Legal/Insurance Question Concerning Birth Center Billing

Updated on August 22, 2016
S.R. asks from Saint Charles, MO
16 answers

Hi mamas, it's been a while, but I have a question for anyone who knows about legal or insurance stuff concerning birth centers in the United States, specifically St Louis area.
We signed on to this birthing center for our fifth baby born last November. Everything went great, we had great midwives, everyone there is very friendly and informative. However, after signing an agreement to pay a specified amount after insurance coverage, which we paid in full, we were sent a bill three months post partum for a newborn medical charge. It was confusing because they never told us about it being separate from the original charge and they never had us sign anything or even asked us if we wanted them to perform the postpartum medical care, I naturally thought it was part of the birth center package of course.
Now don't get me wrong, I have the funds to pay and I'm willing to, I'm just trying to figure out if they tricked me (unintentionally or not) or if I duped it and missed something. I'm always very diligent in keeping a budget so I always ask financial questions and make sure there are no hidden fees for things thats why this really surprised me!
They called today and reminded me that I owe a portion of the newborn care cost out of pocket after insurance covered a certain amount.
Legally, can they charge me without telling me prior to servicing my baby? Was I supposed to sign something agreeing to the charge? Might the extra charge info be hidden in something I already signed? Do you need to see a copy of what I signed (minus names or addresses)? Do you need more info about the situation?
Thanks in advance you smarty pants!

I hate this situation, I really love the birthing center and I would use them again in a heart beat, but it's so frustrating! They are a fairly new business, so maybe they just forgot to mention the charge, but still.
Insurance did already pay about 80% of the original charge, which is great but I'm still pretty upset that I didn't even know about it prior to the service when I specifically asked about all the charges, during my whole pregnancy, that we would have to pay.

Thanks for the info on typical billing process! A little info to clarify and answer a few questions you had: this was my first baby with a birthing center, she was also my first baby on regular insurance as opposed to my first four who I gave birth to on government insurance (where everything is paid in full and you never see a bill or have to pay a cent) and this birthing center is a small business so I knew everyone working there and they did know that I didn't have very much experience with billing and insurance. Since some of you seem unfamiliar with midwives i will let you know that the midwives actually do perform the newborn care as well as all the other services provided for prenatal and labor and delivery, which is the cause for the confusion about the extra charge for newborn care.
Basically the birthing center charges 5000 for their services and they told me that up front and their newborn charge was an additional 1000+, which they didn't tell me about until i got a bill three months after her birth. They sent me a bill for the full amount, which was a huge shock. I called my insurance to see if they would pay most of it. The man I spoke to told me the birthing center sent in the request too late (after the deadline) so they would not be paying it and he actually told me that I shouldn't pay it either. I was upset because of both not knowing about the charge beforehand and the prospect of the birthing center not getting paid. So I called the center and left a message explaining what my insurance told me. Several months later I get a call (the other day) and it's the center asking for the remaining payment saying that the insurance paid their 80% after all.
The center told me, before I began using them, that there would be a nurse as well as the nurse midwife at the birth, I don't know if the nurse was charging for her services separately but they should have said something if she did because the way they described the service it was implied that the original 5000 price included hers.
When I called and asked what the service was they just said newborn care is separate, but if I knew that beforehand I would have taken her to our pediatrician so we would not have been charged extra since the midwife was actually out of our network. That is no reason to not tell me, if that's why then it is deceitful.
In the mean time I will look through the papers I have signed and update you all.
Again, thank you all. If we have a sixth baby I will be better informed of billing procedure!

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So What Happened?

Thank you for the information and some of you had really good ideas that I never would have thought of! We ARE planning to just pay the bill, especially since insurance has covered a good portion of it, just wanted to know if what they were doing made sense!
Most of you thought I was talking about a hospital, but I actually had my baby through a birth center that was not affiliated with a hospital and we had a home birth through them, so the procedures aren't really the same, i was hoping someone out there would know about specifically BIRTHING CENTER billing procedure, even more specifically for home births, and if you do I would still like to know more so feel free to comment or message me.
Thanks again everyone!

Thanks about the eob, I actually never got one until my fourth kiddo, you see MediCal is different from Medicaid, it even differs between each California county. I don't know why they didn't send one before but I did look through the charges, however every single little thing was charged separately, so realistically, how was I to know that when the birth center grouped everything they weren't including the newborn care? Like some of you pointed out, obviously there is going to be a baby there after the birth, so why was the extra charge not included in the first place?
However, I'm disappointed in the change of tone as soon as I revealed I used to be on welfare. Those government programs are set up and used to get people on their feet, and having grown up and stayed below the poverty line as adults (even though my husband and I were both working) and only used welfare for those short years my first four kids were little it did it's job. Because my husband was able to finish his PhD and become a hard working scientist we have been bumped up to middle class and are paying it forward. For the record, I knew at least a hundred other student families who have gotten up on their feet using the welfare system, I don't know a single long term welfare recipient, why are you so bitter about a great and useful program that is working? Jealousy, perhaps? I don't know.
As an active christian, I believe in helping others and I also believe in asking for help when it is needed. It's sad to me that so many people don't feel the same, regardless of religion.
Again, thank you to those of you who gave real advice without harsh prejudice.

Featured Answers



answers from Denver on

Unfortunately, you will probably end up paying it. I can't tell you how many times I have been charged for things without ever being told that there would be a charge. They will call and call until they get paid...
The business office employees don't care what you signed or what you were told, they just want to collect.
Yes, newborn care is separate from the mom's care, delivery, etc.

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answers from Houston on

Baby care is never included in the delivery amount. That is separate as you are separate people and require different care. You owe the money. Check what you signed.

No place can give you an exact amount prior to the birth. Different deliveries cost different. I had 2 emergency C-sections. That cost more. The pediatrician charged us to come after each child was born. The baby is THEIR patient not the OB/GYN.

7 moms found this helpful


answers from Dallas on

Pay the bill, you owe it.

6 moms found this helpful


answers from St. Louis on

This is your 5th child, is this the first time you read a bill? The baby's portion of the bill is always separate.

If it makes you feel better have them explain to you how it all works but you owe it, you always owe it. The baby is not cared for by the same people you contracted with to actually have the baby. Different doctors, different charges.

I just want to add no one is legally bound to tell you exactly what your charges will be after insurance. That is your responsibility between you and your insurance company. We have become leery of even estimating charges because of people like you. Even what you signed with the birthing center surely said something about normal birth. If you had unanticipated complication I would think you knew you would have additional charges. I mean you didn't think if they had to rush you to a hospital you weren't going to be charged by the hospital as well?

I have had 4 knee surgeries performed at hospitals and one at a surgery center. The surgery center staffed their own anesthesiologists so they noted it was covered by the surgery center charge, I still paid my orthopedic surgeon. Hospitals don't staff the anesthesiologist so they bill separately. I would never assume that anything not staffed by a surgery center would be part of the bill. Why would you assume an outside pediatrician would be covered by a birthing center? Why would they know what the charge would be and should tell you? You weren't pregnant when your baby received their care.

I am not a medical professional but I do work for doctors but not in a billing capacity. I actually do analytics and reporting if you want to know how crazy the medical field has become. I make sure they are running efficiently, fun in a bucket. My office used to be by the billers and that is where I learned how many people are confused by all of this. Confusion doesn't mean you don't owe the money. To me a good rule of thumb is if your insurance paid on it, it was a legit charge because they will always kick an inappropriate charge out. Heck they fight to not pay the legitimate charges so that it went right though that is a normal, reasonable and expected charge, just not by you.

Jeez, I wrote a book, sorry about that.

After reading your edit, you need to chill with the terms like deceitful. They did not trick you in any way, you should have known your child becomes a child when they are born. Honestly I find it highly disturbing that you never read your EOB before because someone else was paying for all your care. Do you get how that sounds to those of us who either paid all out of pocket as some friends of mine have, or we had spouses that carried insurance and we had to deal with copays. But not you, you didn't have to pay anything so you didn't care how much everything else cost. Not sure if you understand what I am saying but welcome to our world, pay your bill, no one tricked you. If you had cared about how much of our money you were spending on your first four you would have known the charges for your baby were separate. And sorry, I am well aware that even Medicaid claims generate bills and EOBs you just didn't care.

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answers from Washington DC on

ETA: Sorry - I've not had my caffiene yet today. This charge is for the baby. NOT YOUR CARE. You owe the money.

Take the contract that you signed and go into their office and have them show you where you were going to be charged a separate amount.

Call your insurance company and give them the codes on the bill/invoice from the birthing center and find out what they say.

If you don't like their answer? Go hire a lawyer and have him/her read your contract over and see if you misread or if there is something else going on.

Is this your first time using THIS facility or your 5th? If your 5th - did this happen in the past? Or is this something new?

Good luck!

5 moms found this helpful


answers from Norfolk on

I suppose I'd tell them you've already paid everything you were suppose to pay (you have your prior billing, right? and proof you paid it?) - if you have something that says you paid in full - then that should be it.
You make copies of everything (always keep the originals) and show them what you were billed for and that you paid it - and your papers say you are done.

Billing departments make mistakes.
Maybe it didn't charge you for something they were suppose to charge you for or maybe you got this other charge from someone else s acct - it happens - but a new bill 3 months after the fact just doesn't sit right with me.
What's to say that you pay this new amount and then they come back several months later and try charging you for something else?

When I was in labor, my husband took over my notebook.
Every nurse shift change - we took names!, the anesthesiologists too, every shot, every procedure - he took notes - we caught mistakes.
At one point a nurse came in to give me an rh shot - we asked why? my husband, myself and our son were all A Positive and I didn't need any shot - turns out she had the wrong room and the lady next door needed it.
So we caught that before anything went wrong - and then that notebook saved us when they tried to bill us for that shot.

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answers from Anchorage on

I don't know about what you signed, but I do know that it is normal for newborn care to not be included in birth services for billing, at least at the hospital I had my boys at. It has to do with who the patient is, during birth mom is the patient, but after birth there are two separate patients, two separate bills.

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answers from Springfield on

A birthing center might do things differently, but when our boys were born we had one bill from the OB, one hospital bill for me and one hospital bill for our son.

4 moms found this helpful


answers from Louisville on

Sorry if I missed this in any of the notes on this one, but since you have insurance, you should have received an EOB from the insurance that outlines the charges and shows how much they paid, etc.... That is where you start.

4 moms found this helpful


answers from Portland on

The way you are billed is the same for hospitals and birth centers. The birth center, even for a home birth is the same. The only way you will know what happened according to your contract is to look at the contract. You can ask to see it at the birthing center.

Do you now accept that after born care is a part of the delivery?

ETA After your SWH Newborn care is done after the delivery. It's required by law. You could not have your pediatrician do it. Nurses do newborn care. Please ask one of the nurses what newborn care involves.

Bills that involve insurance typically take a long time. Sometimes months. Talk with the birthing center billing office!!!!! Take someone with you. Contracts are often written using legal terms making them hard to understand.

I suggest you did agree to the newborn care and didn't understand their would be a separate bill. No one would deliver your baby without including newborn care of the baby. I strongly suggest that you didn't understand this when you signed. Perhaps they didn't make it clear. Look how you still don't understand what newborn care involves. The berthing center.would not do a delivery without newborn care. The law requires that be done.

I don't understand why you are using.your time and energy on this. You said you trust the people who helped you. But you think they are deceitful. Go to the clinic, talk with the billing clerk and ask why you weren't told there would be an additional charge. The billing office has your signed.contract. They will ask you to read it. You don't have to wait to find your.copy. Ask, instead of worrying about the bill. You can also talk with one of the nurses.
Do you distrust everybody? Have you considered that your baby did get the care and whether or not you knew, it happened. you didn't know about it nut the service was.provided as required by law.


The later bill comes has paid..It means that your insurance paid less than you expected. I would ask for a statement showing how much insurance paid and how much you paid.

Newborn care is part of the delivery but is billed separately. I suggest that once the clinic bills your insurance and they pay, you are left to pay the difference as you agreed. If you haven't called to add baby to your insurance, they will not pay for newborn care. Your baby is a different person than you,.as far as insurance goes.

I suggest that you are not understanding how your insurance and their billing works. Care for you and care for your baby are 2 different accounts for billing and for insurance payments. That is why you received 2 different bills. I suggest that it's usual to get the second bill. All birthing centers, hospital or not, provide newborn care. Otherwise how would they know that your baby is healthy and do the testing and reports are completed and filed. You are billed $200. That's nothing to know your baby is healthy.

Can you see anyone delivering a baby, then leaving the room, expecting you to do all that's required to make baby comfortable and completing all the tests and filing results with the state? You would expect newborn care for's not a matter of you requesting it. When insurance is involved there will be 2 or more bills. The clinic's business office should be able to explain all of this. Perhaps going to their office in person would help you. I often need to see numbers in writing before I understand.

4 moms found this helpful


answers from Pittsburgh on

At the very least I would ask them what specifically the bill is for that wasn't included in the package. You want to make sure you actually received the services being billed, since it sounds like it was something extra/nonstandard.

3 moms found this helpful


answers from Boston on

OK.. Being the medical insurance/claims queen that I am (20years, 4 insurance companies and one pediatricians office Later)....newborn care in the hospital is a completely separate charge from your delivery and it starts the moment she pops out of you and they start checking for for 10 fingers and 10 toes. Taking your newborn out of the hospital/birthing center and directly to your pediatrician is generally not an option at that moment. so , my feeling, is that you owe that bill

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answers from New York on

Just like in a hospital, baby's care is seperate. Never included. This is your 5th child. You didn't pay for their care when they were born. I'm sure you had a pediatrician come in. Or was it paid in full so you never noticed?

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answers from Los Angeles on

I am so sorry, honestly, i don't have any advice for you that hasn't been stated already, but ever since i joined this site i have noticed more and more often that other moms will come out and say something so mean or rude or judgmental. I usually use mamapedia to search question i have that other moms already asked. this site was created for moms to seek impartial and sometimes anonymous advice and help on topics that have to do with being a mom. but these days, more often than in the past, you get those moms that just comment on EVERYTHING under the sun and half the time it is just a complaint or a projection about something deeper that they are dealing with, and it just ends up being pure judgment. my advice to you is: DONT TAKE IT PERSONALLY. those moms are in their own little make believe perfect world bubble. dont give a second thought! I know I dont! cant waste my time on other peoples opinions, am i right?! even if some people truly have no business giving "advice"

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answers from New York on

I definitely think you should have a conversation with them, to say that you paid everything that was agreed to in advance and you never requested that extra service. Find out what their "excuse" is for why they did that extra service. Then decide whether to pay after that conversation.

I'm not sure what services were covered by the charge you describe, but I could imagine a situation of services that could have been done at a later date by a pediatrician and services that maybe would have been covered by insurance if done at a different time. In that situation I would definitely argue against paying when I had not requested the services to be performed right after birth.

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answers from Dover on

Maternity and post partum are separate so I would say you need to look at what you signed. My guess is that unless it's spelled out to cover all delivery and post partum that they are very separate. Considering this is your fifth child they probably figured you knew that, they certainly were aware. You could sit down with their billing department/office manager. You may be able to meet a compromise.

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