A technical change to obstetric billing could have a big impact on pregnant workers

More than 2 million women in the labor force deliver babies each year, according to US government data.

Once an employee has a child, their employer typically receives a bill from the health plan detailing all the services that worker received during the nine-plus month process, and their costs.

That system will soon change due to a technical change endorsed by the American College of Obstetrics and Gynecologists (ACOG) that’s expected to take effect next January.

While the new system will allow employers to dig into more granular data about workers who receive pregnancy care, it could also mean higher bills and more administrative complexities, leaders from companies in the maternal health space told us.

What’s changing for pregnant patients? The American Medical Association recently rolled out new codes that obstetric providers must use to bill patients and health plans for maternity care services starting on Jan. 1, 2027.

Since the 1990s, the healthcare industry has used codes to bill for a “bundle” of maternity care services, such as prenatal and postnatal care, as well as labor and delivery, according to the ACOG. But this “global bundle” is no longer reflective of how pregnancy care is delivered today, ACOG contends.

“The current payment methodologies simply no longer reflect the care being provided today or the care ob-gyns will provide in the near future,” ACOG CEO Sandra E. Brooks said in a statement. She cited the increased use of “home monitoring and telehealth and additional monitoring needed in the postpartum period for mental health conditions, hemorrhage, and cardiac conditions” as types of care that should be better reflected in billing codes.

Unbundled codes, she added, should better reflect the “nuanced and varied experience of pregnancy.”

Whereas obstetric billing is currently akin to a prix fixe menu, with patients and health plans paying for a bundle of services at the very end of a pregnancy, this new system is more like an à la carte menu, Neel Shah, chief medical officer for Maven Clinic, a healthcare provider focused on women’s and family health, said.

“This seems like this really wonky technical change in codes, but what we’re actually doing is making a generational change in how pregnancy, which is the most commonly utilized healthcare service in America, is paid for,” he said. Shifting how OB services are paid for, he added, will likely also change how they’re delivered to patients.

How employers could be affected. There will be “unquestionably winners and losers” as a result of the unbundled billing system, Shah said. He recounted conversations with members of the healthcare industry who described scrambling to update training for clinicians, as well as software, to align with the new codes ahead of the Jan. 1 effective date.

Shah predicted that HR leaders will see “much more volatility” when it comes to costs for pregnancy care. Under the new system, “if you have a population that skews towards more high risk, you’re probably going to pay more.”

He added that employees will also likely pay more frequently for maternity care under the unbundled system, given they’ll incur a cost every single time they go to the doctor, rather than at the end of the pregnancy.

One upside to the new system could be access to more granular data about patient care, said Shah. This point was echoed by Shyamali Choudhury, chief commercial officer with the virtual care provider Pomelo Care.

“One thing that’s always been hard for employers and plans alike is when you have the global bundle, what it means is you only have one claim, so you don’t see all of the visit level activity and you see things on a delay,” she said. With separate billing, health plans and employers might be able to “identify gaps” in certain types of care earlier, she added.