In January 2027, the way maternity care is billed in America will change more dramatically than it has in four decades. For employers navigating rising healthcare costs and a crowded benefits market, the shift from bundled to unbundled maternity billing represents both significant risk and strategic opportunity.

The change affects the most commonly used health service in America. Twenty-five percent of all hospitalizations involve either a mother or baby, yet despite this volume, outcomes continue to decline while costs escalate.

The mechanics of unbundling

For decades, maternity care operated differently from the rest of American healthcare. While most medical services follow an à la carte, fee-for-service model —labs, exams, and procedures billed as individual line items—obstetrics used a prix fixe approach. One global fee covered prenatal care, delivery, and postpartum visits, regardless of complexity or risk level.

"Training as an obstetrician, I only really had to know two codes," explained Dr. Neel Shah, Maven's senior advisor and chair of the scientific advisory board, during a recent webinar. "Was there a vaginal delivery or C-section? And I would check one of the boxes."

That system made sense when it was created. But care delivery has fragmented significantly since the 1980s. Technology has advanced. Risk profiles have changed. And the single bundled code became increasingly unpopular with physicians who argued they had to wait months to get paid and couldn't account for the vastly different resource needs of low-risk versus high-risk pregnancies.

"The argument that the president of ACOG told me was that they're the only profession that has to wait nine to twelve months to get paid," Shah noted. "And we have a challenge in our country that we don't have enough obstetricians, particularly in certain parts of the country. It was hard for them to stand up practices under a payment system where they take care of people for nine months to twelve months and then it led to cash flow challenges."

After years of lobbying, the American Medical Association's CPT panel voted to unbundle maternity care. And when Medicare and Medicaid adopt coding changes, commercial payers typically follow.

Why the change is happening now

The physicians who advocated for unbundling pointed to operational challenges. Solo practices and small groups struggled with cash flow when reimbursement arrived only after delivery. High-risk pregnancies requiring significantly more clinical time and resources were compensated at the same rate as routine, low-risk care.

To gain CMS approval, proponents had to argue the change would be cost-neutral. The only way to pay more for high-risk pregnancy while maintaining cost neutrality is to pay less for low-risk pregnancy. But that calculation assumes providers can identify risk levels at the first visit—an assumption that doesn't reflect clinical reality.

"When a patient walks into my office, I don't know if they're low risk or high risk for months," Shah said. That uncertainty is what creates the volatility employers and health plans are now racing to understand.

The cost implications for employers

When the comment period opened, the largest self-funded employers in the country, major purchaser coalitions, and health plans all raised concerns about cost increases and implementation complexity.

The speakers used a cable TV metaphor to help benefits leaders explain the change to leadership. Bundled cable and internet gave way to separate subscriptions for Apple TV, Hulu, HBO Max, and others. Consumers now pay more and manage more complexity. 

For fully insured plans, premium increases won't be immediate. Premiums reflect underlying total costs, and those costs depend on both price changes and utilization patterns—neither of which can be predicted with confidence until the new system is in operation. For self-funded employers, the impact will be more direct and visible in claims data, though the timeline remains uncertain.

What unbundling means on the ground

For providers, the change introduces operational complexity and financial risk. Rural practices that serve all patients in their community—unable to select for low-risk pregnancies the way a Manhattan practice might—face potential revenue hits of 20-30% if fee negotiations don't account for their patient mix.

Some may stop seeing pregnant patients altogether, choosing instead to focus on gynecology or shift to hospital employment where the institution absorbs the billing complexity. That trend, already accelerating year over year, would exacerbate access challenges in underserved areas.

For pregnant individuals and their families, the implications extend beyond billing codes. Maternity care is already the most expensive predictable healthcare event most Americans face. Even with insurance, patients typically exhaust their full deductible—often several thousand dollars—during pregnancy and delivery.

Unbundling introduces the risk of cost-sharing at each visit. Under the global code, patients knew they would pay their deductible, but the timing was predictable. With itemized billing, each prenatal appointment, lab test, and ultrasound could trigger a separate out-of-pocket cost.

"There's a difference for most people between paying money now and paying it later," Shah noted. "And there's a difference between having to pay it out in aliquots every time you go in—a little bit painful—as opposed to having to figure it out on the other end."

Research spanning half a century consistently shows that cost-sharing causes people to avoid care, meaning there may be cause for concern for maternal health outcomes.

The upside: better data, better accountability

Despite the risks and complexity, unbundling creates opportunities that didn't exist under the global code system. Granular service-level data will reveal what care is actually being delivered, when, and to whom. That visibility enables earlier identification of high-risk pregnancies and faster intervention.

"The old global codes were a barrier to that because we didn't have granular information about what's happening," Shah explained. "We build one code. Codes are the source of truth in what's happening, what got paid for, and then we would find out at the end of the day that a pregnancy happened."

With itemized billing, employers and health plans can see in real time which patients are receiving appropriate screening for gestational diabetes, which are getting adequate postpartum mental health support, and which may need additional resources. That information can drive accountability.

"You can't fix what you can't measure," Shah said. "And we can hold the right parties accountable to making sure the right care happens."

The new codes also create payment pathways for services that were undervalued or ignored under the global fee. Postpartum care is a prime example: More than half of maternal morbidity and mortality occurs after delivery, yet the standard of care has been a single fifteen-minute visit six weeks postpartum—a visit that only half of new mothers attend.

"Doctors will get paid for seeing people several times after they've had a baby, which is a good thing for everybody, including employers," Shah noted.

Similarly, the codes enable payment for postpartum mental health screening, lactation support, and other services that improve outcomes but weren't explicitly reimbursed under the bundled system.

Maven's approach

While the industry moves toward unbundling, Maven is continuing to offer maternity care with a flat case rate for every patient, regardless of risk level or service utilization.

"At Maven, we believe in bundles," Shah said. "We've gone out into the market and we've said we're going to have a flat case rate to take care of every person that we take care of. That's going to incentivize us to provide the right care. And then either people are better off at the end or not. And we're going to put fees at risk against those outcomes."

The outcomes Maven holds itself accountable for include C-section rates and NICU admission rates—both of which have risen dramatically without corresponding improvements in maternal or infant health. C-section rates have increased five hundred percent in Shah's lifetime. NICU rates have risen fifty percent. 

Payments aligned to outcomes create incentives to deliver the right care at the right time, rather than maximizing the number of billable services. 

Maven's model includes 24/7 access to the largest virtual care network for women and families in the country, covering preconception, fertility, pregnancy, parenting, and menopause for more than 27 million people. The platform uses real-time data from health information exchanges, wearables, and member interactions to identify risk early and intervene proactively.

That approach becomes more valuable in a fragmented billing environment. 

What employers should do now

Ask the right questions of health plan partners

Employers should engage their carriers and third-party administrators immediately to understand their implementation plans. Most carriers are still developing their strategies. The conversations happening now will shape contract negotiations and benefit design for 2027 and beyond.

Model the impact on your population

Employers can and should work with their carriers, consultants, and benefit vendors to model the expected cost impact based on their specific demographics and geography. A population concentrated in Arkansas will face different dynamics than one in New York City. A workforce with higher rates of high-risk pregnancy will see different cost trajectories than a younger, healthier population.

"Carriers can and should be able to help because they know the rates and they know the demographics," Shah said. "And consultants and even benefit vendors like Maven can work closely with you to help figure that out."

Evaluate benefit design and cost-sharing

Employers have the opportunity to structure benefits that minimize cost-sharing for preventive prenatal care, ensuring that financial barriers don't prevent patients from receiving appropriate screening and support.

Consider value-based maternity solutions

In an environment of increased volatility and rising costs, maternity benefits that take accountability for outcomes become even more valuable. Solutions that can operate on bundled payment models with fees at risk provide cost predictability and align incentives toward better health.

"What is table stakes in a world where there's more volatility and costs are likely to go up is a benefit solution for maternity that's taking accountability for the outcome and taking on risk," Shah said. "Full stop."

Maven's approach includes using granular data to provide ongoing, regular updates on population health trends and program performance. That faster feedback loop enables course correction and demonstrates value in real time.

Looking ahead

The unbundling of maternity billing represents a once-in-a-generation change to the most commonly used health service in America. The decision was made by physicians seeking to address legitimate operational challenges, but the implementation will create complexity, cost increases, and access risks that employers and health plans must navigate.

What is clear is that employers who engage proactively—asking the right questions, modeling population-specific impacts, and evaluating benefit solutions that take accountability for outcomes—will be better positioned to protect their workforce and manage costs through the transition.

This inflection point also creates opportunity. Better data enables better care. Payment for postpartum support can improve outcomes. And employers who choose benefit partners that maintain bundled, value-based approaches can insulate their populations from the volatility while driving accountability for the outcomes that matter most.

To learn more about how Maven's maternity care can support your workforce through the transition to unbundled billing, book a demo with our team today.

‍