Paying a midwife (insurance?)

[camprunner]

I'm not yet pregnant but we are going to start ttcing sometime in the next year if all goes well and I like to have an idea of who I'm going to call when I get pregnant before that happens. (I've discovered that no one is good enough after I'm already pregnant).

I was looking at one midwife's web page and she had all of her charges listed. She was charging one price for someone with insurance and another for someone without(a little cheaper). It looks like (at least in our case) the person who has insurance would end up paying the entire fee out of pocket. Then they will charge the insurance company more and any thing that is recieved goes to the midwife.

I do understand that most homebirth midwives are over worked and under payed. So in this case would you just tell the midwife that you don't have insurance and use the insurance in case of transfer? Am I missing something here?

I will probably choose which ever one that clicks with our family better, I just want to prepare myself for this.

**I'm really not trying to come off as rude with this post. I'm just not sure of the purpose of using insurance when the same amount of money is coming out of my pocket either way.

[IAMommy]

That seems strange to me considering that not all insurance companies will even cover home birth. My midwife has one rate, you pay her out-of-pocket, she submits a bill to the insurance company and they cover what they cover if anything and you get a check reimbursing you.
It seems like with the midwife you mentioned, if your insurance company chose not to cover your care, you end up getting billed more than someone who doesn't have insurance. That doesn't seem fair. Do you get a discount of that difference if your insurance chooses not to cover your care?

[camprunner]

See, I haven't called her yet since we aren't even officially ttcing yet. I'm not sure how that works. I think I'm missing something. That's why I was hoping someone could shed some light.

[Paige, CPM]

You should call her and ask her more questions. Basically when you (the midwife) bills insurance you try to bill for every little thing that you do prenatally, at the birth, and post partum in hopes that you can recover all of your fee for your client. If the insurance happens to pay more than her fee then legally the extra goes to the midwife for all her extra work...I believe that is what you were reading, and that happens rarely. So, yes, you do want to try to bill your insurance for her services. Even if you transport if your insurance says they cover your midwife the insurance will cover the hospital and some of her services as well.

Good luck finding the right person for you!

[camprunner]

Thank you for the response Paige. So let me see if I understand:

If her fee is $2500 and I have a $1000 deductible on my insurance (she would be out of network so assuming that copays don't apply). Then if she is reimbursed $3000 for my birth...I would either be reimbursed $1500- $2500 and she would keep $500-$2000? So it would actually save money?

[tibeca]

Maybe I can help clarify some?

My midwife charges our insurance more, but we would still pay the base fee.

So if hb were $2000, she would charge our insurance $2500. We would still only pay $2000. After the insurance comes back and refunds our money, anything over the $2000 goes to the midwife. Make more sense?

[Paige, CPM]

Say the general midwifery fee is $4000. If you don't have insurance this is what you pay for prenatal, birth and post partum services.

If you have insurance that covers your midwife's services then she might take a 'deposit' from you of the $4000 as she will bill the insurance after she has rendered all services. Because she is billing your insurance for her work any insurance payment goes to her. Then IF the insurance pays her you will get some/almost all money back. (You will get copies of all transactions between her and the insurance company, ie copies of all payments so you will know exactly what is going on.)

Say the insurance pays $3000 of coverage for all the care...that is what you will get back from your midwife, more or less. She will keep $1000 from your deposit in order to total the $4000 fee. Say insurance pays $5,200 for all care...then you will get back your $4000 from your midwife and rightly and legally she keeps the remainder. Should your insurance company refuse to pay then you will not get any money returned as that is the general midwifery fee for those services.

Also there are fees involved. For example my midwifery billing company charges 8% of total payments. I charge a $30 admin fee for all the paperwork / time spent involved in trying to get coverage. So, if the refund were $3000, it would actually be that minus $240 (8%) and the $30 fee...$2,730.

Such a pain! I love national health care!

Does that make better sense?

[russsk]

My mw has different fees as well. My oon deductible is higher than her fee, however, so we both decided that I would pay her lower, non-insurance fee and leave the insurance company out of it. There are trade-offs on both sides - she accepts less money but doesn't have to file or wait for payment (I will be paid up by 25 weeks) and I pay less out of pocket but risk higher costs down the line if I need other oon services and have to pay that deductible. If I did decide to use insurance, I would pay her some upfront and she would bill insurance. Depending on how much they covered, I would either have to make up the difference out if pocket to reach the fee, or she would return any overpayment to me. She wouldn't be double billing both me and the insurance, however.

[camprunner]

Thanks. This does help and it sounds like I completely misunderstood what I was reading.

[MidwifeErika]

In some states the insurance companies send the parents the reimbursements directly and so some midwives also take their normal fee and tack on a few hundred dollars to the fee of the insured clients that needs to be paid in advance to cover the biller fees as well.

Some midwives also charge the co-insurance amount, so if their fee is $4000 and you have a $1000 deductible and then a 60-40 plan for out-of-network then your out-of-pocket costs for the birth would be $1000 deductible and then $4000 x .4= $1600 so out of pocket= $2600, the rest would be covered by insurance. Anything above that reimbursed by the insurance would be for the midwife to keep. Confusing, right?

[olstep]

Originally Posted by MidwifeErika

Some midwives also charge the co-insurance amount, so if their fee is $4000 and you have a $1000 deductible and then a 60-40 plan for out-of-network then your out-of-pocket costs for the birth would be $1000 deductible and then $4000 x .4= $1600 so out of pocket= $2600, the rest would be covered by insurance. Anything above that reimbursed by the insurance would be for the midwife to keep. Confusing, right?

If she meets her deductible by paying the deductible to the midwife not to other provider then 40% should be taken from $3000 not $4000

$4000 (midwife's fee) - $1000 (the deductible that has been paid to the midwife) = $3000 multiply 0.4 which makes $1200. Together with the $1000 deductible, her total out of pocket expense will be $2200 not $2600

[olstep]

One more thing to consider. If your midwife (the one you will choose) is out of network provider and there is no in network MWs in your area who can provide the service you are looking for (HB) you may try to get your insurance authorize the MW so that your payments would be as if she is in network.

In this case her fee may not be $4000 but what she will negotiate with the insurance when she will call for the authorization. Usually lower. Then you should pay whatever your in network benefits from the contracted rate (what she negotiated with the insurance)
You should end up paying only your %% of the amount she agreed with the insurance. It would be illegal to make you pay more than that.

It doesn't mean that you can't pay the difference between the contracted rate and MW's normal fee (the full amount or a portion) if you are willing to.

[russsk]

Originally Posted by olstep

If she meets her deductible by paying the deductible to the midwife not to other provider then 40% should be taken from $3000 not $4000

$4000 (midwife's fee) - $1000 (the deductible that has been paid to the midwife) = $3000 multiply 0.4 which makes $1200. Together with the $1000 deductible, her total out of pocket expense will be $2200 not $2600

I don't think this is how it works. The deductible has to come out of the amount the insurance would cover if there were no deductible. At least with with my insurance. In figuring the amt insurance will pay, the mw fee is less important than the allowed amount. If mw fee is 4,000, allowed amount is 3,000, oon coverage is 60% and deductible is 1,000, then insurance will pay $800 (60% of 3,000, minus $1,000). That leaves out of pocket costs at $3200. This is why I am leaving insurance out of my hb.

[MidwifeErika]

Originally Posted by olstep

If she meets her deductible by paying the deductible to the midwife not to other provider then 40% should be taken from $3000 not $4000

$4000 (midwife's fee) - $1000 (the deductible that has been paid to the midwife) = $3000 multiply 0.4 which makes $1200. Together with the $1000 deductible, her total out of pocket expense will be $2200 not $2600

Oh goodness, you are right! Sorry about that!

[ShwarmaQueen]

If you're going to pay cash upfront, maybe she can give you the 'cash' (no insurance) price then you can submit the receipts to your insurance. This way you get the lowest price, and you also get a little back from insurance.

We did this and got back about half of the total fee, but IMO, you couldn't have even put a price tag on my HB experience! It was worth every penny, even without the reimbursement.