Standard Midwifery Fees

We will try to answer the most common questions in this section regarding fees, billing practices and insurance. We spend more time with you than the average doctor visit. However, this means the longer visits must cover the costs to operate the birth center during the operation of the day/month. We value quality care for each mom/baby and therefore, limit our clientele to a number we can properly and adequately manage and balance with our busy lives. This care though comes at a higher cost per client. So,we strive to give you our best care while trying to minimize the cost to our clients.

What our Midwifery Package fee is: $4000 paid by 36 weeks 

What our care includes:

  • Appointments: consultation, 9-12 pre-natals: 30 minute allotted time, 3 post-partum appointments for mom, 3 post-partum appointments for baby (these are from 30-60 minute appointments, sometimes longer)

  • Labs: initial labs (state required stds, A1c, Iron levels, Blood typing and antigen testing, titers), 28 week labs (glucose testing including organic tapioca dextrose for testing, Iron, and Metabolic panel, antigens for RH neg mothers) 36 week testing (retests many of previous tests and adds GBS testing), PLUS any testing we deem necessary eg: rechecking iron, liver, urine or other testing. There are optional testing available at an additional cost.

  • Setting up and maintaining charts and records: This is keeping records, labs, notes from conversations during the week, requests for records, releases for work or medical treatment, making appointments and managing payments. 

  • On Call access 24 hours a day for emergency/critical situations, labor support and other situations that need 24 hour care. 5 day access for non-emergent needs. 

  • A midwife remaining local for full term mothers.

  • Extra appointments or time spent driving to home-births, 2 day visits or office for prodromal labor and labor progress checks as well as heartbeat, ruptured membranes or other situations that may need an evaluation.

  • Birth supplies needed at the birth center or homebirth

  • Tub rental, liners, nets for waterbirths at home or the birth center

  • Trained assistant or senior apprentice, or both

  • Labor monitoring and care,(average time is usually 4-6 hours, though it is not uncommon to spend up to and over 24 hours)

  • Labor support including positioning, comfort measures, birth balls, tens units, counter pressure, training your birth support team as able without diminishing quality of midwifery trained care. Hiring a doula is highly recommended, especially in your first birth for the ability to have more hands-on comfort care.

  • Birth - monitoring you and your baby for anything that would be considered a higher risk, including vitals, heart tones, labor patterns, exhaustion, shoulder dystocia, hemorrhage, and placenta management. Administering medications if necessary.

  • A minimum of 2 hours immediate post-partum management for mom and baby. 

  • Breastfeeding support within the training of each individual midwife

  • PKU or newborn screen performed at 2 day and 2 week for baby

  • Vitamin K oral or injection

  • Erythromycin if desired

  • Access to our lending library

  • Birth - a licensed midwife will be available during active labor, birth and at least 2 hours post-partum

  • A trained birth assistant is planned for every birth

  • Driving time to your homebirth or the facility for a birth center birth.

  • Working with insurance biller to file your insurance, if necessary

  • Collaborating your care with other providers or referrals if it becomes necessary

  • Filing birth certificate

  • Labor support if you transfer to the hospital if desired. 

 

Items that our not covered in our Standard Midwifery Package:

  • Ultrasounds - paid directly to the sonographer. $220 for a diagnostic ultrasound at 18-20 weeks. Other ultrasounds if there is a concern. Sometimes insurance or medicaid will cover these

  • Rhogam shots for RH negative moms if desired. These are offered at our cost

  • Elective labs

  • Placenta encapsulation/tincture

  • Supplements

I have heard more than once that our fees are too high (and surprised at how low) and also had clients agree to pay and then not pay. It makes offering leniency more difficult. We do NOT do this for money, though money enables us to do this. The midwives I know are called into this and feel a passion for caring for women. So I wanted to share the cost of doing care:

  • The facilities: every office has a rent and utilities (water/trash, gas, electricity, internet, phone), insurance, yard maintenance that must be paid. The burden of limiting clients is the necessity of those paying clients to meet their monthly share in paying those bills. 

  • Supplies from birth to labs, toilet paper, laundry, cleaning supplies, medical supplies including a kit for each birth

  • Cost of labs

  • Medications/herbs carried for hemorrhage, oxygen, labor support, and post-partum care

  • Replacement of equipment/supplies from dopplers, birth tubs to towels and sheets

  • Office support : someone is paid to answer phones, make appointments, web-pages, fees for monthly appointments, charting and cell phones and apps to manage office calls, printers, papers, pens, ink

  • Taxes & licensing: this includes licensing for midwives (about $300 a year per midwife), birth center (a $1000 a year), payroll taxes, lab certification fees, classes required to license, fees for CPR and neonatal resuscitation certification

  • Gas and vehicle wear and tear. My average gas usage would be 1-2 tanks a month without midwifery. On a busy month I can use 7-8 tanks

  • Fees for credit card usage

  • Bank fees, checks, business cards

  • Books/DVDs in the lending library that often need to be replenished from loss or wear.

  • Extra meals or expenses from being called on a moments notice and often being gone over 24 hours. 

Other costs: The preceding list highlights the monetary expenses for running a business before any Midwife or assistant is even paid. There are many costs as in family time, health which comes from stress, adrenal fatigue, inability to leave town, 24 hour call and lack of scheduled sleep.

Can I transfer care to you at the end of care and pay less? 
We love being able to offer the ability for women choose a different provider even up to birth. However, the majority of care happens after 36 weeks. Roughly 9 appointments occur before 36 weeks. An average of 7-10 appointments for mom and 3 appointments for baby occur in the last month and post-partum. Birth kit, supplies and waterbirth expenses are incurred. An average of 6-8 hours of labor (sometimes over 24 hours), often times prodromal labor and postpartum care and clean up. Assistant fees.  Birth and 2 day appointments also incur extra driving times. These appointments also take a longer time. The time spent in filing the birth certificate is also post-partum. In addition to this, we are playing catch-up on building a relationship which is so vital for a smooth birth. Also we are requesting records, additional charting and reviewing records which need to be entered in our system. However, with that being said, we do offer small discounts for previous care. 

How is payment expected? 

We would like a $400 payment on initial visit. Referring to monthly expenses listed above, we do request a monthly payment is made. We try to offer leniency and work with you, so that you may use healthshare accounts, bonuses, tax returns etc. We do attempt to work with special circumstances.  We are willing to discuss your situation. 

If I use a student can my fee be discounted? 
Coming from busy apprenticeships, we understand this question. However, we limit our clientele and unlike many busy birth centers, we just do not have the ability to be a training facility that care for many clients and therefore, the monthly operating expenses are less per client. The future of midwifery depends on apprenticeships and we incorporate it into our care and is part of our ability to keep our expenses down and quality of care up. 

If I prepay, may I have a discount?
Referring to the above answer, we try to keep our expenses down and offer a reasonable fee for our services. Since the majority of a prepaid fee would be set aside in case of a pre-full-term transfer, there really is no benefit to us between a prepaid or timely paid contract. 

Do you take insurance? 

Yes, but we are not in-network with anyone and not every insurance pays us. Maggie with Napiermidwiferybilling.com will file your insurance. For a $20 fee, she will check your insurance to see what your coverage is. She is amazing with dealing with insurance companies. If your insurance will cover midwives, she will discuss with you the options and benefits of filing in your situation. If appropriate, she will start an in-network exception to get the most out of your insurance. Some, but not all, will grant an in-network exception. She collects 10% of the money your insurance pays. This is the most reasonable billing fees I have ever seen. If insurance doesn't pay, she receives nothing, even if she has spent a lot of time working on it. If you deductible is too high to receive payment, she will file to apply your midwifery fee to the deductible for $100 if you desire. 

With deductibles and co-pays, often our pre-paid price is cheaper than a hospital birth. 

Do you accept Medicaid or Tri-Care?
No we are unable to accept these insurances at this time. Superior medicaid will often pay for ultrasounds though

Our insurance says the in-network price is only $2500, why do I have to pay $4000? 

Insurance billing is a courtesy. We have no contracted price with any insurance company and  many will not even tell us ahead of time what they will pay so we can agree to it. BCBS (Blue Cross/Blue Shield) will usually pay about $2500 for Global OB Care, all the care from a midwife from prenatal to post-partum. They usually will not cover the newborn at all. If you birth at home, we cannot bill a facility fee. Out of that fee, they will deduct your deductible and co-pay. Eg. you have a $1000 deductible and 20% co-pay. They will deduct $1000 from $2500 making it $1500, then deduct $300 for 20%. They will write us a check for $1200. 

Even with the BCBS in-network price of $2500, that does not include things they do not cover. They do not cover birth supplies, assistant fees, waterbirth rentals. The time spent in filing birth certificates, mileage for homebirth or 2 day check-ups.  That price also does not include any newborn care, newborn PKUs. That price is paid to an OB that averages 10 minutes in an office appointment, a little bit of time at your birth at a hospital (often walking in to catch a baby). (Taken from national average statistics ... there are some that spend more time) They are able to take that price because they see many more clients in the amount of time we spend with our clients. BCBS is also paying the hospital in addition to that fee for the nurses, supplies and facility that do the job we also do. If you birth at the birth center, we can charge a facility fee as well which may help with the total amount the insurance will pay. 

We understand insurance can be frustrating. You pay a lot for it. It should cover something as basic as a baby. We get frustrated for you. We also encourage people to look into Christian Health-share ministries, Liberty Health-share or Samaritan Ministries.

Will I have to pay more than $4000?

The short answer is no as listed in the above fees included in our services. 

Long explanation no, but we may make more than $4000 with insurance, not often but occasionally.  We have to collect your deductible by law. That is why Maggie checks to see if it is worth filing your insurance to begin with. If you have a $6000 deductible, there is no reason to file unless you want it applied to your deductible. 
Possible scenarios:
Scenario 1: You pay me a $3000 before your birth expecting your insurance to cover the rest. $2000 of that is your deductible. Insurance surprises us and pays out a check of $5000. We pay Maggie $500, leaving $4500. That is a total of $7500 in payments from you and insurance (I can wish right LOL). You paid $1000 more than your deductible. So I can refund the $1000. I cannot refund the deductible. 

Scenario 2: You pay $3000 before birth. However, you met your deductible on other visits before birth. So insurance pays me $5000, we pay maggie $500. The total paid is $7500. Since insurance already collected your deductible, I can refund the entire amount you paid of $3000. It leaves me $4500. I can never refund more than you have paid. That's insurance fraud, we can get in a lot of trouble for that ;) 

Scenario 3 (which we find is most likely): We try and guess what you will owe, we try to get pretty close to your actually amount. It's like playing horseshoes blindfolded. You pay $2000 before birth. Insurance decides they will pay $3500, they deduct your deductible and co-pays and send us a check of $1500. We send Maggie $150. The total we have received is now $3350. You owe us $650. This makes the total you have paid $2650. 

Hopefully that helps a little.  You are always able to go to napiermidwiferybilling.com and pay to have your insurance looked at for only $20. It will give you a starting place for insurance. Maggie is really sweet and will help and answer any questions she can.