Maternity care
What is maternity care?
Maternity care is the term used to describe the various healthcare services received during a pregnancy. These often include, but not limited to:
- Prenatal office visits – During your pregnancy, you will have several office visits with your OB/GYN. For an uncomplicated pregnancy, you may expect approximately 13 office visits over the course of the pregnancy. There may be an additional initial visit to confirm the pregnancy before the prenatal visits begin.
- Ultrasounds – Your provider will conduct multiple routine abdominal scans through ultrasounds of your pregnant uterus. Generally, two or three ultrasounds are considered medically necessary – one to confirm pregnancy, one to assess fetal viability and heart rate, and one for a full body anatomic survey around 18-22 weeks. Each pregnancy is unique; Some pregnancies may warrant additional ultrasounds, and some OB/GYNs may conduct an ultrasound during every prenatal visit. Talk with your provider about what they recommend.
- Labs (blood tests and urinalysis) – Over the course of your pregnancy, your OB/GYN will recommend different labs. These could include:
- Complete blood count (CBC)
- Blood typing and Rh factor
- Urinalysis or urine culture
- HCG test
- STI test
- Additional prenatal tests as follow-ups or depending on risk factors
- Genetic testing – Depending on your risk factors, your provider may recommend genetic testing. These test the fetus for certain genetic disorders such as aneuploidy or other inherited disorders like sickle cell disease, cystic fibrosis, or Tay-Sachs disease. Generally, Sidecar Health considers prenatal genetic testing to be medically necessary in a single gestation pregnancy with positive first- or second-trimester screening results for aneuploidy. Please submit a pre-bill for additional review of your specific needs.
- Labor & delivery – On the day of your delivery, depending on which decisions you make with your healthcare provider, there are several different services you can expect to receive, including:
- Facility admission into a hospital or birthing center
- Professional delivery charges – either vaginal or C-section delivery
- Epidural and anesthesia
- Inpatient services provided after delivery or C-section
- Other miscellaneous services (insertion of cervical dilator, insertion of intravenous oxytocin, urinalysis, episiotomy, amniocentesis)
- Postpartum care – After delivery, routine outpatient postpartum visits for the mother within 6 weeks of delivery are often considered the last component of an overall maternity experience.
How will my OB/GYN bill me for these services?
The first thing to understand is the specific procedure codes your provider will bill you for. There are two main approaches that providers take to billing for maternity services.
- Global billing – Your provider may use a special type of medical billing code known as a “global obstetrical (OB) code” that bundles together many of the common services you will receive during your pregnancy. Generally, these codes include a set number of prenatal office visits, the professional charges related to labor and delivery, and any routine postpartum office visits. Note that these global codes do not include any of the ultrasounds, labs, genetic testing, or other labor and delivery costs (such as facility fees), as these would be billed separately. Global codes assume that the same provider delivers the baby that you saw for your prenatal and postpartum visits.
- Itemized billing – Instead of using a global OB code, your provider may choose to bill you individually for every aspect of your maternity care. In this case, you would receive a bill for each individual prenatal visit, the professional charges related to labor and delivery, and any routine postpartum office visits. Instead of paying for all those services together in one bundle, you would pay for them individually at the line-item level.
In addition to the specific codes your provider bills, they may ask for payment at various times during your pregnancy for the prenatal office visits and professional component of the labor & delivery. Your provider may bill you at each visit if they’re using itemized billing. If your provider is using global billing, they will likely ask you to pay the full global charge upfront or by a set date during your pregnancy.
What are my maternity benefits under my Sidecar Health plan?
Your plan’s Benefit Amounts are visible in the Sidecar Health member portal through Care search. Your Member Care team is available to help you navigate your benefits for each option. For more detailed information and to understand your benefits, please submit a pre-bill to Sidecar Health.
Note, the below medical codes (sometimes referred to a CPT, DRG, or procedure codes) are often included during maternity care, but services and procedures included vary from doctor to doctor. Maternity care is personal and there are many options you can work through in conjunction with your healthcare provider (including types of delivery). Ask your doctor what services will be included for the most information on how much your plan will pay.
Medical code |
Description |
59400 |
Global provider fee for vaginal birth |
99203 |
OB/GYN visit provider fee |
768, 796 – 798, 805 – 807 |
Hospital admission for vaginal delivery (specific code may vary) |
783 – 788 |
Hospital admission for Caesarean section without sterilization (specific code may vary) |
795 |
Hospital admission for full term newborn |
76801 |
Fetal ultrasound |
85027 |
CBC lab test |
86901 |
Rh blood typing lab test |
86900 |
ABO blood typing lab test |
84702 |
HCG test lab fee |
80307 |
Drug test lab fee |
87086 |
Urine culture lab fee |
87491 |
Chlamydia test lab fee |
87591 |
Gonorrhea test lab fee |
81420 |
Genomic testing in maternal blood lab fee |
Varies |
Epidural / anesthesia |
What should I remember when shopping for maternity care?
- It’s important when choosing your OB/GYN to understand what hospitals and delivery facilities they work with. This will help you get the most accurate estimate for prices and understand the total cost of your pregnancy.
- Birthing centers often bill the global provider fee included with the hospital admissions as a single bill. In the Sidecar Health member portal, you can see your birthing center benefits under the code "Provider fee for vaginal birth” with the type “Comprehensive through a birthing center”.
- Have a conversation with your OB/GYN about how they bill cash-pay patients for prenatal and delivery services.
- Understand what services your OB/GYN expects to provide over the course of the pregnancy (e.g., number of ultrasounds, genetic testing, types of labs).
- Be aware of what services are not included in the global OB code (like ultrasounds, labs, and genetic testing) and ask for specific prices for those items to compare against your Benefit Amounts.
- Submitting a pre-bill to Sidecar Health is the best way to get an accurate estimate of your Benefit Amounts – ask your provider for a detailed itemized estimate.