q253 ph casino EAGAN, Minn. (AP) — Sam Darnold pinballed around his collapsed pocket to dodge a sack on third-and-8, before slicing through a skinny opening to sprint right in search of more space as Justin Jefferson’s hand shot up downfield. Darnold let rip an on-the-run throw that sailed 45 yards in the air and straight into Jefferson’s arms, where he was stunningly wide open inside the 10. He danced his way into the end zone to give the a 21-13 lead, the harbinger of a fourth-quarter surge . “I’m not going to tell you what I told him in regards to my opinion on how many guys make that throw,” coach Kevin O’Connell said with a smile. The 42-21 decision on Sunday not only gave the Vikings (11-2) their sixth consecutive victory but further validated their decision to let Kirk Cousins leave in free agency for a cheaper replacement. With O’Connell directing the quarterback development program and calling the plays and Jefferson leading a dangerous and diverse group of pass-catchers, Darnold has finally found a place he can thrive in after such an environment had long eluded the third overall pick in the 2018 draft — even in this roundabout way after the season-ending injury to rookie J.J. McCarthy. Factor in a defense that’s allowing only 18.5 points per game, sixth best in the , and leads the league in interceptions (20), and these Vikings are going to be a tough team to outscore in the playoffs. Darnold became the ninth quarterback in NFL history and the first since Aaron Rodgers in 2019 to hit these benchmarks in a game: at least 325 passing yards, five touchdown passes, a 75% completion rate, no interceptions and a 155-plus passer rating. Jefferson and Jordan Addison combined for 15 catches, 265 yards and five scores. “This is definitely the ball that we want to play every single game,” Jefferson said. “Just the energy, the tempo that we had, just going out there and executing the plays.” None more spectacular than that on-the-run from Darnold to Jefferson, who started the play in motion from left to right into a three-man bunch with Addison and Jalen Nailor to set up a favorable matchup with nickel cornerback Dee Alford. Addison ran a clear-out route toward the opposite corner, initially drawing the attention of three defenders. Pro Bowl safety Jessie Bates, who was in a single-high alignment while the other Pro Bowl safety Justin Simmons blitzed, diverted from Addison toward an uncovered Nailor on the other side while ignoring Jefferson streaking behind him. Cornerback Clark Phillips left Nailor to try to catch Jefferson, who’d blown by Alford. “He absolutely cooked the dude on the route,” Darnold said. The Falcons couldn’t have played their coverage worse, leaving three receivers open, but that’s the type of stress the Vikings can put on a defense with the way Darnold is throwing the ball. “We already knew what he was about once we got him on our team, that he could throw any pass,” Addison said. “He’s just put it on display for everybody else.” What’s working Though Darnold has been sacked 40 times this season, he has the athleticism and instinct to extend plays and find one of his tough-to-cover receivers on longer-developing routes even if pressure comes. What needs help The Vikings have allowed their two highest rushing yardage totals of the season in the last two weeks for an average of 4.95 yards per attempt, a trend worth watching for a defense that still ranks second in the NFL against the run. Their final two games against division rivals Green Bay and Detroit will pit them against two of the top five rushing teams in the league. Stock up Rookie Jalen Redmond made his first career start and played 39 of 74 snaps, the most among the interior defensive linemen, and had two tackles for loss and two deflected passes at the line. One came on a third-and-goal throw by Cousins that forced Atlanta to settle for a short kick right before halftime. Redmond went undrafted last year out of Oklahoma, was released by Carolina during the preseason and played this spring in the United Football League. Stock down Will Reichard made all six extra point attempts in his return from a four-game absence to let a quadriceps strain heal, but his only field goal try from 47 yards in the third quarter clanked off the left upright. Injury report CB Stephon Gilmore (hamstring) and backup OLB Patrick Jones (knee) were held out on Sunday. LB Ivan Pace (hamstring) must miss at least two more games. Key number .660 — O’Connell’s winning percentage at 31-16 during the regular season is the highest in Vikings history, ahead of (.621). He’s fourth among active NFL coaches, trailing Nick Sirianni (.703), Jim Harbaugh (.682) and Matt LaFleur (.677). Up next The Vikings finish their three-game homestand next Monday night against Chicago (4-9), three weeks after beating the Bears 30-27 on the road in overtime. The Vikings have a two-game edge on the Packers for the first NFC wild card, the No. 5 seed, and will clinch a spot in the playoffs with one more win or one more loss by the Los Angeles Rams, who were the last team to beat them on Oct. 24. The tiebreaker outlook in the NFC North, however, will likely require an additional loss by the Lions (12-1) in the next three games, even if the Vikings were to win their next three, to set up a division title game on the final weekend at Detroit. ___ AP NFL:

ISLAMABAD -- Pakistan has sealed off the capital, Islamabad, ahead of a planned rally by supporters of imprisoned former premier Imran Khan . It’s the second time in as many months that authorities have imposed such measures to thwart tens of thousands of people from gathering in the city to demand Khan’s release. The rally is planned for Sunday. The latest lockdown coincides with the visit of Belarusian President Alexander Lukashenko to Islamabad on Monday. Local media reported that the Interior Ministry is considering a suspension of mobile phone services in parts of Pakistan in the coming days. On Friday, the National Highways and Motorway Police announced that key routes would close for maintenance. It advised people to avoid unnecessary travel and said the decision was taken following intelligence reports that “angry protesters” are planning to create a law and order situation and damage public and private property during Sunday's planned rally. “There are reports that protesters are coming with sticks and slingshots,” the statement added. Shipping containers in different colors, a familiar sight to people living and working in Islamabad, reappeared on key roads Saturday to throttle traffic. Pakistan has already banned gatherings of five or more people in Islamabad for two months to deter Khan’s supporters and activists from his Pakistan Tehreek-e-Insaf party, or PTI. Authorities have also installed containers to block highways and roads linking the PTI strongholds of Punjab and Khyber Pakhtunkhwa to stop people reaching Islamabad. Ali Amin Gandapur, the chief minister of Khyber Pakhtunkhwa, said he would lead the march from the northwest and that arrangements had been made to remove hurdles and blockades. Khan has been in prison for more than a year and has over 150 criminal cases against him. But he remains popular and the PTI says the cases are politically motivated. A three-day shutdown was imposed in Islamabad for a security summit last month.Stocks wavered on Wall Street in afternoon trading Thursday, as gains in tech companies and retailers helped temper losses elsewhere in the market. The S&P 500 was down less than 0.1% after drifting between small gains and losses. The benchmark index is coming off a three-day winning streak. The Dow Jones Industrial Average was up 6 points, or less than 0.1%, as of 1:52 p.m. Eastern time. The Nasdaq composite was down less than 0.1%. Trading volume was lighter than usual as U.S. markets reopened after the Christmas holiday. Chip company Broadcom rose 2.9%, Micron Technology was up 1% and Adobe gained 0.8%. While tech stocks overall were in the green, some heavyweights were a drag on the market. Semiconductor giant Nvidia, whose enormous valuation gives it an outsize influence on indexes, slipped 0.1%. Meta Platforms fell 0.7%, Amazon was down 0.6%, and Netflix gave up 1.1%. Tesla was among the biggest decliners in the S&P 500, down 1.9%. Health care stocks helped lift the market. CVS Health rose 1.7% and Walgreens Boots Alliance rose 3% for the biggest gain among S&P 500 stocks. Several retailers also gained ground. Target rose 2.8%, Best Buy was up 2.2% and Dollar Tree gained 2.7%. Retailers are hoping for a solid sales this holiday season, and the day after Christmas traditionally ranks among the top 10 biggest shopping days of the year, as consumers go online or rush to stores to cash in gift cards and raid bargain bins. U.S.-listed shares in Honda and Nissan rose 4% and 16%, respectively. The Japanese automakers announced earlier this week that the two companies are in talks to combine. Traders got a labor market update. U.S. applications for unemployment benefits held steady last week , though continuing claims rose to the highest level in three years, the Labor Department reported. Treasury yields turned mostly lower in the bond market. The yield on the 10-year Treasury fell to 4.57% from 4.59% late Tuesday. Major European markets were closed, as well as Hong Kong, Australia, New Zealand and Indonesia. Trading was expected to be subdued this week with a thin slate of economic data on the calendar. Still, U.S. markets have historically gotten a boost at year’s end despite lower trading volumes. The last five trading days of each year, plus the first two in the new year, have brought an average gain of 1.3% since 1950. So far this month, the U.S. stock market has lost some of its gains since President-elect Donald Trump’s win on Election Day, which raised hopes for faster economic growth and more lax regulations that would boost corporate profits. Worries have risen that Trump’s preference for tariffs and other policies could lead to higher inflation , a bigger U.S. government debt and difficulties for global trade. Even so, the U.S. market remains on pace to deliver strong returns for 2024. The benchmark S&P 500 is up roughly 26% so far this year and remains near its most recent all-time high it set earlier this month — its latest of 57 record highs this year. Wall Street has several economic reports to look forward to next week, including updates on pending home sales and home prices, a report on U.S. construction spending and snapshots of manufacturing activity. AP Business Writers Elaine Kurtenbach and Matt Ott contributed.

Lucknow: The BJP won Ghaziabad, Khair and Phulpur assembly seats while the Samajwadi Party bagged Sishamau and Karhal in the Uttar Pradesh bypolls, results of which were announced on Saturday. The ruling BJP is leading in three of the nine seats for which bypolls were held on November 20 and its ally RLD is ahead in one, according to the Election Commission (EC). BJP’s Phulpur candidate Deepak Patel defeated his nearest rival and Samajwadi Party (SP) nominee Md Mujtaba Siddiqui by a margin of 11,305 votes. Patel got a total of 78,289 votes, the EC website showed. In Ghaziabad, BJP’s Sanjeev Sharma defeated his nearest rival and SP candidate Singh Raj Jatav by a margin of 69,351 votes. Sharma got a total of 96,946 votes. In Khair, BJP’s Surender Diler got 1,00,181 votes and defeated SP’s Charu Kain by a margin of 38,393 votes. The SP retained Sishamau and Karhal assembly seats, according to the EC. In Karhal, SP’s Tej Pratap Yadav defeated BJP’s Anujesh Pratap Singh by a margin of 14,725 votes. Yadav got a total of 1,04,304 votes. Karhal assembly seat was vacated by SP president Akhilesh Yadav after he was elected to the Lok Sabha from Kannauj. In Sishamau, SP’s Naseem Solanki defeated BJP’s Suresh Awasthi by 8,564 votes. Solanki secured 69,714 votes while Awasthi got 61,150. The Bahujan Samaj Party’s (BSP) Virendra Kumar was a distant third with 1,410 votes. Solanki’s husband Irfan won the seat in 2012, 2017 and 2022. The Sishamau bypoll was necessitated after Irfan was disqualified from the assembly following his conviction in a criminal case.

DULUTH — Friends and colleagues took to social media to remember Mary Murphy upon the news of her death on Wednesday, Dec. 25. Murphy was the longest-serving female legislator and second-longest-serving member of the Minnesota House. Murphy died at the age of 85 on Christmas Day, just days after suffering a stroke . ADVERTISEMENT House Speaker Melissa Hortman (DFL-Fridley) announced Murphy’s death in a post on Facebook, which read: “She was a wonderful state representative and human being. So many people will miss her, and remember her and her accomplishments fondly.” “Mary was in so many ways ahead of her time and was often the only woman at the table in northern Minnesota,” U.S. Sen. Amy Klobuchar said in a statement. “That’s changed now thanks to her trailblazing legacy.” Murphy was first elected to serve House District 14B from 1977-1982 and went on to serve District 8A from 1983-2002, District 6B from 2003-2012 and District 3B from 2013-2022. In 2022, Murphy lost the District 3B race against Republican Natalie Zeleznikar by a mere 33 votes. Zeleznikar, who retained the seat in the 2024 election, expressed condolences in a Facebook post, writing: “Mary worked hard for northern Minnesota, a place she called home her entire lifetime. Her dedication, service and hard work can be witnessed in multiple projects across the communities she served. I was honored to know her, and work with her on senior care issues during my nursing home administrator years.” A Hermantown High School graduate, Murphy earned a bachelor's degree in history and economics from the College of St. Scholastica and attended graduate school at multiple universities. Before retiring from the classroom in 1997, Murphy also served as a history and social studies teacher at Central High School in Duluth for more than three decades, a career Klobuchar cited in her tribute. ADVERTISEMENT “As a former teacher, she was a strong advocate for improving education for our children and she also fought to protect victims of domestic violence and stalking,” Klobuchar’s statement said. Murphy had championed programs like Head Start and DARE, as well as initiated legislation to fund statewide juvenile correction facilities. Last January, St. Louis County commissioners honored Murphy by renaming the Environmental Trust Fund in her honor. Having worked alongside Murphy during the redistricting process in 2010, Deputy Mayor of St. Paul Jaime Tincher commented: “Mary didn’t raise her voice, she didn’t engage in political sparring. Instead, she led with the quiet power of earned trust and deep credibility. Her effectiveness was rooted in the respect she had built over decades of service, and her ability to bring people together in ways that made them feel heard and valued, no matter their political affiliation.” During Murphy’s time in the House, she chaired multiple committees, including the judiciary finance, ethics, energy, and state government and veterans affairs committees. “As chair of bonding and later the Ways and Means Committee, she demonstrated an unwavering dedication to institutional support, always willing to offer her wisdom and advice on how best to approach the financial needs of our zoos,” State Rep. John Huot (DFL-Rosemount) posted on Facebook. “Mary was a remarkable legislator and a compassionate friend and mentor to many,” State Rep. Jay Xiong (DFL-St. Paul) said in a Facebook post. “Her unwavering commitment to her community and tireless advocacy for those in need have left an indelible mark on our state. Mary's legacy will continue to inspire us all as we strive to uphold the values she championed.” ADVERTISEMENT Murphy left a legacy of advocacy for women’s rights, health care, criminal justice, and labor and advocacy issues. Gov. Tim Walz spoke of Murphy as a “true champion for the Northland” in his post on Facebook and said “Gwen (his wife) and I are sending our love to her family.”

Matt Gaetz says he won't return to Congress next year after withdrawing name for attorney generalThe man accused of burning a woman to death inside a New York City subway train used a shirt to fan the flames, a prosecutor said at his arraignment on murder charges. or signup to continue reading Sebastian Zapeta, 33, who federal immigration officials said is a Guatemalan citizen who entered the US illegally, was not required to enter a plea and did not speak at the hearing in Brooklyn criminal court. He will remain jailed at the city's Rikers Island complex and is due back in court on Friday. His lawyer did not ask for bail. Zapeta is charged with two counts of murder, accusing him of intentionally killing the woman and killing her while committing arson. He is also charged with one count of arson. The top charge carries a maximum sentence of life in prison without parole. Brooklyn District Attorney Eric Gonzalez called the attack a "gruesome and senseless act of violence" and said it would be "met with the most serious consequences." The apparently random attack occurred Sunday morning on a train stopped at the Coney Island station. The victim's identification is still pending. Authorities say Zapeta approached the woman, who may have been sleeping in the train, and set her clothing on fire with a lighter. Zapeta then fanned the flames with a shirt, engulfing her in fire, Assistant District Attorney Ari Rottenberg said in court Tuesday. Zapeta sat on a bench on the subway platform and watched, Rottenberg said. According to Rottenberg, Zapeta told detectives that he didn't know what happened but identified himself in images of the attack. Zapeta's lawyer, public defender Andrew Friedman, did not speak to reporters after the arraignment. Video on social media appears to show some people looking on from the platform and at least one police officer walking by while the woman is on fire inside the train. NYPD Transit Chief Joseph Gulotta said Sunday that several officers responded to the fire and one stayed to keep the crime scene "the way it's supposed to be" while the others went to get fire extinguishers and transit workers. "Officers who were on patrol on an upper level of that station smelled and saw smoke and went to investigate. What they saw was a person standing inside the train car fully engulfed in flames," Police Commissioner Jessica Tisch said. They eventually put the fire out, but "unfortunately, it was too late," Tisch said, and the woman was pronounced dead at the scene. Zapeta was taken into custody Sunday afternoon while riding a train on the same subway line after teenagers recognised him from images circulated by the police. A Brooklyn address for Zapeta released by police matches a shelter that provides housing and substance abuse support. Federal immigration officials said Zapeta was deported in 2018 but later reentered the US illegally. The crime deepened a growing sense of unease among some New Yorkers about the safety of the subway system, amplified by graphic video of the attack that ricocheted across social media. Overall, crime is down in the transit system compared to last year. But murders are up, with nine killings this year through to November compared to five during the same period last year. There have also been several high-profile incidents, including one in September where police inadvertently shot two bystanders and a fellow officer when they opened fire on a man holding a knife in front of a train. Earlier this month, a Manhattan jury acquitted former Marine Daniel Penny in the chokehold death last year of an agitated subway rider. The case became a flashpoint in debates over safety, homelessness and mental illness on the system. DAILY Today's top stories curated by our news team. WEEKDAYS Grab a quick bite of today's latest news from around the region and the nation. WEEKLY The latest news, results & expert analysis. WEEKDAYS Catch up on the news of the day and unwind with great reading for your evening. WEEKLY Get the editor's insights: what's happening & why it matters. WEEKLY Love footy? We've got all the action covered. WEEKLY Every Saturday and Tuesday, explore destinations deals, tips & travel writing to transport you around the globe. WEEKLY Going out or staying in? Find out what's on. WEEKDAYS Sharp. Close to the ground. Digging deep. Your weekday morning newsletter on national affairs, politics and more. TWICE WEEKLY Your essential national news digest: all the big issues on Wednesday and great reading every Saturday. 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Caitlin Clark honored as AP Female Athlete of the Year following her impact on women's sports Caitlin Clark has been named the AP Female Athlete of the Year after raising the profile of women’s basketball to unprecedented levels in both college and the WNBA. She led Iowa to the national championship game, was the top pick in the WNBA draft and captured rookie of the year honors in the league. Fans packed sold-out arenas and millions of television viewers followed her journey on and off the court. Clark's exploits also put other women's sports leagues in the spotlight. A group of 74 sports journalists from AP and its members voted on the award. Other athletes who received votes included Olympic gold medalist Simone Biles and boxer Imane Khelif. Clark’s only the fourth women’s basketball player to win the award since it was first given in 1931. Soprano Angel Blue sings her first Metropolitan Opera 'Aida' in a new production Angel Blue, one of the most admired singers of her generation, is headlining the Metropolitan Opera’s first new production of Verdi’s “Aida” in 36 years. The 40-year-old takes on the title role of the enslaved Ethiopian princess torn between love for an Egyptian warrior and loyalty to her country. It’s a part that comes weighted with history, especially for a Black soprano at the Met, where Leontyne Price embodied the role from her first performance in 1961 until her retirement in 1985. Blue tells The Associated Press she’s long looked up to Price, and directors who have worked with her say the singer is ready for the challenge. Blue’s Met debut in ‘Aida’ will happen New Year’s Eve. Centuries-old angels uncovered at Boston church made famous by Paul Revere BOSTON (AP) — Conservators have uncovered eight angels in a historic Boston church that counted Paul Revere as a bell ringer and played a pivotal role in the Revolutionary War. The angels were painted in the early 18th century but painted over in 1912 as part of a renovation of the Old North Church. Inspired by research showing the existence of at least 20 angels, conservators for the past four months have been removing the white paint that covered the eight angels located on the balcony's arches in the church sanctuary. The public is now able to view them. Swiss Olympic snowboarder Sophie Hediger dies in avalanche, aged 26 Swiss Olympic snowboarder Sophie Hediger has died following an avalanche at a mountain resort. The country's skiing federation says the incident took place at the Arosa resort in Switzerland. The 26-year-old Hediger competed at the 2022 Beijing Winter Olympics in the women’s snowboard cross and the mixed team version of the same event. Hediger achieved her first two World Cup podium finishes in the 2023-24 season. Her best result was a second place in St. Moritz in January. NFL on Netflix: Christmas Day games are a 1st for streaming giant Netflix will have one of its biggest days since the site launched in 1998 when it carries two NFL games for the first time on Christmas. “NFL Christmas Gameday on Netflix” kicks off with a two-hour pregame show at 11 a.m., before Pittsburgh hosts Kansas City. Baltimore faces Houston in the second game. The streaming giant agreed to a three-year contract in May to carry Christmas Day games. Magic and lights draw crowds to an alpine village in Washington state for Christmas LEAVENWORTH, Wash. (AP) — Freshly baked pretzels, shining tree lights and sleds in the snow lend a ruddy warmth to an unlikely collection of Bavarian-themed chalets in the mountains of Washington state. Decades ago, the town of Leavenworth was a near ghost town, one of the poorest parts of the Pacific Northwest. The mines and the sawmill had closed, and even the railroad left. That’s when desperate business owners took a serious gamble -- reinventing the community in the vision of an alpine village. More than half a century later, the result brings tourists from near and far -- especially during the holidays, when Leavenworth takes on the flavor of a German Christmas market. Bill Clinton is hospitalized with a fever but in good spirits, spokesperson says WASHINGTON (AP) — Former President Bill Clinton was admitted Monday to MedStar Georgetown University Hospital in Washington after developing a fever. The 78-year-old was admitted in the “afternoon for testing and observation,” Angel Urena, Clinton’s deputy chief of staff, said in a statement. “He remains in good spirits and deeply appreciates the excellent care he is receiving,” Urena said. Packers clinch playoff berth with 1st shutout in NFL this season, 34-0 over Saints GREEN BAY, Wis. (AP) — Josh Jacobs gained 107 yards from scrimmage and scored a touchdown for a sixth straight game as the Green Bay Packers clinched a playoff berth while producing the first shutout of the NFL season, 34-0 over the hapless New Orleans Saints. Green Bay improved to 11-4 and earned its fifth postseason appearance in six years. New Orleans played without injured quarterback Derek Carr and running back Alvin Kamara. Rookie Spencer Rattler started and went 15 of 30 for 153 yards with an interception and a fumble. The Packers have won nine of their last 11 games. Prosecutors withdraw appeal of dismissed case against Alec Baldwin in fatal movie set shooting SANTA FE, N.M. (AP) — New Mexico prosecutors won’t pursue an appeal of a court’s decision to dismiss an involuntary manslaughter charge against Alec Baldwin. The actor had been charged in the death of cinematographer Halyna Hutchins during a rehearsal on a movie set outside Santa Fe in October 2021. Special Prosecutor Kari Morrissey withdrew on Monday the appeal of a July decision at trial to dismiss the charge. The decision to drop the appeal solidifies the decision by Judge Mary Marlowe Sommer halfway through trial to dismiss the case on allegations that police and prosecutors withheld evidence from the defense. An all-Filipino crew is set to make history in the Sydney to Hobart yacht race SYDNEY (AP) — There have been plenty of “firsts” in the history of the Sydney to Hobart yacht race which was first held in 1945. An all-Filipino crew of 15 sailors will make it another when the annual ocean classic begins in Sydney Harbor on Thursday. With veteran sailor Ernesto Echauz at the helm, Centennial 7 will embark on the 628-nautical mile race. The boat itself is no stranger to the race. Previously, the TP52 yacht was known as Celestial and claimed the Sydney to Hobart overall handicap victory in 2022 under Sam Haynes after being runner-up the year before.Renuka Rayasam | (TNS) KFF Health News In April, just 12 weeks into her pregnancy, Kathleen Clark was standing at the receptionist window of her OB-GYN’s office when she was asked to pay $960, the total the office estimated she would owe after she delivered. Clark, 39, was shocked that she was asked to pay that amount during this second prenatal visit. Normally, patients receive the bill after insurance has paid its part, and for pregnant women that’s usually only when the pregnancy ends. It would be months before the office filed the claim with her health insurer. Clark said she felt stuck. The Cleveland, Tennessee, obstetrics practice was affiliated with a birthing center where she wanted to deliver. Plus, she and her husband had been wanting to have a baby for a long time. And Clark was emotional, because just weeks earlier her mother had died. “You’re standing there at the window, and there’s people all around, and you’re trying to be really nice,” recalled Clark, through tears. “So, I paid it.” On online baby message boards and other social media forums , pregnant women say they are being asked by their providers to pay out-of-pocket fees earlier than expected. The practice is legal, but patient advocacy groups call it unethical. Medical providers argue that asking for payment up front ensures they get compensated for their services. How frequently this happens is hard to track because it is considered a private transaction between the provider and the patient. Therefore, the payments are not recorded in insurance claims data and are not studied by researchers. Patients, medical billing experts, and patient advocates say the billing practice causes unexpected anxiety at a time of already heightened stress and financial pressure. Estimates can sometimes be higher than what a patient might ultimately owe and force people to fight for refunds if they miscarry or the amount paid was higher than the final bill. Up-front payments also create hurdles for women who may want to switch providers if they are unhappy with their care. In some cases, they may cause women to forgo prenatal care altogether, especially in places where few other maternity care options exist. It’s “holding their treatment hostage,” said Caitlin Donovan, a senior director at the Patient Advocate Foundation . Medical billing and women’s health experts believe OB-GYN offices adopted the practice to manage the high cost of maternity care and the way it is billed for in the U.S. When a pregnancy ends, OB-GYNs typically file a single insurance claim for routine prenatal care, labor, delivery, and, often, postpartum care. That practice of bundling all maternity care into one billing code began three decades ago, said Lisa Satterfield, senior director of health and payment policy at the American College of Obstetricians and Gynecologists . But such bundled billing has become outdated, she said. Previously, pregnant patients had been subject to copayments for each prenatal visit, which might lead them to skip crucial appointments to save money. But the Affordable Care Act now requires all commercial insurers to fully cover certain prenatal services. Plus, it’s become more common for pregnant women to switch providers, or have different providers handle prenatal care, labor, and delivery — especially in rural areas where patient transfers are common. Some providers say prepayments allow them to spread out one-time payments over the course of the pregnancy to ensure that they are compensated for the care they do provide, even if they don’t ultimately deliver the baby. “You have people who, unfortunately, are not getting paid for the work that they do,” said Pamela Boatner, who works as a midwife in a Georgia hospital. While she believes women should receive pregnancy care regardless of their ability to pay, she also understands that some providers want to make sure their bill isn’t ignored after the baby is delivered. New parents might be overloaded with hospital bills and the costs of caring for a new child, and they may lack income if a parent isn’t working, Boatner said. In the U.S., having a baby can be expensive. People who obtain health insurance through large employers pay an average of nearly $3,000 out-of-pocket for pregnancy, childbirth, and postpartum care, according to the Peterson-KFF Health System Tracker . In addition, many people are opting for high-deductible health insurance plans, leaving them to shoulder a larger share of the costs. Of the 100 million U.S. people with health care debt, 12% attribute at least some of it to maternity care, according to a 2022 KFF poll . Families need time to save money for the high costs of pregnancy, childbirth, and child care, especially if they lack paid maternity leave, said Joy Burkhard , CEO of the Policy Center for Maternal Mental Health, a Los Angeles-based policy think tank. Asking them to prepay “is another gut punch,” she said. “What if you don’t have the money? Do you put it on credit cards and hope your credit card goes through?” Calculating the final costs of childbirth depends on multiple factors, such as the timing of the pregnancy , plan benefits, and health complications, said Erin Duffy , a health policy researcher at the University of Southern California’s Schaeffer Center for Health Policy and Economics. The final bill for the patient is unclear until a health plan decides how much of the claim it will cover, she said. But sometimes the option to wait for the insurer is taken away. During Jamie Daw’s first pregnancy in 2020, her OB-GYN accepted her refusal to pay in advance because Daw wanted to see the final bill. But in 2023, during her second pregnancy, a private midwifery practice in New York told her that since she had a high-deductible plan, it was mandatory to pay $2,000 spread out with monthly payments. Daw, a health policy researcher at Columbia University, delivered in September 2023 and got a refund check that November for $640 to cover the difference between the estimate and the final bill. “I study health insurance,” she said. “But, as most of us know, it’s so complicated when you’re really living it.” While the Affordable Care Act requires insurers to cover some prenatal services, it doesn’t prohibit providers from sending their final bill to patients early. It would be a challenge politically and practically for state and federal governments to attempt to regulate the timing of the payment request, said Sabrina Corlette , a co-director of the Center on Health Insurance Reforms at Georgetown University. Medical lobbying groups are powerful and contracts between insurers and medical providers are proprietary. Because of the legal gray area, Lacy Marshall , an insurance broker at Rapha Health and Life in Texas, advises clients to ask their insurer if they can refuse to prepay their deductible. Some insurance plans prohibit providers in their network from requiring payment up front. If the insurer says they can refuse to pay up front, Marshall said, she tells clients to get established with a practice before declining to pay, so that the provider can’t refuse treatment. Related Articles Which health insurance plan may be right for you? California case is the first confirmed bird flu infection in a US child What’s up with that brown haze across Colorado’s Front Range when it’s not summer ozone season? Your cool black kitchenware could be slowly poisoning you, study says. Here’s what to do Does fluoride cause cancer, IQ loss, and more? Fact-checking Robert F. Kennedy Jr.’s claims Clark said she met her insurance deductible after paying for genetic testing, extra ultrasounds, and other services out of her health care flexible spending account. Then she called her OB-GYN’s office and asked for a refund. “I got my spine back,” said Clark, who had previously worked at a health insurer and a medical office. She got an initial check for about half the $960 she originally paid. In August, Clark was sent to the hospital after her blood pressure spiked. A high-risk pregnancy specialist — not her original OB-GYN practice — delivered her son, Peter, prematurely via emergency cesarean section at 30 weeks. It was only after she resolved most of the bills from the delivery that she received the rest of her refund from the other OB-GYN practice. This final check came in October, just days after Clark brought Peter home from the hospital, and after multiple calls to the office. She said it all added stress to an already stressful period. “Why am I having to pay the price as a patient?” she said. “I’m just trying to have a baby.” ©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.