Why Do Health Plans Offer Free Prenatal Programs? So They Can Justify Charging Thousands for High Risk Cases & Ignoring Everyone Else!

One of the most frequent responses we receive from prospects is that they already have a prenatal program through their healthcare provider. Well, let me provide a little insight into health plan-delivered prenatal care--quite bluntly, it is inadequate and in most cases, a complete misnomer.

Ultimately, your health plan wants to reduce its care costs--that's the rationale behind prenatal programs. It's not an altruistic endeavor, it's a financial strategy. However, rather that address the entire maternity population, health plans choose to focus on recruiting enrollees who exhibit or are susceptible to developing high-risk criteria.

The goal is to prevent preterm births, low birth weight babies and the onset of conditions such as gestational diabetes that require costly, long-term care and maintenance. When an enrollee demonstrates high-risk characteristics, the full court press is on--the health plan will call that mom repeatedly to encourage her enrollment in the high-risk prenatal program. Then, they'll charge the employer a premium for the high-risk case management--in most cases, amounting to thousands of dollars per individual for that service.

But what if an employee does not meet high-risk criteria? Well, that's where things become interesting. Typically, the health plan will do nothing--no phone calls, no e-mail, no invitation to enroll in the prenatal program. In many cases, it is up to the enrollee to proactively research the availability of a prenatal program. For that, they will receive some brochures, perhaps a book, and access to a Web site with an encyclopedic catalog of medical information.

At the end of the day, the vast majority of pregnant employees within the corporate environment are ignored by their health plan--many are altogether unaware of the existence of a prenatal program, and those that do encounter health plan-delivered programs find them woefully inadequate. And don't count on a physician for prenatal health education--they are overbooked, overworked, undermotivated and unable to provide little more than a brief check-up.

Yet, published studies show that prenatal health education within the general maternity population can deliver a significant ROI--a savings of $3-$5 for every dollar spent. While your health plan might have bigger fish to fry, that’s a significant ROI for employers, for whom maternity-driven expenses can account for as much as 49 percent of total healthcare costs.