Postpartum Care Denied by Insurance? Here's How to Fight Back

The postpartum period — the weeks and months after giving birth — is a critical time for maternal health. Postpartum depression affects 1 in 5 new mothers. Postpartum hemorrhage and infection are leading causes of maternal mortality. Yet insurance denials for postpartum care are strikingly common, often due to obscure billing rules that disproportionately disadvantage new mothers.

Here's what you need to know about your postpartum care rights and how to fight back.

The 90-Day Global Period Billing Problem

One of the biggest sources of postpartum billing confusion is the obstetric "global period." Under standard billing practices, prenatal and postpartum care is bundled together with the delivery into a single global fee. This global period typically covers:

• Antepartum visits from 4–6 weeks before delivery
• The delivery itself
• A single postpartum visit at 6 weeks

Here's the problem: if you need additional postpartum care within that 90-day global period — for example, a wound check, lactation support visit, or mental health screening — your provider may have already been paid a bundled global rate, and separate billing for those visits gets denied or reduced.

How to fight this: Ask your provider to unbundle the postpartum visits when clinically indicated and bill them separately with appropriate codes. ACOG now recommends postpartum care be delivered as an ongoing process with at least one contact within 3 weeks and comprehensive care at 6–12 weeks — not just the traditional single 6-week visit. Insurers should cover these medically necessary additional visits.

Postpartum Depression Screening

The USPSTF gives a B recommendation to depression screening for adults, explicitly including pregnant and postpartum women. Under the ACA, this means PPD screening must be covered at no cost-sharing.

Insurers sometimes deny or charge cost-shares for:

• Edinburgh Postnatal Depression Scale (EPDS) screening during a postpartum visit
• PPD screening at a pediatric well-child visit (where the mother's screening is increasingly standard practice)
• Referral to mental health care following a positive screening

If you were billed for PPD screening or had related mental health care denied, cite the USPSTF B recommendation in your appeal. Also check whether your state has its own PPD screening mandate — many states, including California, New Jersey, and Illinois, have enacted laws requiring coverage.

Postpartum Mental Health Treatment (PMAD)

Perinatal mood and anxiety disorders (PMADs) include postpartum depression, postpartum anxiety, postpartum OCD, and postpartum psychosis. These are serious medical conditions requiring treatment.

If your insurer denied:

• Outpatient therapy for postpartum depression
• Medication for PPD (e.g., brexanolone/Zulresso or standard antidepressants)
• Intensive outpatient or partial hospitalization for severe PMAD

...appeal on the basis of medical necessity. PMADs are well-defined psychiatric diagnoses under DSM-5. Your psychiatrist or OB can provide documentation. The Mental Health Parity and Addiction Equity Act (MHPAEA) also prohibits insurers from applying more restrictive criteria to mental health treatment than they would apply to comparable medical/surgical conditions.

Extended Postpartum Medicaid Coverage

The American Rescue Plan Act of 2021 gave states the option to extend postpartum Medicaid coverage from 60 days to 12 months. As of 2025, more than 45 states have adopted this extension.

If you are on Medicaid and your coverage was terminated at 60 days postpartum rather than 12 months, check whether your state has adopted the extension. If it has, your coverage termination may be a Medicaid eligibility error that can be corrected through an appeal or by contacting your state Medicaid office.

What to Do If Your Postpartum Visit Is Denied

Step 1: Determine if the denial is a global period issue. Ask your provider's billing department whether the denial is because services were bundled into the global obstetric fee. If additional visits are medically necessary, they should be billed separately with appropriate diagnosis codes.

Step 2: Verify PPD screening coverage. If your insurer charged you for a PPD screening, gather the EOB and file an appeal citing the USPSTF B recommendation for depression screening in postpartum women.

Step 3: Document PMAD treatment need. If postpartum mental health care was denied, have your treating provider document the DSM-5 diagnosis and the clinical necessity of the specific treatment sought.

Step 4: Check state postpartum Medicaid status. If on Medicaid, verify your state's postpartum coverage extension and contact your state Medicaid agency if your coverage ended prematurely.

Step 5: File an internal appeal within 180 days. Include all supporting documentation.

Step 6: Seek expedited review. Postpartum mental health crises may qualify for expedited 72-hour appeal review. Make the case for urgency explicitly in your appeal letter.

Key Takeaways

• The 90-day obstetric global billing period can suppress postpartum care claims; additional medically necessary visits can be appealed
• PPD screening is a USPSTF B-rated covered preventive service at no cost-sharing
• PMAD treatment denials may violate the Mental Health Parity Act
• Over 45 states now provide 12 months of postpartum Medicaid coverage
• Expedited appeals are available for urgent postpartum situations

Fight Back With ClaimBack

ClaimBack generates a legally grounded appeal letter for your postpartum care denial. We help you cite the right ACA provisions, USPSTF ratings, and state-specific laws so you can focus on recovery — not paperwork.

Start your free appeal at ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs. External Insurance Appeal: What's the Difference?