What Nobody Tells You About How Hospital Billing Works

At Medallion, we talk a lot about reducing administrative friction in healthcare. But what does that actually mean for patients? Our VP of Marketing Lauren Mitri Abalos put it in her own words — drawing on her own experience navigating maternity care in rural America. Originally published on her LinkedIn, we're sharing it here because the conversation is too important to keep in one place.‍

After my last piece, the messages came in fast. Different hospitals, different states, same story — unexpected bills after carefully planned deliveries, NICU stays that came with invoices no one warned them about, families doing everything right and still ending up on the phone with billing departments weeks after coming home with a newborn.

I wasn't surprised. But I was reminded, again, that this isn't a niche problem. It's the norm.

So here’s the part I didn't get to yet.

I knew going into my second delivery that the bills would be complicated. I learned that the hard way with my first. So I started calling three months before my due date.

I called insurance first and asked them exactly what questions I needed to bring to the hospital to confirm who would be in-network. Then I called the hospital. Then back to insurance with what I'd learned. Then back to the hospital again. Two or three rounds of calls, across two organizations, just to understand what I'd owe before I ever walked through the door.

I share that not to complain, but because I want to be honest about what "being a prepared patient" actually requires in this system. It requires time, persistence, and knowing which questions to ask, which most people only learn after getting burned once.

And even after all of that, here's what a single delivery generated: Four bills. One hospital stay.

• A bill from my OB's office: my physician's fee for delivering my baby.
• A bill from the hospital facility: the room, the medication, the baby's bassinet, the IV line.
• A bill from the OB on-call: not my doctor, not a hospital employee, but a physician from another OB group who held privileges at that hospital, was pulled into my delivery, and billed independently.
• And the anesthesiologist: if you read my last piece, you know how that one went.

According to a 2025 Peterson-KFF report, the average out-of-pocket cost for pregnancy and childbirth is $2,743 for patients with employer health insurance, and that assumes everything goes smoothly. Multiple bills for a single stay is standard. Most women just don't know that until it happens.

And then we had the pediatric bills.

Every day for the first ten days home, we were at our pediatrician's office for jaundice testing. After seven days, the numbers concerned our doctor enough that she sent us to the emergency department

Two more bills. One from the ED. One from the pediatric physician group contracted into that ED — not employed by the hospital, but privileged to practice there.

Two invoices. For one visit. For a ten-day-old.

Emergency doesn't come with a network directory. You go. You have to.

Here's what I didn't understand — and what I've realized most people never get to learn.

I work in healthcare technology. I spend my days thinking about provider operations. And I still didn't fully connect the dots until I was living it for the second time.

Credentialing, privileging, and payer enrollment are three entirely separate processes. And the gap between them is where patient billing breaks down.

1. Credentialing verifies that a provider is qualified to practice.
2. Privileging authorizes them to perform specific procedures at a specific facility.
3. Payer enrollment registers them as in-network with a specific insurance plan.

You can be credentialed. You can be privileged at a hospital. And still not be enrolled with a patient's insurance plan. Which means a provider can walk into a delivery room, do their job, and still generate an out-of-network bill — through no fault of the patient, and often through no fault of the provider either.

That's not a hypothetical. That's what happened in my delivery room.

And it's what happens to roughly 1 in 5 families who deliver at an in-network hospital.

The No Surprises Act was designed to protect patients from the worst of this — and it has helped. But it doesn't resolve the underlying coordination problem: a provider can be privileged at a facility and still not be enrolled with your specific plan, and no federal law closes that gap automatically.

Some of the organizations on those bills I received are Medallion customers. Others are ones we’ve sat across the table from. None of them are bad actors. But, managing credentialing, privileging, and payer enrollment across hundreds of providers, multiple facilities, and multiple payers is hard. And when it falls behind, patients end up holding the gap.

That's what Medallion is built to address. Not the insurance pricing model. Not CPT code policy. But the operational layer that determines whether a provider is enrolled and in-network before they walk into a room with a patient.

I want to be clear: I am fortunate. I have good insurance. I had the time and persistence to make those calls two months out. Most of what I owed was covered.

But we shouldn't have to wonder, mid-contraction, whether the epidural is covered. We shouldn't have to decode a pediatric ED bill while our newborn is under a bilirubin lamp.

If you've been there — welcome to a club nobody asked to join. And if you're on the other side of this, building and managing the systems that touch these moments: this is what it feels like from here.

Medallion can't fix the insurance system. But we can shrink the gap between a provider being qualified and a provider being enrolled, so the billing that follows a delivery reflects what patients were actually promised when they chose that hospital.

The work we do is operational. The reason it matters is personal.