The global billing model was designed in the 1980s, when maternity care looked very different. Since then, prenatal care has grown to incorporate ultrasounds, telehealth, specialized care teams, mental health screenings, and more intensive management of high-risk pregnancies. 

The flat bundled fee structure was never updated to reflect that evolution.

The AMA initiated this change with several goals in mind. The new coding system is designed to let physicians accurately report the care they actually deliver, while giving payers clearer visibility into how maternity care is being provided across populations. Three specific drivers shaped the case for restructuring:

Care has changed significantly. Services that are now standard practice in prenatal care simply did not exist when the global billing codes were created. Ultrasounds, telehealth visits, postpartum mental health screenings, and team-based care models all emerged after the payment structure was set.

Patient complexity has increased. More pregnant patients require intensive monitoring and management throughout pregnancy. A flat fee that pays the same regardless of clinical complexity does not reflect the actual care being delivered, particularly for high-risk cases.

Providers faced structural payment gaps. Delayed reimbursement, lost revenue when patients transferred providers mid-pregnancy, and no mechanism to bill for additional services pushed OB-GYNs and professional associations to advocate for a model that better reflects clinical reality.

Beyond correcting those gaps, the AMA has identified broader benefits the restructure is intended to support. Itemized billing creates more reliable data for quality tracking, risk adjustment, and population-level analysis. It also aligns coding with evidence-based practice, improves the ability to measure and attribute patient outcomes, and supports appropriate postpartum follow-up and intervention.

The shift to itemized billing introduces several financial risks for employees that did not exist under the global model.

Out-of-pocket costs may increase. Under the ACA, routine preventive prenatal care must be covered in full when delivered in-network. However, non-routine visits, such as those triggered by severe morning sickness, gestational diabetes management, or other pregnancy complications, will generate separate claims that count toward a deductible and may trigger cost-sharing.

Billing becomes harder to anticipate. With global billing, patients received a predictable single bill. Under unbundling routine visits and screenings may generate multiple separate charges throughout the pregnancy, with no easy way to project total out-of-pocket exposure in advance.

High-deductible health plan (HDHP) enrollees face compounded risk. Employees who are pregnant across two calendar years will reset their deductible mid-pregnancy, potentially facing significant out-of-pocket costs in the second year before meeting their new deductible.

When patients face unexpected costs, they are more likely to delay or skip recommended prenatal care. That creates downstream clinical and financial risk — for the patient and for the employer's health plan.

Delayed prenatal care is one of the strongest predictors of poor pregnancy outcomes. The clinical and financial consequences are well-documented:

1. Conditions like preeclampsia, gestational diabetes, and hypertensive disorders are difficult to detect and manage without consistent prenatal visits. Left undiagnosed, they become far more serious — and expensive — to treat.

2. Inadequate prenatal care is strongly associated with preterm birth and low birth weight, both of which significantly increase the likelihood of NICU admissions. NICU stays average $3,000 to $5,000 per day and represent some of the largest single claims events on employer health plans.

3. Maternal mortality risk also rises. The conditions most commonly linked to maternal death — hemorrhage, preeclampsia, and sepsis — are most manageable when identified early through consistent prenatal care.

Employers will feel the financial impact of unbundling in several ways, with the timing and magnitude depending on how the health plan is structured.

For self-insured employers, cost implications are likely to appear quickly. What was previously a single end-of-pregnancy claim will become dozens of itemized charges throughout the year. Administrative claim volume will increase, TPA (third-party administrator) processing fees will rise, and there is no longer a built-in cost ceiling for complex, multi-visit pregnancies. Cash flow will also be affected as charges arrive continuously rather than in a predictable, post-delivery lump.

For fully insured employers, the near-term exposure is more limited, but costs will still surface. Insurers absorb the claim-by-claim impact in the short term, but higher administrative costs and increased claims volume will be reflected in premium increases at plan renewal.

It may. More than 35% of U.S. counties already have no OB-GYN or midwife, and hospital obstetric unit closures have been accelerating — particularly in rural and lower-income communities. The billing complexity that comes with unbundling will place a significant administrative burden on smaller and independent practices. That could accelerate consolidation or closure among the providers least equipped to manage the transition, worsening access in areas that are already underserved.

There are three practical steps employers can take now, before the change takes effect.

Identify maternity benefits that already exist in your health plan.

Many health plans include maternity-related benefits that are rarely promoted and often unknown to employers and employees alike. These can include in-network coverage of certified nurse-midwives, doula reimbursement, and more.

Value-added partnerships through the health plan, such as virtual prenatal care platforms, may also exist without being actively communicated to benefits leaders and plan members.

Uncovering and activating these benefits costs nothing and can meaningfully reduce the financial exposure employees face under the new billing structure.

Engage your broker now, before plan design decisions are locked.

The 2027 change creates a clear opening to revisit benefit design with an eye toward both cost management and employee protection. 

Examples include engaging your broker with questions around potential out-of-pocket costs for  typical pregnancy care under this change, or understanding whether or not doula coverage is available.  

Communicate maternity benefits clearly to employees.

Benefits that employees do not know about provide no value — and can actually increase costs if employees defer care because they assume it will be unaffordable. A clear, accessible communication strategy is one of the most effective and lowest-cost actions an employer can take right now.

RMH Compass publishes performance standards and benchmarking data for employer reproductive and maternal health benefits. We work directly with employers to prepare for the 2027 billing transition across all three areas outlined above.

For identifying hidden benefits, RMH Compass audits health plan coverage to surface maternity-related benefits that exist but are not documented or communicated to plan members.

For broker engagement, we provide the analytical foundation and structured questions employers need to evaluate their current plan design and make informed decisions before the change takes effect.

For employee communications, RMH Compass offers Pathfinders, a consolidated resource that outlines all available maternity-related benefits, provider options, virtual care access, mental health support, and more in one place for your people.