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Why don't you carry Malpractice Insurance?

Let's continue to talk about the non-traditional topics in Midwifery. Malpractice. It is covered in 3 different disclosures in my handouts. It is in the Informed Choice Disclosure by the State of Texas. It is in my General Disclosures, and it is in my Financial Document. I do not have Medical Malpractice. I want to discuss a few reasons why I don't and then the MAIN reason I don't.

I originally looked into malpractice when I started midwifery. The midwives that did carry it was for health insurance reasons. Which meant, they had to carry it to be a provider for a specific insurance company to get paid. Some midwives found the cost of carrying the insurance cost more than what the insurance would pay for services. Basically, insurance can set what they pay, and it often isn't enough to make midwifery sustainable. United once paid $900 for 10 months of care and labor and delivery. Then they applied the $900 to the client's deductible.

If I carry malpractice, they can set rates based on procedures. They could increase fees for a VBAC (some have costs of $1500 per birth extra) or any other procedure they deemed too risky. So then, I would be allowing insurance companies to control the care I give. Companies that are interested in the bottom line, not the client. Insurance should never have a say in the healthcare of any patient. Midwifery or not.

There are other ethical concerns I have with malpractice that are more complicated. You can research payouts and who actually ends up with the money.

My main reason for not carrying malpractice is. my clients over the years, have overwhelming voiced they prefer I do not carry it. Honestly, when it comes down to the decision, I would defer to the majority of my client's desires on the matter. I do not pay for malpractice, the client does. I have a set fee to pay my bills, rent, supplies, labs, licensing etc. If I have another fee, it would be passed on. Most of my clients are self-pay. For some, it is a real sacrifice to pay out of pocket. If at any point the majority wanted me to carry AND are willing to pay the extra fee involved, then I would look into it again.

Do you have any questions or comments about malpractice insurance? Times change and make me wonder. Do you have a preference on a midwife carrying malpractice insurance? I would love to hear your feedback.

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