Why are Nurse-Midwive's so expensive? It is really frustrating to me to want a home childbirth but I can't afford it! - Page 3 - Mothering Forums

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#61 of 67 Old 03-07-2010, 10:59 PM
 
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Tricare pays about $1500 for the birth (depending on where you live the amount varies slightly, or so I hear) regardless of birth location but they will also pay for prenatal visits, my last tricare covered birth they paid either $180 or $360 for each prenatal
This was how it worked in my experience too, at least in Kansas. My CNM was already a network provider, and since the area I was in at the time of my delivery didn't have a military care facility that handled births, I was able to choose her and a homebirth without a grumble from Tricare at all. Even when I ended up transferring to the hospital for a vacuum assist (tightening true knot in the cord during descent caused mec and decels), Tricare paid the CNM her birth fee of $1800 as well as her separately billed prenatal visits, and the hospital/doctor got paid as well.

In this state, trying to get Tricare to pay for an a homebirth made my head swim with the rigmarole, though I've heard some people managed it. Thankfully, I was able to switch to Standard and am going to deliver at the nearby birth center, which is the next best thing for us.
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#62 of 67 Old 03-08-2010, 07:10 PM
 
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Hey mama, I am not sure if anyone else has suggested this but have you considered a UC? It may not be for everyone but it can be an incredibly rewarding and empowering experience to take birth in to your own hands. The keys are education and trust, both of which pregnancy provide ample time to build. Some times money qualms can lead us to places we didn't expect to go. Blessings in disguise. I don't think a uc ever would have occurred to me had we not been in a situation where it was just not feesible to pay a midwife. (Hospital birth is out of the question for us). Anyway if you are interested in finding out more about UCs- what they are, safety, etc. a good place to start is Laura Shanley's website.

Lots of birth blessings!

Free-birthing, un-schooling (Waldorf style), extended breastfeeding, cloth diapering Earth Mama to Kayleb, ( 10/07) and Anaya ( 5/10)! Joyfully married to my beloved I hug trees and plant seeds.
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#63 of 67 Old 03-08-2010, 11:54 PM
 
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Paying over $5k here in the Boston area to have a C-section risk of about 10% compared to 30-40% in the local hospitals, to not be pressured to induce, to eat real food snacks with my midwife at our hour-long prenatals, to experience real labor support for as long as it takes, for an ardent fighter for our wishes to be upheld to the extent possible if we have to transfer, to have a choice in my position of labor, pushing, and birth; to have uninterrupted face time with my baby (if all is well) at birth; to experience EVIDENCE-BASED birth as research says is safest and best for me and my baby.

I worked part-time as an L&D RN making crapola money, and my hubby is a full time grad student. We MADE this work financially because I was NOT going to risk our experience to the hospital protocols and policies and take a 30-40% risk of being forced to experience unnecessary major abdominal surgery. It is really unfortunate that our insurance won't cover it, but this is someting that matters enough to me that I was willing to make it work.

I am paying for the faith of knowing that if I have a CS, it's NECESSARY.
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#64 of 67 Old 03-09-2010, 01:45 AM
 
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Originally Posted by mbhf View Post
Tricare pays about $1500 for the birth (depending on where you live the amount varies slightly, or so I hear) regardless of birth location but they will also pay for prenatal visits, my last tricare covered birth they paid either $180 or $360 for each prenatal, I remember the checks being $363 but I don't remember if that was for 1 or 2 prenatals. I have always been on prime, I did have to argue with Tricare quite a bit but eventually they granted me an out of network exception because they didn't have an in network provider that offered the service I was looking for.
I'm in this boat and for our area my midwife is expecting Tricare Standard to cover about $1400 of her $3000+ fee (leaving me to pay the rest, which I'm fine with doing). The thing that infuriates me is how some mamas want to constantly point out that midwives are not technically allowed to "balance bill" - claiming that we should apparently be putting our feet down to these mean midwives and demanding that they just accept the amount that Tricare wants to give them. I don't feel right about that, even if they are only "supposed" to bill me for 15-20% above what Tricare allows.
Sure, Tricare may think their services aren't worth all that much, but how does it make the situation better or care easier to access if we aren't willing to pay out of pocket to make sure they receive their full fee (which we'd be paying 100% of anyway if Tricare actually *didn't* pay for homebirths)? I really haven't heard of any midwives (at least not locally) who are willing to more than cut their fee in half in order to accommodate Tricare's billing rules (I don't think they should have to). It seems pretty standard here to either request full payment and let the client file for reimbursement (and the client be happy with whatever amount she receives from Tricare), or else the midwife will anticipate a certain amount from billing Tricare directly and have the client pay the rest before the birth. Kind of rambling I guess but just my two cents.

ETA that I have not been successful at all with getting an exception from Tricare so I finally decided to bite the bullet and switch to Standard.

Wife to 8/07, SAHM to DS1 12/08 & DS2 7/10
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#65 of 67 Old 03-09-2010, 02:30 AM
 
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Hi there! Another OB RN here and I had my youngest baby at home. It was so much nicer for both me and my baby than the previous hospital birth!
No way do I have time to read the replies to this thread so my apologies if all of this has already been stated.

Of course it cost a bunch, it is a business. I'm sure she doesn't get to pocket all of the money as she has business expenses and overhead to cover. That said, a midwife is still a lot cheaper and also spends way more time with the laboring mama than an MD. My insurance would have paid for the hospital birth but paid nothing for the homebirth. It was worth it to me to pay out of pocket.
Some things to consider:
-You may be able to get some early prenatal work and lab work done by an OB (thus, paid for by insurance) and then transfer the medical file to a midwife midway through pregnancy. I did that and it probably saved me $400 or so. You don't have to tell the OB that you plan on transferring out (I think I transferred around week 18).

- You may be able to deduct all or part of the midwife/hb fees from your Federal Income Tax. Check online for specifics, but if any given year out of pocket medical expenses total a certain percentage of your annual income, you can write them off. My hb wouldn't have been enough to deduct but later in the year I paid for laser/corrective eye surgery. That made it enough to write it all off! I always save my medical receipts all throughout the year because you just never know if you'll meet the requirement or not.

- Your midwife may offer a discount for a cash payment paid in advance. Mine did!

-Some midwives will let an apprentice work with her and reduce fees that way. It doesn't hurt to ask.

- A family doctor may be able to order things like lab work for your midwife and your insurance may cover it that way. Or, maybe your mw can arrange for some prenatals through the county health department and I think those are offered for a sliding-scale fee. Maybe your mw will be okay with lowering her fees for last trimester care & birth only.

- If you still think you can't swing it, ask your mw if she can work out a deal via bartering. Maybe you can do some web work, office work, house cleaning, etc. for a discount.

- If you haven't verified coverage w/ your insurance yet, do so. I don't know this personally but have read if your insurance says they'll cover homebirth but don't have any mw's listed as providers, that you can call and ask for an "out of network" provider to be covered. I don't know all the details. Maybe someone can pipe in w/ advice on this if they haven't already.

-If you can't have a homebirth and are worried about having an advocate for you in the hospital, you can hire a doula to help you!

Good luck with everything!

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#66 of 67 Old 03-09-2010, 11:45 PM
 
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SAME predicament here as many of you. There are few midwives here (that I know of) and they charge $3500-3800. Yes, that is cheap compared to hospitals. But, we also, are frequently in the red, and having to come up with a monthly payment of $475 or more is waaaaay beyond our budget.
And, I am wanting a VBA2C, so getting a doctor to go along with that is darn near impossible (around here it is, as I know it is almost everywhere). So my options are either: go to hospital and have another c/s or have an unassisted birth. I personally am not comfortable to have UC, so I really don't know what to do.
What can you do you know???

Blessings, Shannon
Mama to 3 Beautiful Boys - 10, 7, & 3 - and our 1st girl due 11/8/10! VBA2C hopeful!
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#67 of 67 Old 03-09-2010, 11:54 PM
 
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Originally Posted by Night_Nurse View Post
) and then transfer the medical file to a midwife midway through pregnancy. I did that and it probably saved me $400 or so. You don't have to tell the OB that you plan on transferring out (I think I transferred around week 18).
!


This is a GREAT idea mom nurse, and I plan on calling the local midwives tomorrow and discussing it with them. I have a GOOD feeling about this! THANK YOU for your insight, I'm sure I'm speaking on behalf of MANY of us!

Blessings, Shannon
Mama to 3 Beautiful Boys - 10, 7, & 3 - and our 1st girl due 11/8/10! VBA2C hopeful!
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