Pregnancy Care Is About to Get a Lot More Expensive

Practices are being told to begin the transition this fall. The American Medical Association (AMA) has restructured charges related to maternity care, essentially creating an à la carte menu for expectant mothers. What was once a "bundle" of charges for one condition (pregnancy) becomes a system of multiple charges based on individual services. Essentially, one billing code will turn into multiple billing codes for your insurance company. That might not sound concerning at the moment, given the myriad other crises America is facing right now, but it is extremely concerning to anyone aware of the rising cost of healthcare. This "unbundling" is a recipe for inflation in medical care, creating new pathways for more tests and procedures. As business advocate Magda Rusinowski explained to the Jacksonville Journal-Courier , "Fee-for-service in every discipline incentivizes more tests and higher-level providers because that's what generates higher billing." This "unbundling" is a recipe for inflation in medical care. We know this to be the case because every Medicaid and Medicare fraud case we've seen has been related to extra billing: ordering unnecessary tests, prescribing unnecessary medications, or simply billing for services never offered in the first place. The pattern shows up in the government's own audits. A 2025 report from the HHS Office of Inspector General found that for 42% of eye injections billed to Medicare over a single year, providers also billed a separate office visit on the same day using a modifier that lets the claim bypass the system's built-in checks. When auditors pulled the documentation on 24 of those visits, 22 didn't support the separate charge. Medicare paid $124 million for same-day visits of that kind during the audit period. The original "bundling" system for insurance companies was meant to mitigate exactly that threat. That is why the Centers for Medicare & Medicaid Services (CMS) created an entire National Correct Coding Initiative to provide uniform, simple medical coding. Unbundling will necessarily create the price inflation they sought to avoid. The American College of Obstetricians and Gynecologists (ACOG), which petitioned for the change , says the old global payment was a major pain point for OB-GYNs and that the new structure will reduce administrative burden, improve data collection, and let doctors be paid fairly for care that increasingly involves telehealth, home monitoring, and multiple unaffiliated providers. All of that may be true. It also creates a new pathway for extraneous billing. Yes, medical school is expensive. Yes, operating costs are expensive. No, these are not issues for the consumer to solve. Patients should not be responsible for the lifestyles of their doctors. If doctors are upset with the rising costs of the care they provide, they should address those issues at the provider level, not restructure billing in a way that will necessarily be passed on to private insurance holders. It isn't fair for women to pay the price. And make no mistake, it will be women who pay the price, both financially and mentally. Patient advocate Caitlin Donovan of the Patient Advocate Foundation shared her story, saying her third pregnancy "amounted to a money grab" of extra tests and services when doctors forced her into the "geriatric" category, despite being perfectly healthy with no issues and no prior health risks. It will be women who pay the price, both financially and mentally. Writing in STAT in July, health policy analysts argued the same thing: that eliminating global billing is likely to raise the cost of childbirth with no guarantee of better outcomes. The AMA says the change will be cost-neutral, but that depends entirely on assumptions its own update committee made about whether fee-for-service will drive more utilization and higher billing intensity. Childbirth already costs an average of $2,743 out of pocket, on top of total charges averaging roughly $15,700 for a vaginal delivery and $29,000 for a cesarean. Most of the added cost will land on employer-sponsored plans and Medicaid, which each cover about half of all deliveries. Unbundling will not only inflate total costs; the increased testing will inflate anxiety as well. Pregnancy is a joyful but stressful process. In my first pregnancy, I took every doctor's order as gospel. I imagined if my doctor was prescribing it, it could only be of the utmost importance. Every test was a new way to fail, but unlike school exams, this type of failure meant danger for my unborn child. These are the unquantified stresses of every young mother, and they act as very real hurdles in maternal care. How will a woman know which tests are needed and which are extraneous? After a half-decade of lectures on COVID "safety" and medical care, nearly all of which turned out to be wrong at best and deceptive at worst, trust in medical professionals is at an all-time low in this country. Gallup polling shows Americans' trust in doctors' honesty and ethics has dropped 14 percentage points since 2021, its lowest point this century. Adding more doctor interventions (and charges) to an already stressed relationship between patient and provider seems counterintuitive. There is another aspect of the billing code changes that few are considering, and that is the devaluation of female bodies, something women have been suffering for the last decade as the transgender movement continues to blur the line between sexes. We have moved from "expectant mothers" to "pregnant people" and "women" to "people with uteruses." This movement reduces womanhood to a feeling, which is fine when that feeling only affects the person having it. When that feeling intrudes on the medical industry, it can end up having dire consequences for standard patient care. Pregnancy is one condition, beginning to end. It is exclusive to the female body. The symptoms of pregnancy cannot be divorced from the condition, and yet that is what the AMA is attempting to do. If we divorce pregnancy from structured medical care, we are reducing the pregnant woman to a series of treatments. The function of the woman's body becomes irrelevant. Is this purposeful? Perhaps the intention doesn't even matter when the outcomes are so potentially dire. Typically, we blame insurance companies for growing healthcare expenses and declining service. While the system does bear its own faults, in this particular case the pressure originates elsewhere. The change in billing codes is the work of the AMA, at ACOG's request, not the insurance market. This is the piecemealing of women's healthcare, and it will result in the piecemealing of their peace. 36% of adults under 50 already believe they can't afford to have a child. With the birth rates for native-born Americans at unprecedented lows, is now really the right time to make the process of bringing forth new life even more expensive and more stressful? You get more of what you incentivize, and if the reward for reducing pregnancy care to a series of conditions is more money, what happens to the incentive to grow families? It is already an expensive and arduous process when tied to the formal care industry. A Pew Research poll showed 36% of adults under 50 already believe they can't afford to have a child. Expenses vary, of course, depending on lifestyle, and having a family provides other advantages that outweigh any economic disadvantages. However, the added charges of unbundled pregnancy care will almost certainly do nothing to ease the financial burden associated with growing a family. America needs families. America needs children. Even were we to remain exclusively with the financial argument the AMA is making, fewer children in America means fewer customers, doctors, and medical staff in the future. American medical practitioners and their governing bodies should be making childbearing more accessible, not less. And with womanhood itself under attack daily, perhaps it is not the best idea to separate the journey of creating a life from the medical journey itself. Pregnancy is one whole process, beginning to end. It is not a separate process from the normal functions of a woman. Separating the charges for our care separates the very notion of quality care from the exclusivity of female care. In a day and age when women's rights are top of mind for many people, this sounds like a dangerous problem to foist upon our healthcare system.