Cobb County readers advised to verify maternity bills after new coding rules

New billing codes for maternity care take effect on Jan. 1, 2026, replacing long-standing codes that bundled much of pregnancy care. The change breaks down costs for prenatal care, labor, delivery, and postpartum services. Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, said the shift could make individual service costs easier to see. She noted, however, that it is not yet clear whether the change will help patients stick to a budget. Corlette added, “I could see where it might be advantageous to the provider. But I’m not sure I’m seeing benefits to the patient.”

The timing of the rule change comes as federal regulators continue to delay the “advanced explanation of benefits” requirement. This rule, part of the 2020 No Surprises Act, was due to take effect on Jan. 1, 2022. Corlette said it has been roughly four and a half years since the rule was supposed to be available. She described the delay as a source of frustration for many consumers. “People have a right under the law to know these things,” Corlette said.

Grace Griffin of Calumet, Michigan, experienced the difficulty of estimating these costs before her daughter was born in June 2026. The couple, both 26, reviewed their UnitedHealthcare student plan’s Summary of Benefits and Coverage. The document estimated out-of-pocket costs for a routine pregnancy at about $2,700. Griffin said the estimate seemed manageable. “We thought, ‘OK, that’s doable,’” she said. “We should be able to save up that much and pay for that out-of-pocket.”

The actual expenses exceeded that estimate significantly. The hospital charged about $18,000 for the delivery. Griffin’s plan required a $500 deductible and 20% coinsurance for in-network care. By early October, the family’s out-of-pocket expenses totaled more than $9,000. This amount was more than three times the initial estimate. The Griffins are currently working to cover the bills. Griffin qualified for Michigan’s Rx Kids program, which provides $1,500 during pregnancy and $500 a month for the baby’s first six months or year of life.

Experts advise parents to understand their plan’s maximum out-of-pocket, or MOOP. For 2026, the Affordable Care Act caps this amount at $10,600 for an individual and $21,200 for a family. If a pregnancy spans two plan years, the maximum resets to zero at the start of the second year. The Griffin family had an $18,000 MOOP, while Griffin’s individual maximum was $9,000. Corlette recommended that patients verify which providers are in-network, including labs and imaging facilities. She suggested explicitly telling doctor’s offices to send tests to in-network providers to avoid surprise bills.

Parents should also check every bill for errors. The Affordable Care Act requires certain prenatal services to be covered without additional cost. These include prenatal visits, folic acid, anxiety and depression screening, and breastfeeding counseling. If an insurer refuses to pay for a covered charge, filing an appeal is an option. Most hospitals also offer financial assistance programs. Corlette advised patients to get any payment arrangements in writing to prevent accounts from being turned over to collections. Enrolling a newborn in health coverage quickly is also critical. Many employer plans require enrollment within 30 days of birth, while Marketplace plans generally allow 60 days.