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Originally Posted by possum  I think my midwives were worth every penny we paid AND many times over again. However, my insurance did not cover any mw services - only hospital OB care. I feel I need the insurance "in case" of an emergency - birth related or just general life happenings. We are also paying taxes to subsidize free health care for others. We were glad to be able to afford what we saw as a reasonable fee to our mws, but significantly higher fees would have been cost prohibitive since we were paying for the medical care of others' and into a corrupted insurance system. I am glad that my mws seem to be able to make comfortable livings on reasonable fees without charging as much as they think they could possibly get. Wouldn't you want to get paid as much as you possibly could? Would you turn down a raise because you didn't want to cost your company too much? NO! You're worth whatever you are able to get in business, dear, and midwifery is a calling, a passion, a love and it's also how midwives put food on the table and shoes on their kids feet. WHY is it demeaning or wrong for them to get whatever they're able to charge? OB's certainly do NOT have this qualm about fees... hello?? Do you know how much the average OB makes??? they're not biting their nails thinking... oh oh oh, maybe I'm chargin too much!!! But this is because THEIR services are paid through insurance, so they're "invisible" to the average consumer. But we all still PAY for it. If midwives are as valuable as we all seem to think they are, then they DESERVE to be paid a professional wage. I think what you charge is based a lot on who you want to work with; not everyone wants to work with people just because they can pay a lot of $$$. Charging lower fees (yet reasonable for both parties) would allow a person to be better able to choose clients based on a good match rather than just the bottom line.
Melinda
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Dang, I had this really great reply and something ate it. But my, now much shorter (lucky you, reader) point is that with midwives being licensed and being able to bill insurance, wouldn't this be a MOOT point? I mean, basically, midwives who's skills and professionalism are similar to a nurse practitioner (in my mind, mind you... my opinions, soley) are being paid about 30% of what a NP makes, and about 20% of what an OB makes. Most midwives make less than a L&D nurse!! That's not right!
Doesn't anyone know of CPM's who are sucessfully billing insurance?
I'm really more familiar with insurance than I care to be, and I know this - insurance companies are ALL about the BOTTOM LINE and the bottom line is
MAKE MONEY. If they were shown that a comparable service - OOH birth - is going to save them THOUSANDS of dollars, tens of thousands, perhaps hundreds of thousands of dollars a year, you can BET YOUR BOOTS that they would pay attention to this.
Figure that OOH birth accounts for about 3% of today's births in America. So, I'm an insurance company and I have to insure 100 pregnant women. With a C-sect rate of about 33%, I am paying for 32 women to have c-sections, and 65 women to have vaginal deliveries. Just for this example, we'll say that the epidural rate is 85% for the 65 vag deliveries, and that costs $1500 more. So, normal vag delivery with no epidural is $8000, normal vag with epidural is $9500, and c-sect is running, on average, $14,000. ($448,000 for 32 c-sections) ($522,500 for 55 epidural-assisted vag deliveries) ($80,000 for 10 non-epidural vag deliveries) So, your total cost is for insuring and paying out on these 97 women is $1,050,500 - Yes, One Million, fifty thousand, five hundred! Three of your 100 women have opted out entirely, with (dividing the total cost by 97 remaining women, average cost is 10,829) a savings of $32,498 (and for these three women, they only ONLY paid their midwives a total of less than $9,000, which is LESS than a third of what the insurance company WOULD HAVE BEEN WILLING TO PAY!!!! Ok, but now it gets interesting.... now insurance has "gotten it" and they're willing to pay for OOH births too, because they've figured out THIS fun math. Let's say that ONLY 6% of the women decide to now have OOH births, but their insurance is going to pay for it. The insurance will pay $4000 of the OOH fee (which is almost twice what the average midwife here is charging). But they're HAPPY to pay it, because of this fun fact... it saves them on average, (10,829 subtract $4000, multiply by 6 women) 40,974!!! Now, real cost savings is ONLY $8476, because now they're paying for all 100 women, including the 3 that previously paid cash. BUT BUT BUT.... $8476 is nothing to sneeze at, ESPECIALLY when you multiply that number by 10! What if we're talking about not 100 women, but 1,000 women? Is this more interesting? Now the company just saved $84,760 in JUST ONE YEAR! Whooo hoooo, somebody deserves a raise in that insurance billing company!
Well, yes, there is one more thing, I forgot to add the c-sect transfer rate costs... so lets factor that in.... an average of 5% transfer, out of the 30 women in our 1,000 woman insurance pool.... that would be... uh... 1.5 women.... 50% of which needed a c-sect... which is .75 woman... uh.. ok, so let's be generous and say that it's 1 woman. So, the insurance company insuring 1,000 women didn't save $84,760... they would have saved only uh... one more c-sect, plus one half of one vag transfer deliver... would be... 14,000 plus $8,000.... uh.... Ok, I got it, they only saved around $60,000.
Now, go to your local insurance guy and ask him if he thinks that Aetna or Farmers or Blue Cross or an HMO of some type would NOT be interested in saving $60,000 per 1,000 insured pregnant women?!?!?!? That's a cost savings of $60 per
every woman who becomes pregnant while insured under their plan.
I think they'd be interested -a lot interested, but that's just me. I could be wrong.....
Notice that's just a cost savings based on only 6% of their insured pregnant women taking this lower cost option. The savings go up as the numbers do, so 10% of women choosing OOH birth? That number is not unrealistic. Considering that we have about 350,000 births in this country per year, we're talking about 35,000 OOH births with insurance companies saving about, oh.... 20 million dollars a year. A YEAR.... a year.... holy crap... do you think they'd notice then?
I mean, PLEASE check my math... I could be TOTALLY off the mark, and I'm NOT being sarcastic at all... I'm tired, I've got lots of work still, but I just had to sit down and figure this all out. I'm not a cpa or even very good with numbers, but it just seems that a nice chunk of the "healthcare crisis" we hear about every election, every time someone needs some press and starts harping on the high cost of healthcare.... a nice chunk of it would be eliminated with midwifery care and we'd have BETTER results than we have now!!! Probably higher breastfeeding rates, lower incidences of and severity of PPD and PPP, lower incidence of iatrogenic infections and injuries, and a whole host of other WONDERFUL things that would occur with properly licensed, insured and included (into the healthcare realm) MIDWIVES!
yay... I'm out of breath... well, out of ...uh.... finger strength?
I think we'll need more midwives!!!!!
Optimistically,
Jen
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