Talk to me about the financial aspects of transfer?

[lalemma]

Hi mamas:

We're planning a HB with a lovely CNM. Our insurance covers only a small amount of her fee, so we're basically paying out of pocket.

Our MW requires us to have a backup OB-GYN, and has given us the names of five doctors who are willing to backup MWs in this area. It's a very short list, and none of them are on our insurance. (I get the impression that those are the only five guys in all of LA who do this. I don't think we're going to have any luck convincing someone else to get on board.) Assuming that everything goes well and I deliver at home, that's not a big deal: we'd just have to pay for a single visit to the OB-GYN out of pocket.

In the second scenario, a serious emergency, we'd just transfer to the nearest hospital, and our insurance would cover it as it would any other emergency.

But in the third scenario, a non-emergency "failure to progress" type of transfer, we would be expected to go to the backup OB-GYN. Because none of these guys are in-network, a birth at their preferred hospital looks like it could run us thousands upon thousands of dollars in costs. Paying that hospital bill on top of essentially paying out of pocket for MW care is just not something that's realistic for my family (or, I imagine, for many families at all.)

(Frustratingly, if I were to drop the HB completely and go with one of the in-network OB-GYNs, the entire pregnancy would cost us two or three hundred dollars. Hmph.)

I'll be asking our midwives as well, but: how do other people handle this? I just can't imagine I'm the only person ever to have this issue.

[mysticmomma]

But in the third scenario, a non-emergency "failure to progress" type of transfer, we would be expected to go to the backup OB-GYN. Because none of these guys are in-network, a birth at their preferred hospital looks like it could run us thousands upon thousands of dollars in costs. Paying that hospital bill on top of essentially paying out of pocket for MW care is just not something that's realistic for my family (or, I imagine, for many families at all.)

Why? You are in labor and are entitled to care wherever. I would go no matter what the circumstances.

[cileag]

I'm sure your midwife would prefer you to go to certain OBs, and you may in fact receive better and more colloberative care there as well, but if you can't afford it, than you should be up front with your midwife and let her know that.

I'm and L and D nurse and work at a hospital that my midwife prefers NOT to transfer to in an emergency, but *I* feel more comfortable knowing my coworkers and the MDs/CNMs on staff there, and it's the closest to our house, so unless it's a baby emergency (in which case we'll go to the one with a level 3 NICU) we'll be going to my hospital. And she's okay with that.

[D'sMama]

I imagine if you had a non-emergency transfer, your insurance would still pay some part of the fees for the out-of-network doctor, correct? And perhaps if that happened, you could work out a payment plan with your midwife.

I understand the worry - my homebirth was covered 100%, but if we'd transferred, I would have had to pay my midwife's fee directly, since the insurance then would have covered the hospital birth. But that didn't happen, DS was born at home. Make sure you do your best to get rest and stay nourished and hydrated while in labor, to help prevent a transfer for exhaustion.