Is $800 reasonable for three visits?

[Farore]

I was really disappointed to receive a letter from my midwife today, telling us that she is leaving her practice. We also received a statement listing all of our charges up to this point. Her fee was $2600. We were to pay $200 upfront and the rest by 34 (or was it 36?) weeks. We decided to pay ahead a bit, and had given her $800 as of today (22 weeks). Somehow, the statement added up to exactly the amount we had paid, plus a dollar and change. We only saw her 4 times, one of which was a free consultation. So for $800 we got three office visits of about an hour (in her home) and 3 urinalysis dipsticks. I realize that midwives go above and beyond, and I am all for paying a reasonable fee, but this sounds high to me.

It's not just the amount that bugs me, but how some of the charges are classified. For every appointment, we were charged not only for an office visit, but also for a "prolonged face-to-face" charge of $100+ I do not remember being at any appointment for over an hour--if so it was definitely less than an hour and a half. We were never told that there was a time limit on appointments, or asked to cut it short. In fact, it seemed like she encouraged us to keep talking. The worst was one day when we had an appointment scheduled for 1 p.m. and she asked us to move it back until 3 p.m. We stayed about an hour. On that day, we were charged an after hours fee! We have never even called her, except to schedule the consultation!

This woman is a new midwife, but has been a doula for years. She is loved and respected by many, and I don't wish to bash her but frankly I am feeling really frustrated and betrayed right now. Do you think that is justified?

[Mom31]

That does seem a bit strange.

[MidwifeErika]

In the original contract you signed was there any breakdown of how you would be billed for prenatal appointments if a refund had to be given? Have you contacted her to let her know that you are upset about the way some of the things are itemized?

I certainly feel that you should not be billed additionally for things like "After hours" if she is the one who re-scheduled your appointment for that time. I consider it to be "after hours" if someone asks me to come in later than I normally do, specifically asks me for a weekend, or calls on a day that I am normally not doing appointments because of a problem or issue. I also just lay it out there in my contract exactly what the breakdown of costs would be in the event that someone cancels care with me or needs a refund. I try to make it easy on myself and on the family.

[Farore]

Thanks for your feedback.

MidwifeErika, I have not contacted her yet. I wanted to put my feelers out and see it and if what she is charging is normal before I make waves. I think she is going through some personal struggles and I don't want to make this more difficult. The contract does not list prices in case of a cancellation. It simply states that the fee covers "prenatal, birth and postpartum care." It also states that the birth kit, various elective tests, and infant medication are not covered. I suppose I should have asked up front to see a prorated fee schedule. It's a mistake I won't make again.

Also, if I can find a new midwife, I want to make sure I am not breaking etiquette in some way. Is there some unspoken rule that our appointments shouldn't go over a certain amount of time? I have not had a homebirth before (I have used hospital midwives) so maybe I missed something. I would hate to offend the midwife and get slapped with double the charge for my office visit again.

[kathrineg]

I think it is really interesting that her fees add up to exactly what you already paid, and that she included extra services that you did not ask for and/or do not remember. It's almost like she fudged the numbers until they matched up so that she would not have to return money.

The midwives I talked to in NYC were not charging $800 for three visits...ouch. Of course that could be reasonable in your area, but usually everything is pricier in NYC (unless you live in California...)

I am not a midwife, though, and ended up going with an OB because the midwives I wanted were full, so this could be a billing practice that I simply don't understand. 

[northrend]

I'm not homebirthing and I'm seeing an OB, but I thought I'd share my OB's fees to help you compare a bit.  She does global billing, and her contracted rate with my insurance is $3000 (it obviously ends up being more if she does a c-section and things like labs and ultrasounds are billed separately) for my regular prenatal visits and delivery.  I have had a couple of visits that fell outside of the "global billing package" and it cost my insurance $106 per office visit.  I live in Orange County, CA, so things are obviously on the expensive side here.  I know that comparing OBs to midwives can be a little like comparing apples to oranges, but I still can't see how your midwife can justify charging you $800 for those three visits.  Like a pp said, I think she probably just fudged your bill around to make it add up to the amount you had already paid so she doesn't have to refund you anything. 

[Farore]

We're nowhere near New York. Cost of living in our area is about 20% below the national average, if that gives you a point of reference. The actual office visits were only $108 (standard for that medical code as I understand), but each was doubled by the "prolonged-face-to-face" charge, whatever that means.

I have now spoken to her. She says that the detailed summary was for our convenience (for tax or insurance purposes). Apparently the after-hours charge was not for the later appointment, but for an ultrasound she ordered for us after the appointment that day. As far as I know, she feels the charges are reasonable--in fact she told my husband it should have been more (that may have been a reaction to the heated nature of the conversation, and I probably added some fuel to that fire myself). Nevertheless, she is willing to negotiate and we are now talking reimbursement.

Thanks, all, for your input.

[seafox]

yeah, just percentage-wise it doesn't make sense. If her fee is 2600, and she sees you like an ob/gyn sees you (once a month, then every two weeks after a bit, then every week towards the end?) I saw my ob/gyn 11/12 times or so (8 weeks, 12 weeks, 16 weeks, 20 weeks, 24 weeks, 27 weeks, 29 weeks, 31 weeks, 33 weeks, 34 weeks, 35 weeks, 36 weeks) - so if her fee was ONLY office visits (no birth?!) that still would be ~ 235$ a visit, which is 700. But that would mean not charging at all for the actual birth! So I'd ask her how she'd break down a whole pregnancy/birth by that fee - if the 'birth' part is 1K or something, then the visits would be WAY less. And I'd ask how many visits she'd expect to have, I'd guess that there'd be at least 10-11.

[BubbleMa]

I don't want to badmouth someone I don't know...but...it sounds like she spent the money you already paid and doesn't have a way to pay it back.  So she thought of every possible way to make the bill add up to $800.

[futuremamaheather]

My midwife charges $75/visit flat fee for visits that happen at her office, and $100/visit if the visit happens in our home.

[AbbieB]

Way to much!

[Nicole730]

That sounds like way too much.  My midwife charged $40/appointment.  They usually lasted an hour because we were chatting about stuff.  I did the urine dipstick at every appointment.

[Farore]

Thanks again for your input.

There could be something to BubbleMa's theory, and I think that's why it really rubbed me the wrong way. Each charge has a corresponding CPT billing code, and it almost looks like they were cherry-picked to add up to the right number. She thought the charges were fair, based on how far along I was (22 weeks when she cancelled). She was going by how long I had been pregnant and not what services she had provided. The thing is, almost all of the appointments are concentrated in the second half of pregnancy--not to mention the birth and a couple of postpartum visits. I'd like to think it's a case of bad math and not a deliberate attempt to rip me off.

Oh well. She is making it right now, and that's what matters. Like I said, I don't want to bash her. She really does seem to be a good, caring person. I just think she was new to the business end of the profession (she has attended births in various capacities for years) and got in over her head.