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Partial refund after miscarriage?

post #1 of 51
Thread Starter 

I've never posted here before (but was reading a lot, as I was planning my first homebirth), but I want to hear opinions.

Background: I was receiving care from a homebirth midwife for the first 16 weeks of my pregnancy. There was a free consultation, then the 12-week appointment and the 16-week appointment. The total fee for prenatal and post-partum visits and the birth (midwife plus one attendant) was $3000, expected to be paid in full prior to 36 weeks, with a partial payment at each visit, but nothing more specific than that.

12-week: approx. 1 hour, included urinalysis (strip provided by midwife, handled and checked my me), blood pressure, Doppler (midwife thought she heard heartbeat but I didn't hear it), and hemoglobin check

16-week: approx. 30 minutes, included urinalysis (same as before), blood pressure, Doppler (couldn't hear heartbeat)

After the 16-week appointment, I made the choice to get an ultrasound privately, and when no heartbeat was seen, I chose to follow-up with OB care, where it was officially confirmed that I had a missed miscarriage. I kept the midwife updated via email, but the 16-week visit was the end of her care. If it's significant, she did tell me that there were ways to get things going naturally (not what they were), and I replied stating my interest, and she overlooked that email. I think she would agree that her care ended after the 2nd prenatal visit.

So, my question is, how much should the cost be for those 2 visits? I should add that she did come to my house, about an hour drive each way, so that time/expense should be taken into account; she doesn't have an office so she only does home visits.

We paid $500 at the 1st visit, nothing at the 2nd visit (given the circumstances, we agreed that made the most sense). At this point, I believe that a $200 refund would be appropriate (so, she'd keep $300 for the 2 prenatal visits), and she's now saying that $300 was "to reserve the spot" (first time she mentioned this) and it's $100 per prenatal visit.

Opinions? (If you need me to clarify, please let me know.)
post #2 of 51
Did you sign a contract? My MW required a $400 non-refundable deposit to hold the spot, but I signed a contract stating that at the same time I wrote her that check. Each visit is billed at $50 if care is terminated early. So if it was my MW, I would be out the $500 you paid.

If you didn't sign a contract, then you might be out of luck trying to get a refund. She should have provided you with a website or printed materials outlining her fees. If she hasn't got any materials, you can ask for a refund, but you might not get one. You can also ask if she would be willing to credit you some of the money toward a future pregnancy and birth, which she might be more willing to do.

Good luck. I'm sorry you have to deal with this financial hassle on top of the emotional ones that come from a mc.
post #3 of 51
Thread Starter 
Thanks for replying.

The contract was very general, no "hold a spot" fee or per-visit fee stated, just $3000 total, with a partial payment at each visit, to be paid in full no later than 36 weeks. (We signed the contract at the 12-week visit, didn't ask for a copy, and happily handed over $500, with the expectation that the rest of the pregnancy would be as uneventful as my other two.)

The midwife and I are both flexible here, and if she keeps the full $500, we can live with that. However, it does seem like a bit much for two visits, which is why I told her that a $200 refund seems appropriate to me. She responded with that $300 was to reserve the spot and that $100 per visit is a "bargain" but she also doesn't want me to feel like I'm getting cheated. I'm here to hear others' opinions because I'd rather that neither of us feels cheated.

I don't think I'll go back to her for another pregnancy. There were a few minor issues that weren't enough to cause me to discontinue with her care, but I do think that they're enough that I'd likely choose someone else next time (hopefully there is a next time).
post #4 of 51
That's about what I'd expect to pay ($500). $100 for an hour long visit plus driving is a bargain in my book too. Sorry you're going though this.
post #5 of 51
I lost my first baby at 12.5 weeks and my obgyn did not charge me a dime...I had already had 3 visits. I was charged for the tests (urine, blood etc.) but since you don't pay for the birth and prenatal visits until after the birth, they never even charged me. In fact, they asked me to come in after the m/c (i had it at home) to do an u/s to make sure there was nothing left inside me and they did not charge me. I thought that was really sweet of them.

To be honest i'd be annoyed with your midwife. No way should she keep 300 for the "spot" since you are no longer going to need that "spot".
post #6 of 51
I think that refunding you 200 is the right thing to do. She can't unload a 300 "fee" that she never told you about verbally and you never read about. I don't think that is legal.
post #7 of 51
It seems about right to me.

Even if you did not use that spot later on she may have turned away other Mamas with the same due date during those 16 weeks, so your spot was being saved and she should be compensated for that.

$100 per visit seems reasonable especially with the driving.
post #8 of 51
My midwife had some rates in her contract ($100 for an office visit, $200 for a home visit) in the event of transfer of care. Perhaps suggesting a $100 refund would be a compromise that you and the midwife could live with?

$500 does seem a bit steep to me for two appointments....
post #9 of 51
I went to the gp, ended up seeing his PA, waited an hour was sitting in the room waiting another 15 minutes, was actually seen for 5minutes total, charged 120$ they do have billing for extended visits for around 15 minutes you pay 180$ there are no free visits at my docs, now one of the techs does the urine dip, and they send you to the lab for lab draws.
post #10 of 51
I also think $500 is too much for 2 visits. I miscarried at 11 weeks. Although I had only seen my chosen MW for one meet and greet, she offered me a Rhogam shot for free (I paid for the meds but not the visit) in her home. Never did she mention paying her for anything (though I never had an official visit until after the Rhogam).

Re the reserve the spot fee: I think that's fair if that's her policy but I would expect to know that very clearly and way upfront. NOT after a miscarriage!

I would ask in birth professional how common a reserve the spot fee is and how it is handled by way of a contract.

Incidentally, I am pregnant again and my MW is saving a spot for me until the 12 week visit. I would be surprised and disappointed if I found out there was a charge for this service in the event of a miscarriage.

Sorry you're going through this on top of all things, mama!
post #11 of 51
Thread Starter 
Thank you to everyone who responded. I'm still not sure what to do, but the replies are helping me think about it. I just want both of us to pay/keep a fair amount.

I think what's making it difficult for me is that it almost seems like she's making up amounts to fit exactly what we paid, which seems like quite the coincidence, since that just happens to be what we gave her at the first visit (to which she reacted as if we were being very generous, at the time - I get the feeling people don't usually pay 1/6th of the total fee at the first visit).

To clarify the "reserve the spot" thing, she did say that we should pay something at the first visit, in order to keep the spot, but not a specific amount and certainly not in addition to her (unstated at the time) per-visit fee. She gave us the idea that paying anything (within reason) at the first visit was appropriate. Had we given less than we did, I still think the second visit would've gone the same way (no heartbeat heard, no fee paid) unless we'd significantly underpaid the first time. I can't be sure of that, but it does seem like whatever we happened to pay at the first visit would've been our total.

I don't know if this is worth mentioning or not, but due to some health issues of her own, I don't think she would've taken on other clients to "replace" me. At one point, I thought I'd have to find another midwife because she missed our appointment without calling, was unreachable for over a week, and when she did explain what had happened, I understood but still didn't have the confidence in her that I had up until that point (I'm not blaming her, just being realistic). Considering this, I don't know whether to be sympathetic and not want to haggle about the cost/refund or to be more upset that she doesn't think we're entitled to a refund, given that we'd already had some issues in the short time in her care.
post #12 of 51
We also paid our midwives a $500 deposit. We had one free consult and two prenatal visits. We miscarried at 13 weeks. They refunded us back most of the amount less $75 per visit.
post #13 of 51

If I were you I think I would try to find another local MW (maybe just in the state) and ask them how they handle miscarriage/deposit. Here on MDC there is a forum for practitioners where I think you can ask these kinds of questions. If you get a significantly different response from them, I would just mention that to your MW.

Originally Posted by MJ123 View Post
To clarify the "reserve the spot" thing, she did say that we should pay something at the first visit, in order to keep the spot, but not a specific amount and certainly not in addition to her (unstated at the time) per-visit fee.
I would interpret that as you have to start contributing you your bill on the first visit so MW knows you aren't going to just transfer care w/o paying - not that there is a *fee* for holding the spot.

As I recall, my current MW requires people to gradually start paying, have paid $1200 by the 7th month and the rest on some sort of arranged payment plan after that.

I have to agree with your feelings that it's pretty coincidental that MW's charge for 2 visits + "save the spot fee" = exactly what you paid. Sorry to sound suspicious of a MW but I just wanted you to know that I'd probably feel the same way if I were you.

I really think there is no harm in letting her know your feelings. So long as you are confident that you want to pay her for her time, I feel like you have some valid points that would be good for her to hear.

For the record, I have gone to 3 HB MW's and my experience with billing has always been that it is very clear and upfront and I think that is a reasonable expectation.

I hope it all works out.
post #14 of 51
Thread Starter 
Belle, that is what I was expecting/hoping would happen, that she'd consider the $500 an overpayment, and whatever (reasonable) amount she thought of for her time/supplies/travel expenses for the two visits would seem fair, and she'd issue a partial refund. I wasn't thinking either of us would need to get nitpicky about the numbers after a miscarriage.

IdentityCrisisMama, I'm glad to know it's not just me who'd be suspicious that the numbers seem made-up based on what we paid. And, yes, that's exactly how I took it, about paying at the first visit to keep the spot, that we'd start paying then and continue making payments at each visit, as opposed to giving x amount as a non-refundable payment even in the event of pregnancy loss at any stage. When I said that this "reserve the spot" fee was not mentioned before, she responded that this $300 fee not only "reserves the spot" but also covers "getting started" and "creating the file." The "file" is a file folder with papers in it that I provided, including copies of a few prenatal tests from prior pregnancies and my recording of what I ate for 3 days (at her request - this was given to her at the 16-week visit), along with whatever paperwork we did at the first two visits. In my opinion, the charge for making/keeping paperwork from the prenatal visits is part of the fee for the prenatal visits; everything else in this file was provided by me. "Getting started" is also not something that warrants a surprise $300 non-refundable charge.

I emailed her today to reiterate that $300 (i.e. refund of $200 of $500 payment) seems like a fair cost for the two visits. I told her that since the "reserve the spot" fee was not mentioned until after the fact, I do not think it is fair to include that in the calculations, and I think that $300 is fair for two visits, including getting started and creating the file.
post #15 of 51
My MW has a $500 non-refundable deposit. But we also have a contract that states this.

There's also a break down of what the fees are if we transfer out so we'd know what to expect back.

If you don't have that in a contract, you may be outta luck, honestly...

I'm so sorry you're having to deal with this after everything else.
post #16 of 51
My mw does have a non-refundable $300 deposit, and I think she charges $70? per visit in the event of transfer. The $300 is completely used up with bloodwork at the first visit. It's very clearly stated in her contract, though.
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post #17 of 51
I agree w/your gut - that she's just conveniently "making up" fee amounts to keep the $500. On one hand I don't entirely blame her (she could have easily spent the $ and was likely expecting more to come in given that you'd be birthing w/her) but on the other, what a shitty thing to do to a mama who's miscarried.

I think what you suggested was more than reasonable and she should give you a refund. If there was nothing in the contract (or on her website, other materials, etc.) about a "reservation" fee than that's bunk and honestly she should be giving you the $300 back, not just the $200 that you suggested.

I hope you can come to a compromise that doesn't make you feel any worse than I'm sure you probably do about this m/c experience
post #18 of 51
Thread Starter 
I wish I had the contract in front of me but I wasn't given a a copy (hindsight is 20/20, right?). However, I know for sure that nothing was broken down. The contract was regarding the total fee being $3000 and a payment being expected at each visit, to be paid in full no later than 36 weeks. Under that were the lines where we'd write in each payment, date paid, and sign. We didn't ask for a copy or even a receipt (our cancelled check would be the receipt). For the record, she didn't even give us an expected amount, even verbally, aside from the total, prior to the loss.

I am more than willing to pay for her time and expertise as well as any expenses she incurred. Her expenses are limited though, with travel being the most significant. She does not do bloodwork (hemoglobin test kit aside), nor could she prescribe it, nor did she contact anyone on my behalf to set it up. I opted out of the prenatal screen mainly because I did not think it was worth the hassle of finding a practitioner to prescribe it. (I was still thinking about whether I'd make the same decision about future prenatal tests, as this was not something that was discussed at the consultation.) So, her expenses were from travel (4 hours), 1 hemoglobin test kit, 1 set of gloves, 2 urine test strips, and a few sheets of paper and a file folder.

I don't know when I'll hear back from her, but the more I think about this, the more I feel like $500 is too high. I think that everyone who replied so far that paid or would've paid $500 for the first two visits also had it spelled out beforehand, and that's not what happened to me.
post #19 of 51
Originally Posted by Maluhia View Post
It seems about right to me.

Even if you did not use that spot later on she may have turned away other Mamas with the same due date during those 16 weeks, so your spot was being saved and she should be compensated for that.

$100 per visit seems reasonable especially with the driving.
I agree with this, except that she really should have spelled this out in her contract. She didn't, so hopefully she will issue you a partial refund and chalk this up to a learning experience for her; she needs to revise her contract.
post #20 of 51
Thread Starter 
mcimom, I was typing my other reply while you posted. Yes, I'm feeling that way too, that the $300 I'm "letting" her keep seems pretty generous to me.

And, you're right, I don't like dealing with this on top of everything else. Luckily, it's not as fresh right now, but it hasn't been a good experience.

At 12 weeks, I didn't hear the heartbeat even though the midwife said she did. (I've had two healthy pregnancies, so I know what it sounds like.) I've always waited until the beginning of the second trimester to tell people about the pregnancy, but this time, I decided to wait until I heard the heartbeat, so we set up the next appointment for about 15 weeks, in place of the 16-week appointment, so that we'd be able to hear the heartbeat then. Since we made the appointment in person, I emailed her to confirm the date and time, and replied that she'd see me then.

For that visit, we waited and the midwife didn't show. After a while, my husband called her to find out if she was on her way. She explained that she was in the hospital, had been for 4 days, and was going home that day. She also said that she'd called all of her appointments already and she had another client in our time slot. I absolutely understand that she may have to miss an appointment sometimes, and being hospitalized was a good reason. I didn't appreciate not getting a call, and based on what she said, it sounds like if she wasn't in the hospital, she still wouldn't have shown up. That said, mistakes happen, and aside from being anxious to hear the heartbeat and hear that everything was okay, I got over it.

I couldn't reach her for the rest of the week, and I thought that I might have to find another care provider, but then she called and we set up another appointment for a little after 16 weeks. This time, she said she thought she heard something that might be the heartbeat but I told her I didn't hear anything so she kept trying. She wasn't concerned (or maybe that's just her disposition) but we discussed getting an ultrasound.

The next day, I called an OB's office where I went for a previous pregnancy, and they wouldn't take me as a patient unless I set up two appointments, one to meet with a nurse and discuss pregnancy in general and the next one, possibly as far as 2 weeks later, would be my first visit with a doctor. I was very clear that I was calling because of a suspected missed miscarriage, but it didn't make a difference. After a very stressful morning, I ended up going to one of those private companies that do 3D/4D ultrasounds, of course explaining my situation beforehand so that they'd understand that I wasn't their typical client. (The difficulty of setting up an ultrasound that day, prior to calling that place, was the first time I'd ever regretted my decision to homebirth. I'd considered the "what if something goes wrong" factor, but I had no idea it would be so hard to get care if it did.)

That ultrasound confirmed that there was no heartbeat. The very nice man who did the ultrasound called a local OB for me after I explained what I'd gone though that morning, how difficult it seemed to be to get an OB appointment. That OB's office gave me an appointment, where the doctor and I discussed options (waiting it out or D&C), and I decided to do a mix of the two; I set up the D&C appointment for 20 weeks so that my body would have more time to let things progress naturally.

In the meantime, I emailed the midwife an update of each appointment (as she requested), not expecting replies because they weren't necessary. She replied that I didn't have to do a D&C and that there were natural ways to get things going. I replied with interest, and she never wrote me back until after I had the D&C (never had any other signs of miscarriage, but I had a total of 3 ultrasounds, including one at 20 weeks, to be certain that the baby had no heartbeat and had stopped growing - I don't know how long it would've taken to complete the miscarriage naturally) and emailed her to let her know.

Don't even get me started on what I was almost charged for the D&C (high deductible health plan, so it was mostly out of pocket). This disagreement over finances that I'm having with the midwife almost seems silly in comparison, but it's still a couple hundred dollars that I'd rather not just give away.

Emotionally, I'm doing better than expected, maybe because my loss happened over a course of a couple months. The D&C was recent, but I was already concerned about a loss at 12 weeks (based on size, the baby stopped growing somewhere in the 12-14 week range) when I didn't hear the heartbeat, even if there was one. At 16 weeks, I was upset but not totally surprised; I wasn't expecting a loss, but I also hadn't totally gotten my hopes up and allowed myself to feel totally connected with the baby, if that makes any sense. By 20 weeks, I was ready to move on and hopefully conceive another child as soon as we're able. And that's where we are now.

Sorry for going on and on. We never did tell anyone about the pregnancy (care providers aside), so it's nice to be able to talk about it here.
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