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#31 of 51 Old 09-17-2010, 11:32 PM
 
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About breaking down the costs, I'm a math person so I've done that a bunch. Including prenatal and post-partum visits for a healthy 40-week pregnancy, we would've had 17 visits, not including the birth, and I pointed that out to the midwife. To me, if you count the birth as 3 "visits" (which, in time, expertise, and supplies used for the birth not to mention the second attendant who I never met, is a very low estimate, but it helps make a round number), that's 20 "visits" for $3000 total fee, so $150 per visit, or $300 total that I want her to keep. I think that's generous since the birth would really be a larger portion than I'm accounting for.
It just doesn't work that way. All midwife hours are not equal. What about the time she spends on call, ready to drop everything in her life at a moment's notice, to give up possibly entire days of her life to be with your family? You can't put a price on that commitment. What about the liability of attending a delivery and being the care provider for a laboring woman, a postpartum woman, a fetus, and a newborn? There's no way to equate a birth with any number of prenatal visits.
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#32 of 51 Old 09-18-2010, 12:01 AM
 
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I think the thing is, NM, that if you're charging for a service....you kind of are putting a price on those things. I agree that the services homebirth midwives charge are an absolute bargain! But with pregnancy the way it is, it can be expected that the MW be able to break down her service in the event of a miscarriage, a missed birth, transfer of care and etc.

I n the case of MJ's MW she broke her services down to 50/50 prenatal/birth, estimated the average number of prenatal and came up with something like $88/visit.

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#33 of 51 Old 09-18-2010, 12:13 AM
 
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I think the thing is, NM, that if you're charging for a service....you kind of are putting a price on those things.
Of course you put a price on it, but it's faulty thinking to ever try to equate the monetary value of the birth to any number of prenatal visits. Apples and oranges.
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#34 of 51 Old 09-18-2010, 12:20 AM
 
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Oh, I see. Yes, I agree they are so very different. It's just that most MW (as I'm sure you know) just charge a flat fee...and then when they need to break it down I guess they kind of have to divide the fee up.

It would be interesting to hear how you divide the fees up in the event of a miscarriage or transfer of care. If you care to share. I was kind of interested to hear a MW's perspective.

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#35 of 51 Old 09-18-2010, 12:34 AM
 
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Oh, I see. Yes, I agree they are so very different. It's just that most MW (as I'm sure you know) just charge a flat fee...and then when they need to break it down I guess they kind of have to divide the fee up.

It would be interesting to hear how you divide the fees up in the event of a miscarriage or transfer of care. If you care to share. I was kind of interested to hear a MW's perspective.
In my case, those fees aren't actually "divided up". That flat fee (or global fee) is a package price for maternity care (prenatal, delivery, and postpartum) and it does not break down into separate components. It's like buying a value meal at McDonald's. You pay one price and get the burger, the fries, and the drink, and when you order that way you pay less than if you ordered each one separately. If a client leaves my care and that flat fee no longer applies then I wipe the slate and start over with a new itemized bill.

Does that make sense?
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#36 of 51 Old 09-18-2010, 12:50 AM
 
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Does that make sense?
I guess.

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#37 of 51 Old 09-18-2010, 01:43 AM
 
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I just realized why this whole situation seems so odd to me. It was like a ding-ding moment.

MJ, this whole time I felt like I knew my MWs fees for prenatals and her fee for birth and I *did* and here's why:

I needed to be aware that in the event of a hospital transfer, I (or my insurance) would have to cover the MW and the cost of the hospital birth. In my case insurance was paying so it was important for me to know the out of pocket expense I would owe to the MW if we transfered. The prenatals from the MW would still be covered by insurance but birth would not.

NashvilleMW, can I joke with you a little? I was also thinking of your comparison of a McDonalds Value Meal to a MW's "global fee" and thought it was funny that you thought that was oranges to oranges. But prenatals and birth are French fry to hamburger.

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#38 of 51 Old 09-18-2010, 02:05 AM
 
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In my case, those fees aren't actually "divided up". That flat fee (or global fee) is a package price for maternity care (prenatal, delivery, and postpartum) and it does not break down into separate components. It's like buying a value meal at McDonald's. You pay one price and get the burger, the fries, and the drink, and when you order that way you pay less than if you ordered each one separately. If a client leaves my care and that flat fee no longer applies then I wipe the slate and start over with a new itemized bill.

Does that make sense?
Do you charge your entire global fee when a woman has a miscarriage after having 2 visits with you?
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#39 of 51 Old 09-18-2010, 01:36 PM
 
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No. The global fee is for prenatal, delivery, and postpartum. If a client leaves my care and that flat fee no longer applies then I wipe the slate and start over with a new itemized bill.
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#40 of 51 Old 09-20-2010, 10:42 AM - Thread Starter
 
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It just doesn't work that way. All midwife hours are not equal. What about the time she spends on call, ready to drop everything in her life at a moment's notice, to give up possibly entire days of her life to be with your family? You can't put a price on that commitment. What about the liability of attending a delivery and being the care provider for a laboring woman, a postpartum woman, a fetus, and a newborn? There's no way to equate a birth with any number of prenatal visits.
nashvillemidwife, I think you misunderstood my post. I'm not in a situation where I'm paying for the birth and not prenatals and trying to set a low value for the birth and everything directly associated with it. In my situation, I'm paying for 2 prenatal visits; it would benefit me to put more value on the birth, and I'm purposefully not doing that. I'm trying to err on the side of benefitting the midwife.

I was breaking it down roughly and my estimate of birth = 3 visits was a purposeful (significant) underestimate of the value of the birth, which in this case overestimates what money the midwife gets paid for the prenatal visits. I absolutely think the birth (including the things you mentioned, such as liability and being on call) is "worth" more than 3 prenatal visits. Breaking it down like that would mean that I should pay LESS for prenatals, and I was calculating to err on the side of paying more.

I'm not trying to underpay. I want to pay a fair price, and to me, $300 for 2 prenatal visits still seems like an overpayment, but one I'm willing to do. ($500 for 2 visits seems unreasonable to me, which is why I'm trying to get $200 back.)
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#41 of 51 Old 09-20-2010, 10:51 AM - Thread Starter
 
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No. The global fee is for prenatal, delivery, and postpartum. If a client leaves my care and that flat fee no longer applies then I wipe the slate and start over with a new itemized bill.
I know each midwife would answer this differently, but what would you charge in my situation?

Summary: 12-week and 16-week prenatal home visits, 2 urine test strips, one hemoglobin test kit, possible 4 hours of travel (midwife does only home visits, has no office), client declined prenatal screen (would've had to find a doctor to prescribe, not through midwife), client found ultrasound provider and scheduled ultrasound to confirm loss. If it's significant, midwife missed appointment during this time period, with no phone call, and was unreachable for about a week following.

Total fee $3000 includes approx. 12 prenatals, birth, approx. 5 post-partum. Contract is general, listing total fee and that a partial payment is expected at each visit, but no details.
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#42 of 51 Old 09-20-2010, 05:29 PM
 
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I'm trying to err on the side of benefitting the midwife.
That's definitely how I understood your post, MJ.

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#43 of 51 Old 09-24-2010, 10:02 AM - Thread Starter
 
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Thank you again to everyone who responded.

I heard back from the midwife today. She told me that while she stands by what she said before about her unstated policies (i.e. the undisclosed $300 non-refundable fee), she will refund the $200 I'm requesting (making the total $300 instead of the $500 we paid).

She also admitted that she does not have a policy for cases like mine and that she has no intention of creating one. I guess that's her choice...

Another thing she said confirmed what I mentioned here earlier. She told me that if we had paid $200 at the first appointment, she would've been fine with that as the total.

To be honest, none of this makes sense to me at this point. She's basically saying that she still feels entitled to the $500, she still believes her undisclosed policy should stand, she has no intention of disclosing this policy to future clients, but whatever we'd paid at the first visit would've been the amount she'd feel entitled to, even if it was less than what we're willing to pay her.

I still think she's a nice person and I appreciate that she's going to issue the refund, but her business practices seem weird to me, given this whole ordeal.
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#44 of 51 Old 09-24-2010, 12:02 PM
 
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What you have described isn't just weird, it's unprofessional, and shady. If you're going to put yourself out there as a professional you need to act like one in all aspects of your practice, including your financial policies. I'm glad you got some resolution even if it was arbitrary.
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#45 of 51 Old 09-24-2010, 04:07 PM
 
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She also admitted that she does not have a policy for cases like mine and that she has no intention of creating one. I guess that's her choice...
Hm, that seems odd. Miscarriages happen - along with transfers of care for various reasons. It seems like it is a good thing as a midwife to have policies in place for such situations.

I'm glad to hear that she is giving you a refund.

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#46 of 51 Old 09-24-2010, 06:12 PM
 
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Yea, MJ. I think your instincts were right from the beginning. She seems like she has a fairly odd relationship with money...I guess many people do. I always want to think of midwives as evolved in every way shape and form. That's probably not fair, ha?

I'm glad you got it worked out but wish for you that you could feel better that she was going to try to fix this problem for future clients.

I don't know how many MWs you've been to but I've been to 3 in 3 different cities and I can say that this was not something that ever would have happened with them -- so, there's hope in finding another MW down the road where you won't have to deal with this.

Thanks for sharing your most interesting experience!

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#47 of 51 Old 09-24-2010, 11:43 PM
 
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What you have described isn't just weird, it's unprofessional, and shady. If you're going to put yourself out there as a professional you need to act like one in all aspects of your practice, including your financial policies. I'm glad you got some resolution even if it was arbitrary.
Totally unprofessional.

My midwife's contract very clearly states how much she charges in the case of transfer (prenatal or during pregnancy). Very, very clearly. And it's most likely to never be relevant to me because of the insurance I have but she still has all her clients read and sign it just in case so there's no misunderstanding.

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#48 of 51 Old 09-26-2010, 12:52 AM
 
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Her business practices do seem odd...from what you've described she kind of seems sloppy about things in general. The midwife we first hired for this baby was like that (at least that was my impression of her based on a lot of little things). We ended up terminating her services after my second prenatal visit. She had initially wanted a $200 deposit (I think it was nonrefundable, don't remember what the contract said) which we paid upon hiring her...the contract didn't say anything about a per-visit fee. I did not offer to pay her anything additional and she did not ask. I feel like what we paid was completely fair to her given that I only had 2 short prenatals and some labwork (that I know only cost her $40 in lab fees) and her total fee was $2200 which included all lab work. I guess she could have asked for more but I don't know that I would have paid it since nothing was spelled out in the contract and I was pretty dis-satisfied with her quality of care overall.

Anyhow, I'm glad you got your partial refund.
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#49 of 51 Old 09-26-2010, 12:54 AM
 
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That really is unprofessional and Id be a little leery of dealing with someone who works that way with money. Of course, I like having everything laid out before I agree to anything so i might just be overally cautious.

~Heather~ Mama to Miss E (1/07), Miss A (11/08), Mr.T (2/11) and Miss A (10/12) Expecting our newest blessing sometime late Sept/early Oct.. Wife to my Marine since 11/2005
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#50 of 51 Old 09-28-2010, 11:58 AM
 
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IMO

1) She needs to edit her contract significantly- it should state how much is a non-refundable deposit and how much will be kept for each prenatal if care is discontinued prior to 36 weeks.

2) She needs to offer a copy of the financial contract to clients who would like one.

I'm sorry for your loss.
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#51 of 51 Old 09-28-2010, 01:09 PM
 
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I know you have this resolved and I really like your attitude about all of this. I thought I would post what is in my midwife's contract. They are the exact same as far as $3,000 total to be paid by the 36th week. The contract also says:

"In case of termination of services or a decision to transfer care to another provider, an adjustment will be made whereby $150.00 will be charged for the initial prenatal visit and $75.00 will be charged for each subsequent prenatal and postpartum visit. Reimbursement of fees will occur within 30 days."

Thought that might help. So, if you had seen my midwives, you would have been charged a total of $225 and been refunded $275 within 30 days.

I think it is probably a good idea for a midwife's contract to include situations like this.

Aimee wife to Matt Mama to Asher (4) and Ari (Due 11/6/10)
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