High-Deductible Plans May Increase Patient Costs for Maternity Care

Family planning takes on a whole new dimension for physicians who work with couples with high-deductible, consumer-driven health plans, or CDHPs, according to a June 12 study by the Georgetown University Health Policy Institute and Kaiser Family Foundation.

That's because -- depending on their CDHP -- patients may need to plan for their financial obligations to physicians, laboratories and hospitals for maternity care as carefully as they plan the spacing of their children. The study found couples with CDHPs could be financially liable to their physician for up to 82 percent of their prenatal and delivery costs depending on their plan.

The study, "Maternity Care and Consumer-Driven Health Plans," (PDF file: 46 pages / 1 MB. More about PDFs.) compared out-of-pocket expenses for maternity care under traditional health plans and CDHPs. The results show that families with CDHPs pay more out-of-pocket expenses for maternity care under most scenarios, but planning for those expenses can be difficult, given the complexity of the plans and the unpredictability of pregnancy.

"This study finds that families can expect substantial financial liability for the cost of maternity care under CDHPs, although for any given plan, anticipating out-of-pocket cost liability is difficult to predict, even in the best of circumstances," the report authors write. "Unanticipated medical complications, timing over a calendar year and network participation of providers all make a tremendous difference in costs and are not easy to control or predict, even for the savviest health care consumers."

The study compared out-of-pocket expenditures for three maternity care scenarios under traditional insurance and various high-deductible, CDHPs. Results indicated that families would owe

The results reflect CDHPs' high deductibles, co-insurance requirements and limited definitions of a covered service, study authors said. The study's implications should raise caution flags to families -- and the physicians who care for them, said the authors.

For example, most CDHPs do not consider prenatal care as a covered preventive health service and, therefore, subject those services to cost sharing. Although such expenses can be paid through a patient's health savings account, or HSA, they still may put a dent in a family's overall budget, given the current annual tax-free contribution limit of $5,650 for HSAs.

"A pregnancy can easily wipe out several years of savings and leave families exposed to future costs for other health needs," the report says.

Study authors call for greater transparency in CDHP contracts so both patients and their physicians can anticipate out-of-pocket expenses.

"Given low rates of health literacy in the general population, it may not be practical to expect consumers to understand and compare so many, often hidden, health plan features and complex rules," the authors say. "Overwhelmed by complexity, consumers are more likely to focus on recognizable plan features (such as deductibles) and make assumptions about their insurance protections without regard to other important factors (such as what expenses count toward deductibles)."

Family physicians who provide maternity care can help ensure they are paid for their services with a few proactive policies, according to "Consumer Directed Health Care," (PDF file: 20 pages / 144 KB. More about PDFs.) a paper developed by the AAFP to discuss the impact of CDHPs on physician practices. The AAFP advises members to familiarize themselves with the terms of CDHP contracts. FPs need to find out whether these contracts permit them to collect copayments and co-insurance at the time of service or if they require that physician claims be filed and processed before the patient is billed.

"Practices can likely expect their billing and collection costs to increase for high-deductible health plans due to an additional need for statements and collection phone calls," the paper says. "Patients may not have accrued enough monies in their personal health savings account to pay for the provided services. Then, patients have to decide if and/or how much they will pay the physician for the already provided medical care. Will the practice make arrangements with a credit organization to assist patients with payment issues to fulfill their financial obligation with the practice? With the HDHPs shifting the upfront financial burden to the consumer, the result is a great potential for an increase in physicians’ bad debt expenses."

In addition, if a patient's CDHP considers a prenatal or maternity service "non-covered," FPs should ask the patient to sign an advanced beneficiary notice and request to not bill the insurance carrier. Why? Although the insurance carrier won't cover the code, it may apply a discount to the code, thereby obligating the patient to pay only the contracted rate rather than the billed rate.