Photo: AP

Recently, I talked to women about what it was like to be pregnant and uninsured. Shortly after my story was published, Reyhan Harmanci, an editor over at Topic, mentioned that she was billed a little over $6,000 for services rendered during her hospital stay. The bills were in her recently delivered infant’s name:

The idea that a brand new person would begin racking up hospital bills only seconds into their existence struck me as a pretty dark quirk in the system. But apparently, it happens a lot. There are frantic posts about it on new mom message boards all over the internet: About $5,000 charges for “newborn nursery” services billed to the baby when it never left the hospital room, or surprise charges to infants women thought were covered under their policies.

One father I spoke to sent me a $200 bill for the time his newborn apparently chose an out-of-network provider while his wife, exhausted after labor, was sound asleep.

Because the transmissions between patients and hospitals and insurance companies are so complicated—and because a parent with a newborn probably doesn’t have receipts at the forefront of their mind—there isn’t even much consensus about when this kind of thing happens. Healthcare policy experts I spoke to had “never heard about” infant billing, and a handful of women’s healthcare advocacy groups referred me elsewhere. Three of of the country’s top medical billing advocate firms (we live in a country where third parties that help people navigate their hospital bills are part of a rapidly growing industry) declined to explain this practice to me.

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Adam Nicolai, who worked in insurance for more than a decade, told me that he remembered separate billing as being very common. “It seemed weird to me too until I realized the newborn is (of course) another human being,” he wrote in an email, “receiving their own distinct services, so the hospital treats them as a separate patient.” Usually, he says, the baby’s charges were applied to the new mother’s policy. Which is what happens most of the time. States have individual rules about how long an infant must be covered under a mother’s policy. ACA plans usually kick in immediately, and most private insurers are required to cover a child for the hospital stay during a normal birth, even if the bills are filed under separate names.

But because our healthcare billing systems are so complex they feel like a vast and nefarious conspiracy against anyone who ever needs to see a doctor, and because a woman’s ability to bear a healthy, debt-free child is something of a privilege, some infants do fall through the cracks. Kate Ende, an advocate at the Maine-based Consumers for Affordable Health Care, said she’d recently come across a problem: A woman in her early 20s had a kid while still covered by her parent’s employer-sponsored health plan. The plan may have applied to children, but grandchildren were certainly out of the question. The family went home with thousands of dollars of medical bills bearing the newborn’s recently christened name.

Ende is good at her job. When the panicked family called her, she helped them get on Medicaid. They had received bad information from a local Health and Human Services representative, who had told them there was no way they would qualify—another common failure, considering one-fifth of uninsured American women could be on Medicaid, but aren’t.

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That newborn babies, as separate entities, start getting charged the second they exit the womb isn’t the most counterintuitive hospital policy I’ve encountered. That so few women know to anticipate these bills, and the way they’re delivered, is a symptom of an incomprehensible network that takes advantage of patients’ relative ignorance. And all those bills stacking up right after a delivery are good reminders of how financially difficult having a child in America is. Since these children are minors, they aren’t responsible for the bills: The parents, or often just the mother, are. And if the debt was left unpaid for 18 years, it would take the sneakiest collections agent to twist the law and try to recoup that money. (Not that collections agents don’t use vile and illegal tactics all the time.)

Earlier this month, when I spoke to women who were uninsured and pregnant, many of them blamed the unexpected bills on themselves. Considering how few people were readily available to give me a straight answer about a common hospital policy, it’s no wonder so many new mothers go through a pregnancy—and its aftermath—feeling so baffled and alone.