At A Health Clinic Built ‘For Women,’ Patients Say Their Pregnancies Went Undetected

This story was reported in partnership with LA Public Press, an independent nonprofit newsroom advocating for a better Los Angeles.

When Areli Ramos arrived for her appointment at the women’s health clinic Tia in June 2022, she was showing signs of pregnancy. Her ankles were swollen, and she had missed several periods.

At Tia Inc.’s Scottsdale, Arizona clinic, providers performed a pelvic exam and collected urine and blood samples. Ramos assumed she was being tested for pregnancy. 

A provider told her a urinary tract infection was causing her symptoms, prescribed antibiotics, and told Ramos she was not pregnant. 

Her symptoms continued. Between June and October 2022, Ramos visited Tia three times and participated in additional telehealth consultations. She didn’t request pregnancy tests, but each time, various providers affirmed she was not pregnant. 

Ramos said because she trusted each provider’s word, she never performed an over-the-counter urine pregnancy test at home. She had no reason to believe multiple providers would repeatedly tell her she was not pregnant without first performing a test. 

That trust stemmed, in part, from Tia’s carefully cultivated image. The company positions itself as more attentive and welcoming to women, who are too often dismissed by traditional healthcare providers. Its clinics are marketed as a modern alternative, a place where women can expect to be heard and believed and where care is personalized and holistic. 

Unsatisfied, Ramos eventually sought a second opinion at a different clinic. After hearing her symptoms, the provider immediately began an ultrasound. Ramos was 21 weeks pregnant. 

Ramos is one of three former Tia patients interviewed by LA Public Presswho said they were incorrectly told they were not pregnant by providers at Tia, which operates 10 clinics in three states, including six clinics in Los Angeles County.

In a January interview with LA Public Press, Tia co-founder Felicity Estey did not respond directly to questions about the three pregnant patients. 

Speaking generally, Estey told LA Public Pressthat patients’ complaints are monitored by administrative and clinical staff to prevent negative experiences from happening again. 

She said many complaints made by patients are not unique to Tia, and that healthcare is a hard business.

“It’s not an easy thing that we’re trying to do,” Estey said. “We hope to continue to expand Tia across the country, as well as continue to deepen the services that we are able to provide for women.” 

After coming across a torrent of negative online reviews of Tia, LA Public Press interviewed 29 current and former patients, plus three former employees, who shared a range of concerns about the company’s quality of patient care, billing practices, and upselling of alternative medicine.

Five said they were denied anxiety medication or prescription pain medication for invasive procedures and instead offered expensive Tia-provided alternative natural remedies. 

Six said they were unable to see a doctor instead of a nurse. 

Nine said they weren’t able to see one provider consistently. 

Seventeen said they received surprise bills for up to thousands of dollars in out-of-network or specialist services that Tia told patients would be covered by insurance. 

Two said they had their lab samples either lost or mis-coded by Tia, resulting in an unexpected bill for hundreds of dollars in one case. 

Four said they were seen by Tia providers who referred them out to non-Tia providers for common conditions like endometriosis and benign ovarian cysts, resulting in more co-pays overall to receive basic treatment elsewhere.   

Estey said negative experiences are not the norm at Tia and that patient complaints about surprise bills are common across the industry. Many patients interviewed by LA Public Pressnoted they appreciated Tia’s unique mission and interior design. 

In an email to LA Public Pressin April, Estey said these negative patient complaints “reflect outdated, incomplete, or inaccurate characterizations of our services,” and that the company is happy to discuss how Tia’s model is effective and expanding. Estey did not respond to the specific patient complaints made to LA Public Press about in-network patients receiving surprise bills, frequent referrals to non-Tia providers, the lack of pain control options, and difficulty seeing the same provider.

Launched in 2017 as a healthcare app, Tia opened its first brick-and-mortar clinic in 2019 in New York City, landing Estey and co-founder Carolyn Witte a spot on the Forbes “30 Under 30” list. By March 2023, the company had raised more than $150 million, including investment from Melinda Gates’ Pivotal Ventures, which could not be reached for comment. 

Today, Tia operates six locations in LA County, plus two in New York, one in San Francisco, and one in Arizona, with another in that state opening soon. The clinics are marketed as cozy one-stop shops for all of a woman’s typical healthcare needs, including primary care, therapy, gynecology, and dermatology. Decorated with pink wallpaper and stocked with fluffy robes and free snacks, the clinics are designed to be a departure from traditional exam rooms. 

It’s not just the clinics. On social media platforms, the company posts bright, pastel-colored infographics of health tips and fun facts. 

The company’s website states: “What is different about Tia’s mission compared to others is that we are anchored in choice and transparency for our patients … Tia is on a mission to make healthcare both higher-quality and more accessible for all, regardless of age, sex, gender, race, ethnicity, religion, ability, sexual orientation, and economic status.”

The mission and the marketing has attracted patients. Multiple women interviewed for this story said they chose Tia because they believed it would provide a warm and welcoming environment and that providers would take concerns about their pain seriously. They trusted that the company, with its stated commitment to transparency, would not hit them with surprise bills. 

Alejandra Garcia, a Brooklyn patient, said she left Tia after six months because she was never able to see a doctor despite requesting one and did not like how the company encouraged virtual appointments. She now advises her friends to go elsewhere for care. 

“Ultimately it felt like style over substance, which is not at all what I’m looking for out of a healthcare provider,” she said. 

In LA, Tia clinics are located in affluent areas: Silver Lake, Pasadena, Culver City, Playa Vista, the Sunset Strip, and Studio City. According to the home page on the Tia website, the clinic accepts most major PPO health insurance coverage, but not government-funded plans such as Medicaid. 

Emily Rymland, medical director of Tia’s LA clinics, told LA Public Press the practice of referring patients out to non-Tia providers for treatment was previously “too common” at Tia. She also said the company purposefully opens clinics in areas where patients are more likely to have insurance plans accepted by Tia.

“I would love for us to go into the Medicaid space at some point,” she said. “[But] this is a for-profit business. There’s investors that want to make money. We’re driven by that.”

Dr. Annabel Sowemimo, a community sexual and reproductive healthcare consultant based in London, said the issues faced by companies like Tia are common in the start-up healthcare industry. She pointed out that founders usually begin with noble intentions, but are inevitably met with the reality of the profit-driven healthcare industry. 

“It becomes very, very difficult to ensure what a person needs remains at the center as opposed to offering them things they don’t necessarily need to make a profit — especially when you have investors who want their money back,” she said. 

As a result of medical misogyny, Sowemimo said many women who have had negative experiences with reproductive healthcare become disillusioned with the entire system. 

“That disillusionment is really ripe to be capitalized on,” she said.

In October, citing rising labor costs and pressure across the healthcare industry, Tia laid off 23 percent of its staff. 

One former provider who quit before the layoffs said she witnessed the company “trying to do too much, too quickly.” Another former provider said the company’s co-founders’ lack of experience in healthcare management was apparent, leaving clinicians feeling unsupported. 

“Their attention was not, for me, the most helpful things to be focusing on — like the interior design of the clinics,” the provider said. “If you don’t have a full case set of clients, and if you don’t have good support for all your clinical team, then you shouldn’t be really putting so much effort into building out these really expensive clinics.”

If Tia continues to open more clinics, Rylmand said she doubts the company could manage them all well.

“We want to be what’s called a medical home. We want to be able to provide everything,” Rymland said. However, she added, “I feel like we need to get these up and running really smoothly before we just keep building more.” 

The company’s fictitious business licenses, which allow providers to practice under a name other than their own, were expired for nearly two years beginning in April 2024 in San Francisco and November 2024 in Los Angeles County. Tia clinics in both counties remained open while their fictitious business licenses lapsed. The Medical Board of California confirmed to LA Public Press that practicing under an expired fictitious name permit violates the Medical Practice Act. 

In a January interview with LA Public Press,Estey claimed the company was in full compliance with licensing requirements. 

The Medical Board did not provide direct comment on Tia’s previously expired business licenses or any possible disciplinary action, but confirmed that the company’s renewal application was received in late February — one month after Estey’s interview with LA Public Press.

Estey did not respond to additional questions about Tia operating under delinquent business licenses.

Intrauterine device (IUD) insertions and removals are notoriously painful procedures for which patients often do not receive adequate pain medication. Multiple patients told LA Public Pressthat Tia providers seemed to lean away from standard pain medication options in favor of such alternative therapies as acupuncture and herbal remedies. 

LA-based patient Amy Beaver said her experience getting an IUD removed at Tia was “horrifically painful” and left her vomiting all afternoon.

At Tia’s Silver Lake location in 2023, Beaver said she was refused prescription pain medication for her IUD removal and replacement. Instead, she was given socks emblazoned with the words “inhale” and “exhale” to wear during the procedure. She said she was also told to “cough” as the provider yanked out her IUD. 

She said when she asked for pain medication, her Tia provider told her, “that’s not something we really do.” Beaver  said her options at Tia were to either put up with the pain or use natural remedies like in-house acupuncture services, which were pushed by her Tia provider.

“I started to get really angry because Tia was supposed to be at the forefront of women’s health, and instead, they were at the forefront of my pain,” she said. Beaver canceled her membership shortly after the experience. 

A Tia patient in New York for nearly three years, Sara Baumberger said she decided to stop using Tia when her provider referred her to a new CBD company’s vaginal suppository to treat cramps. 

“I was like, ‘Okay, this doesn’t feel like healthcare anymore,’” she said. “I left [Tia] thinking they’re kind of just like everyone else.”

Dr. Staci Tanouye, a board-certified OBGYN who practices in Jacksonville, Florida, told LA Public Pressthat while there is some data supporting acupuncture for period pain relief, its use for procedures such as IUD insertions is nonstandard and not backed by significant scientific research. 

She also said she’s “unfamiliar” with the use of vaginal CBD suppositories for pain control and has not heard of any data backing their use in the standard gynecological health setting. 

“The standard of care is certainly that discussion with the patient, talking with the patient, seeing what their comfort level is, what they would prefer, what their concerns might be and addressing that,” she said. “We should be offering patients options and discussions surrounding pain control.” 

Tanouye pointed to the American College of Obstetricians and Gynecologists’ new guidelines released in May 2025 recommending a variety of topical or injected pain or numbing medications for procedures, including IUD insertions. 

Rymland, the medical director of Tia’s LA clinics, said most procedures offered by Tia — including IUD insertion — should not be painful. She added that Tia is “very careful about prescribing controlled substances.”

IUD insertion, Rymland said, is “more about anxiety than it is about pain. “We use acupuncture, for example, during an IUD insertion, to prevent someone from having to take anti-anxiety medications and pain meds,” she said.

Rymland also noted that insurance companies rarely cover acupuncture services for pain reduction during IUD procedures. The service costs at least $324 out-of-pocket at Tia — on top of the cost of the actual IUD procedure. 

When Annaliese Estes began experiencing heavy periods and cramping in early 2024, she said her providers at Tia’s Williamsburg clinic in New York City thought it could be endometriosis and gave her an outside referral instead of offering treatment. 

“Tia almost works best for healthy people as a monitoring situation,” she said. “They basically just referred me out to a regular gynecologist.”

According to Estes, her new gynecologist said she had been on the receiving end of Tia referrals before and pointed out that Estes had already had access to gynecologists at Tia. 

Estes added that she did not like having to see a different Tia provider at each visit, leaving her unable to list a specific primary care provider on medical records. A number of patients interviewed shared the same complaint.

“Usually I found that I was repeating all of the same stuff that I already told other people, and they’re asking the same questions that had already been addressed,” Estes said.

Similar to concierge medicine, for years Tia charged monthly or yearly memberships on top of typical co-pays and out-of-pocket costs. Last year, it launched Tia Essential, allowing patients without membership plans to access Tia services “with fewer barriers.” Today, patients can either make individual appointments or sign up for a plan that costs $25 monthly for benefits including more flexible appointment scheduling and extended hours. 

Tia makes sense for patients who have good health insurance coverage, said Kellee Bedford, a Los Angeles Unified School District teacher who has enjoyed its services. But, she said, Tia patients need to be “very savvy” to avoid surprise bills. 

“You can’t just go in willy-nilly for any need … You could end up paying for that because it’s not covered by insurance, which is the crummy part, I will admit,” she said.

When Emily Hurst went to a Tia clinic in LA for an IUD insertion in 2024, she said she confirmed with Tia that the procedure would be fully covered by her insurance. Weeks later, Tia sent her an out-of-pocket bill totaling more than $4,000, according to screenshots of a conversation between Hurst and Tia’s billing department, reviewed by LA Public Press. At least 16 other patients interviewed shared similar stories of receiving a surprise bill for up to thousands of dollars that took months to resolve.

Tia offers monthly “Predictable Payments” capped at $100 per month until an existing balance is paid off. Both Rymland and Estey said patients sometimes have a change in coverage between the time Tia confirms services are covered and when the insurance company receives the bill, causing unexpected costs. Only one of the patients LA Public Pressspoke to reported a change in insurance coverage between an appointment and receipt of their bill. 

“It really is on [patients] to understand their insurance policy,” Rymland said. “But if we’re at fault, we’re totally willing to look at that and improve our systems.”

Multiple LA-based patients said they were told by their insurance that Tia had assigned them either a specialist or an out-of-network provider, resulting in unexpected out-of-pocket costs. Rymland said all LA-based providers are considered in-network with Tia, so patients should not receive bills from out-of-network providers.

Prospective patients can fill out a short online insurance form to confirm if Tia is in network. 

Rymland claimed surprise billing issues do not happen often at Tia because the company is upfront about which insurance plans are in-network, but of the patients LA Public Pressinterviewed, nearly two-thirds reported issues with Tia’s billing department. 

Sherry, who requested a pseudonym to protect her privacy, is one of three women interviewed by LA Public Presswho said Tia providers missed their pregnancies. 

As a Black woman, Sherry said she was drawn to Tia’s advertisements about providing a more inclusive healthcare environment. 

After experiencing unusually painful cramps in early 2024, despite taking birth control pills and not having had strong period symptoms for years, she booked an appointment and requested tests for pregnancy and sexually transmitted infections. 

One week later, she received test results showing she was negative for all STIs, with no mention of a pregnancy test result.

Her symptoms persisted. Unsatisfied, Sherry booked a follow-up appointment with Tia for an ultrasound and discovered she was nearly 10 weeks pregnant. 

“It turned out that they had never given me a pregnancy test,” she said. 

Screenshots of correspondence between Sherry and a Tia representative show she received a $269 bill for an appointment during which she requested a pregnancy test but didn’t receive one. Sherry had an abortion and later messaged her Tia providers to complain about her experience, only to receive a generic customer service response.

“I’m so sorry to hear that you had a negative experience with us,” a Tia care coordinator replied. “That is never what we want to hear because we strive to provide the best care possible here at Tia. We take your concern very seriously and have escalated it to a member of management.” 

Another LA-based patient told LA Public Pressshe went to Tia to confirm she was pregnant after several at-home pregnancy tests came up positive. 

Claudia, who is also using a pseudonym, said as she sat in the public waiting room area after taking a urine test, a Tia provider came out and said she was not pregnant. 

Confused, Claudia immediately texted her husband the results. Minutes later, a second nurse pulled her into a private room to apologize, saying the first nurse had evidently not waited long enough for the results to appear on the urine test, and that Claudia was pregnant.

“I just didn’t like how I was told that information,” Claudia said. “One, in the waiting room area, and two, you’re a nurse — you should know [better].” 

Pregnancy testing is among the simplest and most routine diagnostic tests performed in medicine.

“If someone comes in obviously concerned or questioning pregnancy, the point of care test in the office is a urine pregnancy test,” said Dr. Tanouye, the Florida-based OBGYN. “The tests that most physician offices use are nothing special …  Even cheap and inexpensive tests will pick up a pregnancy by the time of a missed period.”

The tests must look specifically for the hCG hormone to confirm pregnancy as a standard urinalysis and complete blood count panel do not automatically test for pregnancy, Tanouye said.

But in Arizona, Areli Ramos’s medical records, which were reviewed by LA Public Press, show Tia never performed the correct hCG hormone blood and urine tests to check for pregnancy. 

After realizing Tia providers had failed to detect her pregnancy, Ramos promptly canceled her membership. 

“I feel like it was just me trusting them blindly,” she told LA Public Press. “At one of my telehealth visits, the provider said that it was very important for me to get my period because if I didn’t, it would lead to cancer … It really freaked me out.” 

Ramos said her daughter Olivia was born healthy, but it felt like “playing catch-up” trying to get prenatal care more than five months into her pregnancy. 

“The frustrating part is not getting the attention that would have been needed at the beginning,” Ramos said. “I can’t imagine for someone else to go through the same thing that I went through, and not have the choice to see what they want to do.”

Ramos said she complained to Tia only to receive a generic response about her experience being shared with management. 

She never heard back. 

Benjamin Royer contributed to the reporting of this investigation.