Mad about "the system" ($$) and homebirth

[Snapdragon]

I am mad about something right now. I pay a monthly amount to my medical insurance. and they would pay in full for a hospital birth, but they won't pay a penny for a home birth. And then the midwives, knowing this situation, charge us $3600 to attend a home birth. It feels like way too much.

[seashells]

I can sympathize with the frustration that insurance won't cover homebirth; makes no sense imho. I can't help but think this will change in the future.

But, sorry, can't sympathize at all with your feeling that $3600 is "extortion." It's more like "charity" (the midwife providing services for something like minimum wage) from where I see it.

[seashells]

Just as another point, midwives lose a lot of business because people don't want to pay out of pocket. Charging high fees would put them right out of business. Just to stay in business, they have to charge bottom of the barrel prices. The price of course covers all the prenatals, not just the birth. Plus they have to be on-call which affects their entire lives. Plus, unlike a hospital, they don't go home when their shift is over. Plus, unlike a hospital, they aren't pumping you full of pit when it's "taking too long." My midwife was here for 21 hours for the birth alone, not counting the prenatals and postpartum visits. (One postpartum visit she actually ended up spending the NIGHT with me to help with breastfeeding problems). Plus of course they have to pay the assistant, they aren't exactly pocketing the whole thing. Etc.

[Belle]

Are you blaming the midwives or the system?

$3600 is a bargain for one on one care, an hour long prenatal appointments, the midwife being on call for several weeks straight (at least) for your birth, near guarantee of the provider that you chose, newborn care, home visits, post partum care and you have a provider that provides evidence based care rather than someone who is only looking out for themselves.

Yes, its sucks that your insurance won't cover it. A hospital birth will cost them much more than an uncomplicated homebirth. Have you tried appealing? What did they tell you?

My homebirth also cost $3600. We paid our midwives ahead of time. They were also able to bill insurance after the fact and the insurance company paid them more than they said they would for the birth. I ended up getting back all but about $300 of the cost of the birth. It was worth every penny and I'd do it again.

[Fujiko]

I'm in your situation right now (right down to the dollar amount that the midwives charge) but I'm mad at the insurance company, and secondarily at the hospital. My midwives (I will have 3-4 midwives or midwife apprentices at my birth, because that how my midwife rolls, lol) get a free pass because I know that this work is HARD work emotionally, mentally, and physically for anyone. As far as I'm concerned they earn every penny, and it's not their fault that insurance companies are bass ackwards. The insurance company...gosh, what can I say? It makes no sense.

For my last pregnancy, I went with the same midwives I have now. My insurance, at the time, did cover 60% of homebirth (which they no longer do). Unfortunately at 38 weeks I developed pre-eclampsia and my midwife had to transfer my care to an OB. My labor didn't go well during pushing, and I ended up with a c-section. (My midwives attended me in the hospital even though they didn't have privileges, they were essentially doulas #2-4, talk about labor support!) So I was charged for a homebirth, a hospital labor (which is a hospital charge above and beyond just being a patient), and an major surgery. For dd and me, the total for the hospital was $19,000. Homebirth was about $3400 at the time. (Insurance covered 60% of the homebirth and all but $2000 of the hospital.) The charges just for the hospital labor (which doesn't include supplies, drugs, physician's fees, room & board, any of my daughter's bill, or any part of my c-section) was $3400. Add to that one-on-one care from my midwives and the professional liability they take on, and I find the homebirth fee quite reasonable.

[Nanasi]

Just a different perspective here... My husband and I pay for individual insurance to the tune of $400/mo. for the two of us. Our insurance company would be happy to have me give birth to our twins in the hospital (where they can dictate how things ought to be done), but we feel that welcoming our babies into the world at home with the help of some stellar midwives is far safer for me and the babies. We're paying for this birth out of pocket during a time when we can't afford to keep an apartment and are forced to live off the charity of family because this is what we feel is best for our family. Remember, in the end it's just money. Do what's best for your family--whether that's going to the hospital or staying home.

[Gena 22]

Can't believe insurance doesn't cover homebirths. I had my twins at home. No surgery, no NICU, just a smooth, uncomplicated birth and 2 healthy babes. I saved the insurance co. many, many thousands of dollars. And got to pay out of pocket for the privilege.

But I agree that what I paid my midwives and my doula was a FRIGGING BARGAIN! They were worth every penny and more. I feel like I was paying to ransom my body (and my children) from those who would cut me without my permission. My hospital has an 80% c/s rate, and as a first timer, I wasn't going to fall in that "happy" 20%.

Go midwives!

[SleeplessMommy]

My hospital birth for baby #1 was billed to insurance at $24,000 (vaginal delivery!) plus another $3000 for OB/GYN care during pregnancy.

My midwife is charging less than 10% of the above total for pregnancy care at my home, blood tests, delivery, everything. I told her she should raise her rates

The insurance company is the one who needs to change - home birth is very cost effective for low risk Moms.

[MrsMcCullen07]

I understand I have medicaid so essentially to me a hospital birth is free but i dont want another c-section or to go through all the trama i went through after my first birth... that being said my midwife cut her fee down to $2000 for us but i am not sure we can pay that ... ... but at my last OB visit (i am being followed by both just in case since my son had hydrocephalus at birth and couldn't be delivered vaginally) my paper said it was already over $6,000 I am only 5 months and have had 2 ultrasounds but geez ... that is already 3x what the midwife charges for everything .. its crazy but in NC midwives arent legal or aren't legally able to attend homebirth or some crazy bullsnot so i dont think there is anyway around it here

[RPS67]

I agree that there's something wrong with our health care system. I didn't have insurance when my 3 year old was born, so we paid the mw 100% on our own. Since I was unemployed from month 7 of my pregnancy, I probably could have gotten on medicaid and had a hospital birth for free.

This time, I have HMO insurance and they are paying $1800 and then I have to pay $1000. For me, if I had to pay 100% of the mw again, I would do it. Heck, I would do it for TWICE the cost because I think it's worth it. I feel like I get much better care, I'm an actual person, not a number, and I can count on my mw to be there for me.

I wish the insurance companies would get their act together and recognize when a subscriber is saving them money.

[Snapdragon]

I seriously don't mean to offend anyone or midwives or devalue them. I just am feeling frustrated with having a bunch of expenses and that primarily it sucks that insurance, which I pay every month, won't put a penny to a homebirth. But secondarily I do feel that 3600 to attend a birth at home is too much. I know many people disagree with this and I don't really want to argue the point- if that's okay. I guess I was just venting that it does feel like a lot of money to charge- and personally I think it is too much. Of course if we compare it to doctor fees it iis cheap. Of course I think doctor fees are too expensive too!

as for the "extortion" I know that was too strong a word- please take that lightly- I wrote the original post when I was inflamed aout this. What I meant by that was- seeing my choices- I am having a baby. So I can have an insurance paid hospital birth, which I don't want, or an Unassisted birth, which I want in some ways but not others. or pay 3600. Kind of like- 3600, or the two choices you don't want. I was exaggerating on that word but it was something dh and I had been discussing.

[Belle]

I understand your frustration. Yes, the system is really effed up and backwards. It makes no sense why they would pay thousands more for a hospital birth when homebirths are so much cheaper. It does seem like its a lot out of pocket, but hopefully it will be worth it for you. Or if you choose to UC, I hope that it is what you really want.

I think a lot of people (including myself) reacted very strongly to your choice of the word "extortion". Its hard to convey tone online.

[seashells]

Yeah, the extortion thing is just really over the top.

Is your midwife driving a Rolls Royce or something?

My mom is a nurse, and the doctor she worked for last (she's semiretired right now) had 13, count 'em, THIRTEEN cars between himself and his wife (also a doctor). These cars were Mercedes, Audis, a Toyota Spyder, etc. But anyway, I agree that just because someone makes less than a doctor doesn't mean they aren't overpaid, but I'm curious to know how you came to the conclusion that yours is.

Midwifery is not exactly a high-paying profession. It just seems to me like complaining that your mailman is overpaid... just a real stretch, and attacking completely the wrong person who is a victim in this as much as you.

[wbg]

Mama.

I know you are so frustrated and I understand. We pay so much in health care and then they will not cover the costs of a very skilled MW for the birth.

They would rather spend triple that amount for you to get sub standard care from an OB( and I know that is a little unfair, I infact, am in the minority here, because my OB in Australia was a rock star and I love her!!) and even open themselves up to paying way more money due to OB convenience-interventions leading to cmplications etc( again, I know, big generalisation so to the small minority of OBs out there who dont abuse their interventions and use them when truly needed, I salute you ).

I am sorry the system sucks. I know there are many wise women and their families and friends currently fighting the system to try to improve it.

In the meantime, the MWs give so much of their time and yes for those of us, who have been blessed with uncomplicated pregnancies and deliveries it can seem excessive, I think the fee is knowing that they are available and would work crazy hours and use their skills should your pregnancy or labour suddenly get complicated.

MY MW was $5000 and 18 months later I am still feeling the financial fall out. But I wanted a skilled birth attendent and I did not want to go to the hospital and so I paid my MW. For the hours I needed her, it was a huge fee! We did not connect as much as I hoped and my labour was short and uncomplicated. But for the years she spent training, for the months she was on call, for her knowledge and experience I have to admit she was probably underpaid. In another lifetime, with a cooler budget I would have paid her 4 times that! Of course I also would have given birth in my completely built from scratch eco friendly villa, served her only organic produce and done a few other wonderful, but a little out of my budget things! choices! hee hee

Anyway Mama, good luck with your pregnancy. It is frustrating that you have to consider and make these choices based on finances. Feel free to come to MDC and rant anytime!!!

[fruitfulmomma]

And I have to pay them 3600 to just- be there.

No, not to just be there. They have to pay to purchase and maintain their equipment, including life-saving equipment like oxygen. They have to pay their assistants. They have a lot of paperwork to file. They have to pay the state a HUGE amount of money to maintain their licenses. They have to pay to continue to update their education. They have to pay for all expenses for their offices, gas money to your home, malpractice insurance if they have it, etc...

[Snapdragon]

Thanks everyone. I always feel weird when I vent in an inflamed moment on MDC because it is so hard to know the context and subtext of what one is saying just from a post. Sorry I used the word extortion- as I said that was an exaggeration. I always wonder if maybe when I am in a pissed off mood about something and so speaking really candidly if then I shouldn't vent on MDC but just vent to someone IRL, because usually I get responses that were offended by my strong vent and then I feel worse
oh well- so it goes.
moving on now.
okay- edited out that word from OP.

[LiLStar]

My insurance said they would only cover a cnm, but I ended up recovering ALL the money I paid to my midwives + $200 (which I of course gave to them) since they bill insurance higher than they charge parents. Its always worth submitting the claim to insurance, and if its declined, appeal it! You never know, the claim might end up being processed by someone who would rather just pay it and get it off their desk and be done with it Can't hurt.

And my mw certainly wasn't paid thousands just to be there! I ended up with shoulder dystocia severe enough that it couldn't be resolved by changing posiitions/gaskin maneuver. ds needed real help getting out and resuscitation. My live healthy baby is most definitely worth the midwife fee. Not to mention my intact perineum, delayed cord clamping, and uninterupted bonding that most likely would not have occured in the hospital given our circumstances!

I love my mw I know she's not making herself rich by babycatching but I certainly think she deserves to be!

[quiverfull]

Just another perspective.....

Where in the US do you live? That makes a big difference in the cost of ones midwife. We live in an area that doesn't have a high cost of living (or income!), and my midwife charges $2900 (because I'm a repeat client, she's charging me the same as she did 3 yrs ago with my last LO- $2500).

It is really aggravating paying over $800/mo in ins premiums and not have anything covered (although I'm keeping my fingers crossed!), but truly, it is totally worth not having to deal with the whole OB/hospital thing (unless, of course, you have issues). I feel for you!

Holly

[Snapdragon]

I do understand the usefulness of midwives and I am grateful to have the opportunity to do a homebirth. And when I posted this I was feeling a bunch of other things I was wanting to pay for and it all kind of got more talked about than I wanted to (my own mistake.) thanks I was just processing a charged up moment originally.

[NishaG]

Well, you can close the thread, if need be.