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Wow!! Itemized Pricing for MW Services???!!! - Page 2

post #21 of 29
I think the biggest issue here is not what her itemized fees are and how they compare with other midwives, but the fact that you didn't have that refund policy and itemized fees as part of the original contract. That is a HUGE issue. And then you top off the fact that she fraudulently transferred your signatures? I would let her know that what she has done is illegal.
post #22 of 29
I'm also thinking that there is a difference between what is reasonable to charge you directly, and what she would bill to insurance. I know my MW in NY billed for over $8000 worth of itemized things to the insurance co, in an attempt to get at least $5000. But if the insurance hadn't paid, I wouldn't have owed the $8000 amount. Only the $5000.
post #23 of 29
Thread Starter 
Quote:
Originally Posted by Lady Lilya View Post
I'm also thinking that there is a difference between what is reasonable to charge you directly, and what she would bill to insurance. I know my MW in NY billed for over $8000 worth of itemized things to the insurance co, in an attempt to get at least $5000. But if the insurance hadn't paid, I wouldn't have owed the $8000 amount. Only the $5000.
Very true...as the birth center/home we used before this pregnancy also did the same. The difference is that this mw is not set up to accept insurance of any sort at all so each of her clients are going into it self pay.

As far as discounting it...the same thought had crossed my mind...or at least leaving it where the original price was and not continuing to jack it up. But I had also given though tot the extra assistants' fees. But, in our case, the other 2 inexperienced midwives were coming for no charge and at their own travel expense, even stating they would make as many "dry runs" as they had to in order to make sure they were here for "the real deal and the big show", as they both desperately wanted the twin experience also and were very eager to attend. The 1 mw with the experience that I was told I wouldn't meet until birth did have a 200.00 assistant fee, from what I understood. But yet my mw was charging me an extra 500.00 for the "twin fee" and all of the extra expenses incurred with an extra baby. I asked specifically what these were and basically the only answer she ever gave was extra cord clamps, hat and the small baby items after birth. So, I was always a bit bewildered by the extra 500. It was one of the biggest deterrents and what orginally started raising our eyebrows over the whole ordeal. After it all got a bit stirred up and then we faced the whole number of birth team people, interventions and so forth it just kind of ended it for me. When she pulled the stunt with the contract it was shocking and confirmed our decision to leave her care. The whole contract thing is still just a shock we are having to get over since I never suspected her capable of doing such things. We probably would've even used her again for a single baby birth later. But, not anymore. She seemed so good and kind and trustworthy. I'm not even sure why anybody would go to these lengths if they'll never take it to court anyway. I think mainly it was out of anger and hurt and even embarrassment on her part over having lost the opportunity to attend the birth....and she may have been just trying to prove a point and scare us. Who knows. I just know by the end of it I didn't have alot of choice in the choices that she was supposedly giving me. I'd give her my opinion or answer on something and she'd even come back and counter it or just state we couldn't do it that way cause it was the only option we had...like the one attendant I wasn't so in love with. Supposedly I had a choice in who attended and the number of people. By the end of it 4 were mandatory, 5 preferred and 7 if she had it teh way she liked. When I showed dislike of one of them she said there really wasn't an option left and I had to have her. I gave in but never really was ok with it and the more changes that took place and the more charges incurred the more fed up we got with it all. By the end of it, it kind of seemed like building a house with an open ended budget and no ceiling on the expense of it.
post #24 of 29
Tell her (in a certified letter, not email) that you want a copy of the ORIGINAL contract, or else you are going to pursue forgery charges and start making complaints to NARM and your state's midwifery licensing board. And I would not pay her anything until she complied. The $891 that you've offered her is more than fair, all things considered.
post #25 of 29
Quote:
Originally Posted by Lady Lilya View Post
I'm also thinking that there is a difference between what is reasonable to charge you directly, and what she would bill to insurance.
Um, no. You are suggesting that a midwife is not worth her entire fee just because some choose to offer a discount to clients who do not have insurance. The insurance fee should be her actual honest and fair fee.
post #26 of 29
Quote:
Originally Posted by nashvillemidwife View Post
Um, no. You are suggesting that a midwife is not worth her entire fee just because some choose to offer a discount to clients who do not have insurance. The insurance fee should be her actual honest and fair fee.
However, in the situation Lady Lilya was discussing, the midwife was billing higher individual prices in hopes to get her normal fee, so I think that's a pretty different situation altogether. I agree that her insurance fee SHOULD be her actual honest and fair free, however some midwives find that it's easier to get it if they overcharge to the insurance. Sure, it's not exactly fair or right, but neither is the system that makes it so that their only option at times to get the full fee is to overcharge because they know it will be reduced so much. It's a ridiculous and sad situation all around. If insurance companies weren't so screwed up and would pay the full fee no problem, then I would have serious issues with overcharging "just because." But this is one of those cases where it's just an unfair game all around. In essence, get the insurance company before they get you, in hopes to receive what you deserve in the first place.
post #27 of 29
Quote:
Originally Posted by nashvillemidwife View Post
Um, no. You are suggesting that a midwife is not worth her entire fee just because some choose to offer a discount to clients who do not have insurance. The insurance fee should be her actual honest and fair fee.
No, that is not what I am saying at all. I am saying that many midwives routinely bill to insurance for a lot higher than they charge for a birth, because they know that insurance will fight them for much of it. They itemize what they send to the insurance co, because they will pay for some of the items and not others. So they have to jack up all the items, so the ones that will not get paid will be balanced by the ones that do.

So, I wouldn't be surprised if the rates the OP was given are the rates that would have been billed to insurance.
post #28 of 29
How that can be done is a cash discount otherwise it is also considered fraud charging the insurance co more than the client, but insurance companies can get away with paying less than individual payers I guess through group discount. With all the agravation and work insurance co put you through to get reimbersed they should pay more and in states that dont have a timely deadline law they drag out payment for as long as possible.
All the ins and outs of business is one of the areas that midwives can be lacking in education. I would say inform her that the contract you received is not the one you originally signed and perhaps she did not realize that your info was transferred over to the itemized form it was probably just a mistake and you would hate for criminal fraud charges to be an outcome for her being a new midwife and all. Even if it might be intentional I would jolly her along with the benefit of the doubt cuz ick what a mess. Bottom line the original contract is what you signed and after that the specific charges that were not previously defined are going to have to be agreed upon.
post #29 of 29
Quote:
Originally Posted by mwherbs View Post
How that can be done is a cash discount otherwise it is also considered fraud charging the insurance co more than the client,
True enough! Fraud doesn't become ok just because one thinks there is a "really really good reason and everyone else is unfair and it serves them right and...."

Valerie
Former IL homebirth midwife
Current IL attorney
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