The invisible invoice: Estimating maternity unbundling costs
Starting January 1, 2027, maternity care stops being billed as a single global code and starts being billed line by line — labor and delivery, prenatal and postpartum visits — each itemized and priced on its own.
Why this actually matters
In an early look at claims data, roughly 80% of members will see some kind of line-item impact from unbundling, affecting approximately 10% of their total maternity spend.
As employers work to understand the impact unbundling will have on their own populations, an early estimate of unbundling’s impact may increase the maternity code bundle by 5-10%, based on unbundling trends across healthcare. While this may not seem like a seismic shift, maternity is typically in the top three areas of spend for an employer, meaning small impact can have a meaningful effect.
Even more important is taking a holistic view of management of this huge cost center, by understanding what drives your spending and how to lower those risks.
What unbundling will do
Puts a price tag on line items that were already happening, which may cause small shifts in billing, coding, and care delivery.
What actually drives cost
High-risk pregnancies and NICU stays. It's the one part of this equation that's still in an employer's control, before the claim exists, not after.
“What are we doing about the high-risk pregnancies driving total maternity costs?”
And how do we use the transparency these coding changes provide to better understand and manage our population?
Walk through what actually happens to the cost of a pregnancy under three models: the bundled system most plans run today, the unbundled system, and when a managed clinical model is layered on top.
Calculate the invisible invoice
Pick a scenario below to see how the math changes and impacts your bottom line.
Choose your scenario:
Watch the bundle come apart
Starting January 1, 2027, maternity billing splits into itemized charges. We modeled what that split could cost your organization — bundled, itemized, and with Maven’s clinical model in place.
Standard Delivery
An uncomplicated, full-term vaginal delivery — no NICU stay, no major complications. This is the pregnancy most cost models are built around, and the one most likely to understate what’s coming under itemized billing.
Under the current global billing code, prenatal care, delivery, and postpartum follow-up are paid as a single package rate — one line on the claim.
Global maternity care — prenatal care, ~13 routine visits, delivery and postpartum, all under one code
Starting January 1, 2027, that same care is billed as three separate phases. The total doesn’t automatically go up — it depends on how closely billing tracks guideline-recommended care.
Likely 5–10% increase from bundled code
Maven’s clinical model is built around ACOG-aligned care pathways — the same standard itemized billing now prices against. Maven’s role isn’t to beat the itemized total on paper; it’s to keep this pregnancy in the low-risk, low-cost category in the first place.
- 2:1 clinical ROI on near-term medical cost savings
- 4:1 total business ROI, incl. productivity + RTW gains
- Up to $9,600 saved per birth
- Up to 27% lower NICU admission rates
- Up to 15% lower C-section rates
Validated across 25,000+ pregnancies in independent, claims-based analyses.
High-Risk Pregnancy
A pregnancy involving a NICU admission, extended maternal complications, or both. This is a small share of pregnancies that can drive a disproportionate share of claims cost.
Maternal health factors
Pre-existing or pregnancy-related conditions: hypertension or preeclampsia, gestational diabetes, obesity, autoimmune conditions, advanced maternal age (35+), or a prior C-section/complicated delivery.
Pregnancy-specific factors
Things that emerge during this pregnancy: multiples (twins/triplets), placental issues, preterm labor risk, or a fetal growth or anatomy concern flagged on imaging.
Situational/access factors
Late or inconsistent prenatal care, conception via fertility treatment (which independently raises multiples and preterm risk), or limited access to maternal-fetal medicine specialists.
How unbundling will impact this: The same changes apply as a standard delivery, alongside the costs for C-section and NICU stays. This is where your costs start to snowball.
Prenatal care, ~13 routine visits, delivery and postpartum, all under one code (C-section bundle).
Global maternity care — prenatal care, ~13 routine visits, delivery and postpartum, all under one code
(Source: KFF Health System Tracker)
(Source: Nationwide Children’s Hospital, Jan 2022)
Starting January 1, 2027, that same care is billed as three separate phases. The total doesn’t automatically go up — it depends on how closely billing tracks guideline-recommended care.
(Source: KFF Health System Tracker)
(Source: Nationwide Children’s Hospital, Jan 2022)
Likely 5–10% increase from bundled code ($250 – $501 more)
Where the real savings are: preventing maternal complications. Here’s how:
Maven’s care model doesn’t wait for a complication to happen — it works to prevent one. High-risk members are proactively enrolled in dedicated coaching.
- 40% lower risk of NICU admission (with birth planning)
- 67% lower risk of preterm birth (with birth planning)
- 39% lower NICU risk (with childbirth education)
- 44% lower preterm birth risk (with education)
- 15% lower C-section risk (with doula support)
Fewer complications means fewer of the high-cost claims that itemized billing will now make visible line by line — which is where the savings actually come from.
Go deeper with Maven’s fertility resources
Maternity care unbundling FAQ
Webinar: The End of Bundled Maternity Care
The maternal health benchmarks for high risk pregnancy
A high-impact approach to high-risk pregnancies
Countdown to Unbundling: What You Need to Know for 2027
Gwinnett County: stronger wellbeing with Maven
The million dollar blind spot
Want to understand the impact a program like Maven can have for your population?
Whether you ran the numbers, read the FAQ, or you’re just catching up on the January 2027 changes — we can walk through your specific exposure in about 30 minutes.
Maven’s fully managed platform is built for exactly that. We help you meet IVF mandate requirements, support employees through every path to parenthood, and keep costs in check — because 30% of Maven members conceive without ever needing treatment, and integrated maternity care drives 27% lower NICU rates and 15% fewer C-sections. That’s up to $9,600 in savings per birth, one platform, and a benefit your employees will actually use.