionally. Women need to rest and take care of themselves as they recover from labour and birth. This often requires that other family members and friends help out. It is therefore very important that women regain their strength and maintain their health as they adjust to life with their new baby. Women in the postnatal period need to maintain a balanced diet, just as they did during pregnancy. Iron and folic acid supplementation should also continue for three months after birth. Women who are breastfeeding require additional food and should drink sufficient clean water.

In addition, it is important to discuss the importance of birth spacing and counsel on the use of a family planning method. Women should also be made aware of the changes to their body after childbirth that may affect resuming sexual relations. The tiredness that many women feel after childbirth means that they often have little desire for intercourse. The first time they have sex may be painful, especially if they had stitches to their perineum.

Postpartum health issues are not easily brought up, given that they involve the most private areas of our body. These include urinary and anal incontinence, dyspareunia (pain during sex), postpartum depression, tokophobia (fear of childbirth), and chronic pain in the lower back and pelvic area.

Medicaid and CHIP

Medicaid and the Children's Health Insurance Program (CHIP) are government initiatives designed to support families with newborn health coverage. These programs are especially helpful for families facing affordability challenges.

Medicaid is a state and federally funded program that offers comprehensive healthcare coverage, including prenatal, delivery, and postnatal care. It is designed to provide health coverage to low-income families and is particularly accessible to pregnant women and newborns. Eligibility for Medicaid often extends to a broader range of income levels for pregnant women, making it a viable option for expectant mothers who might not typically qualify. There is no restricted enrollment period for Medicaid, meaning eligible individuals can apply and enroll at any time of the year. Post-birth, Medicaid coverage for the newborn can often continue, providing access to vital healthcare services such as well-baby visits, vaccinations, and any necessary medical treatments.

CHIP, on the other hand, provides health coverage to children in families that earn too much to qualify for Medicaid but too little to afford private coverage. CHIP is available in all states and provides low-cost, comprehensive health coverage, including dental and vision care, inpatient and outpatient hospital care, and laboratory and X-ray services. CHIP coverage and benefits can vary from state to state, and eligibility guidelines differ as well. However, like Medicaid, there is no limited enrollment period for CHIP, and eligible children can enroll at any time.

Both Medicaid and CHIP play a crucial role in ensuring that families, especially those with financial challenges, have access to essential healthcare services for their newborns.

Frequently asked questions