Wow!! Itemized Pricing for MW Services???!!! - Mothering Forums

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#1 of 29 Old 09-30-2010, 08:38 PM - Thread Starter
 
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So, we ran into a few problems with my midwife. I really did like her and feel such a bond but after finding twins at 21 weeks the more hands off approach became very much a hands on approach. She has no twin experience whatsoever....as in, she has never even cared for or seen a twin pregnancy or birth in all of her years of training and apprenticeship. We went from just she attending a single baby birth to now needing 5 present for the twin birth...herself, 2 other certified midwives that have no twin experience, another cert mw that does have some twin experience but that I would never meet until the birth and a student. The more weeks that passed the more she seemed nervous and intervention/transport happy and the more what we desired went out the window as to what she thought neccessary and was beginning to impose on us. I think alot of her nervousness came from suddenly reading books and a ton of materials with no twin experience to really balance it. To make a long story short, we ended up terminating care due to the differences in our approach.

At the beginning at my 12 wk appt we signed a single page contract that only stated originally the services that her 3,500.00 charge covered. We also lived 1 mile over her 31 mile travel distance fee of 300.00 so this was to be tacked onto her 3,500 service fee. She did agree to let us go to her for appts so we could get around that 300 expense. She is very newly licensed as of this past June. Because of this and the fact our financial fee contract was drawn up by her husband around our special financing situation we didn't receive a copy of some of the hings we signed. Some we did, some we didn't. Stupid, I now know. When we terminated care and we're settling on an agreement to be paid the primitive 1 page contract miraculously turned into a lengthy detailed 3 page contract, 2 pages worth of content we had never seen....the 2nd and 3rd page having never existed when we signed it orginally. She took our sigs and moved them to the bottom of the 3rd page. The one we orginally signed was only the 1 page and our sigs were at the bottom of the one page. The new content now had what she DOES NOT cover in her price and also itemized her prices in the event of termination of care. We are still realing over the dishonesty of it all and how totally we trusted her and were wiling to birth with her.

Prices seem absolutely outrageous to us..how do your mw's compare? Is this even close to realistic??? I called my old mw we now live 350 miles away from just to ask what she charges. She is a CNM, runs a birthing center, does booming business, and has 25 yrs of birth experience. She only charges 150 for the initial visit and a mere 60.00 for subsequent prenatal visits!! Our pediatrtican didn't even get 200.00 a visit....nor did the internest dh once saw. And our insurance..we were self pay as she didn't accept insurance but was amazing for comparison in prices....refuses to pay more than 200.0 for an MD visit and more than 100.00 for a non MD visit. This mw, as I stated earlier, was just licensed in June, is a CPM vs the status of the CNM we had before and has little to no professional experience. I apprenticed as a midwife for 7 yrs before getting married and attended 150 births so mw and I actually discussed and joked about how I had attended more births than she has. It never bothered dh or myself and we were comfortable with it until her nervousness began to really interfere with everything we desired. But, for someone with little to no experience and NO twin experience whatsoever who is a CPM is this reasonable?

"Transferring or Upon Termination of Care:

500.00 non refundable fee for the intial visit
200.00 for each subsequent prenatal visit
120.00 for initial standard lab work
100.00 for childbirth material rented from her library during time she cared for client
10.00 for each telephone consultation between 9-5 M-Sat ( we never called her, as she called us for lab results and such)
25.00 for each telephone consultation outside of normal business hours shown above
25.00 for each hemoglobin check or antibody screens beyond the initial lab work PLUS any other client specific lab charges incurred (emphasis as appearing on her "new" contract).


Clients who transfer before 36 weeks may receive the following services from their midwife on a pay as you go basis:

900.00 for attending a hospital birth as a doula
200.00 for any postpartum home visits
120.00 for a postpartum PAP smear

Once you have reached 36 weeks there will be neither a refund due, nor relief from the full cash payment fee of 3,500.00."



None of this stuff existed when we signed our contract. Yet our sigs now appear on this "agreement"???

We were also told initially that the birth pool rental fee was another 200.00 in addition to her 3,500.00 fee. Yet in the altered contract it states that it's an additional 250.00 rental fee on top of her services fee. We bought the very pool we were going to rent for a mere 184.00! And in the new part of the contract that we supposedly signed it states that the birth kit is not covered...an additional 70.00. That was not in there because she shocked us by pulling that out at my 32 wk appt in which we were presented with the order sheet. It had just never been discussed...I never thought to discuss it early on. So, we were a bit taken back by this additional expense. There was also a 500.00 twin fee that magically appeared a week after the surprise discovery of twins. Her fee started out at 3,500 and we were at 4,200.00 and still climbing by the time all of the additional surprise stuff had been figured in. Yet another reason we decided to go ahead and terminate care...as the charges just kept escalating.

But the itemized charges now that we never agreed on and certainly never signed??? 500.00 for the initial visit and 200.00 per visit after that??? I'm still just kind of in shock over prices and the dishonesty of it all.

I guess more than anything....is this itemized list realistic for mw prices?

Blessed wife of a firefighter/paramedic and mom to 10...including 2 sets of very surprise twins!....with a sweet tiny boy welcomed into heaven at 14 wks gestation in 9/09
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#2 of 29 Old 09-30-2010, 08:51 PM
 
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I think that's awfully ballsy of her. What on earth!?!? It almost makes me wonder if people have been dumping her as a midwife and these new charges are coming from, as a way to make sure she has an income. No matter what, that is so weird!

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#3 of 29 Old 09-30-2010, 10:04 PM
 
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Have you paid her anything yet? If so, how much?

IF this goes to small claims for some reason I'm pretty sure her new contract would not fly. She obviously doesn't have the ORIGINAL signed 3 page contract since you didn't sign one. If she's simply providing a COPY of a 3 page contract you can easily argue that she could have changed it to put your signatures there. Any decent judge would ask her to show the ORIGINAL signed contract, not a copy, which she obviously won't be able to provide. Not to mention the random twin fee...if she was so "ZOMG!" about you having twins, what on earth would make her even think about a twin fee if she's never had to deal with it before and obviously never considered the possibility before? Sheesh!

And that $100.00 for rented materials just slays me. Seriously. My midwife lets me pick out a book to take home and then bring it back at the following appointment. If I told her about that fee I'm sure she would crack herself up laughing. Libraries don't even charge you a flat fee for borrowing books! Ridiculous!

ETA: You could just make a simple threat to sue and let her know that changing your contract to 3 pages is forgery (a conviction of which could land her in jail and cause her to lose her license). Just the threat, especially considering she JUST got licensed and it could totally screw her career before she even gets a real shot at it, might be enough to sway her. You could also ask midwives in the area what their fees would be and tell your ex-mw what the average came out to be and tell her you are only willing to pay that.

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#4 of 29 Old 09-30-2010, 10:14 PM
 
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My midwife charged $3,000 flat fee. Half was given at the 2nd appointment and the rest was due at 36 weeks. There were no hidden or extra fees for anything, though I did not do any prenatal testing so I don't know if there were additional charges for that. As for the birth kit, she gave us a list of items we needed to purchase ourselves (comfort items, really) but the majority of things were provided. I elected to buy a kiddie pool for the birth tub instead of renting hers, which I think was around $200.

Mama, why don't you UC? You have had lots of experience both attending and giving birth - I am sure you would make your own best midwife!

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#5 of 29 Old 09-30-2010, 10:16 PM
 
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Wow. That is so incredibly unprofessional. I'm glad you dropped her! I would tell her that you have contacted a lawyer as you never signed that agreement. That is so ridiculous!

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#6 of 29 Old 09-30-2010, 10:59 PM
 
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Do you have a copy of the original 1 pg contract you signed? I like smeep's ideas.

Sorry you're dealing with this. It's so ridiculous and unprofessional. I'm glad you got out while you did!!

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#7 of 29 Old 09-30-2010, 11:19 PM - Thread Starter
 
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No...we don't have a copy of the original. It was just a primitive 1 page paper printed out from her printer that her dh came up with. We signed it and she stuck it in my file. I never thought to ask for a copy...never dreaming we'd have issues. We even teased about how primitive and elementary it was...laughing about it.

Smeep....that's exactly what dh and I did. We came up with a letter stating that we were willing to pay 891.00, as opposed to 2,900.00 for total services rendered. 100 for the initial visit and 65 for each sub visit after that since that is the going rate. I checked and called 6 other midwives, my old one that is the CNM, 3 other local CPM's and 2 that close friends have used in other states. We offered my mw the high end of the prices we got from everybody. Some charged 75.00-85.00 for the initial visit with 100.00 being the highest. Sub visits ranged from 50.00-65.00. So we offered her 100 for the initital visit and 65 for every visit after that. Then added up the lab costs that were incurred since I have low platelets and tend to be anemic. We tested these 3 times over the course of 12-35 wks and I had my thyroid level checked since she thought I may have a low thyroid issue...which I don't. But after I stated we would only be paying her 891.00 she mailed back this "contract" with all of her itemized figures. The phone consultation fees and the "library" fee are what really got me...along with the 500.00 non refundable initial visit fee. If I hadn't been so shocked I would've laughed. I never called her. She was the one calling me to give lab results. Amazing. She did end up "giving in" to 891.00due to our financial situation and knowing how strapped we are. So she let us know she was being extremely generous and was willing to "let us off the hook". What hook? I didn't think we were ever on the hook. And yes...there is definitely no original signed copy. Dh says she clearly and conveniently copied and pasted our sigs to the 3rd page and that is what we received in our email attachment from her. She even kind of condemned herself since there is actually a place on the bottom of the 1st and 2nd page now for initials. We initialed numerous medical consent forms so to have initials missing on this looks suspicious since everything else is initialed properly. Our initials are not on either the 1st or 2nd page of the new contract since those spaces did not even exist when we signed it. Dh is certain it wouldn't stand a chance in court if she were to take it that far.

As agreed upon, she had to provide enough services so that we could access the money is our medical savings account and possibly wait on teh remainder when our tax return was received around Jan 15th. She knew this upon beginning my care and was fine with it and the 1 page contract was signed upon this agreement. Upon receiving her receipt for services this past week we submitted our medical reimbursement form. Once this is received..should be tomorrow....she will be paid 500.00 in cash and the other remaining 391.00 by Jan 31st, as stated in the original contract...the REAL contract. So, no. She has received no money from us yet...for which I am now entirely grateful. I'd hate to be in the boat of trying to get it back from her.

And tracymom1..since UCing twins is highly controversial I left that out. But to answer your question....we terminated my prenatal care with her to UC. We UC'ed our 7th baby and it was an absolutely life changing experience. Since he's a paramedic, I studied and attended as many births as I did and we have now had 8 chidren we are not fearful. Our UC birth was by far the best of all of our children. I am soooo excited!! We orginally had planned to UC our last pregnancy but after a loss at 14wks I was really wanting the reassurance of a midwife and access to a u/s for this pregnancy. The more all of this went on, the more she changed the plans and added people and the closer I got to birth the unhappier I became with all of it....especially all of the extra fees incurred. Our heart's desire really came out and we realized how badly we just wanted to UC. So, we'll have my closest friend, who also happens to be a doula, attend...if she makes it into town in time....to help with fetching and clean up and stuff and it will be kept at that. We are all very very at peace with this and entirely excited. It finally feels like I can be excited and really embrace the upcoming arrival of these babies.


And the mw gave us a list of things we needed to gather for the birth..the comfort items as you mentioned....but then she also handed us the birth kit list we had to order for 70.00 that included all of the things she did not provide.

Blessed wife of a firefighter/paramedic and mom to 10...including 2 sets of very surprise twins!....with a sweet tiny boy welcomed into heaven at 14 wks gestation in 9/09
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#8 of 29 Old 10-01-2010, 12:17 AM
 
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I am glad you didn't pay her yet, because what she is doing is both illegal and immoral! I'm married to a DA, and forgery (as well as breach of contract) are not things he would let slide. I can't believe she would even think that you would go for her photoshop changes, as if you wouldn't remember what you had signed.

I did sign a multi-page contract for my MW, and it included some itemized charges spelled out in case of early termination, and those rates were much less than those prices she quoted on your MW's new and "improved" contract. And a fee to talk to her on the phone? Seriously? Even my OB doesn't charge a fee for a phone call! What, is she a high priced lawyer now, billing hours? Give me a break!

Sounds like you were wise to terminate care with her and UC. Someone who would do something like that is not a person I would want sharing my space when I am emotionally and physically vulnerable during labor.

CD'ing, homebirthing, milk making school teacher. Supporting my family on my income and trying to get out of debt in 2013!
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#9 of 29 Old 10-01-2010, 12:49 AM
 
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as in, she has never even cared for or seen a twin pregnancy or birth in all of her years of training and apprenticeship.
Disclaimer: I'm not a med prof... nad I've been drionking tonight... but this raises many many red flags for me. Even as a doula I've seen twin pregs and births. If she hasn'tl she's either very very new, or omitting experience.

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#10 of 29 Old 10-01-2010, 12:50 AM
 
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where is pam? she seems to know a lot... .

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#11 of 29 Old 10-01-2010, 01:47 AM - Thread Starter
 
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Originally Posted by mysticmomma View Post
Disclaimer: I'm not a med prof... nad I've been drionking tonight... but this raises many many red flags for me. Even as a doula I've seen twin pregs and births. If she hasn'tl she's either very very new, or omitting experience.
Why in the world would you omit twin experience if it's only going to help your cause? And I kind of thought the same thing but then since we'd had twins before and I was desperately desiring a homebirth we just felt comfortable with her inexperience. Really comfortable. I knew that she could probably learn alot and gain twin experience and it was comforting to me to have her there. She did several disconcerting things throughout the pregnancy like check for TTTS at 33 weeks. If they were going to develop TTTS it would've been between 17-24 weeks and most babies with severe TTTS are both deceased by 24 wks. But yet the u/s to check for this was scheduled for 33 wks. Since dh and I both knew they had separate everythings we felt comforatble just letting her go knowing that these 2 are probably most definitely fraternal and since they share nothing were in no danger of having it. She told me up until the very day I had the u/s that it was most definitely a single baby pregnancy. But, she was just really obviously clueless about twin pregnancies and potential problems. As in...I really seriously knew more than she did. I never said anything since I figured it wasjust part of the learning curve and was grateful I could be her 1st client so if anyone did come in with mo/di ID's that she would know to look for TTTS much earlier. 33 weeks would've been much too late in the majority of cases. After my u/s she was then convinced she had 2 other moms probably expecting twins based on how my pregnancy had progressed so she had them get u/s's. She also started out saying any position was deliverable other than transverse. By the end of it and after a few weeks worth of reading she handed over a new consent form that I had to sign that stated I would transfer care in the event that babies presented in unfavorable positions such as 2 breech (this was NOT going to work for me and had been discussed alot since finding twins), A breech/B vertex (possible chink lock that I discusssed at the appt following the u/s that revealed twins, in which she knew nothing about this position and said it was deliverable), footling breech in either A or B or both (this was also one of the deliverable positions for me that we did not agree on) or, obviously, transverse babies. There was also alot of other stuff now listed that she would transport for or for which she would refer services to an OB. At the 22 wk appt following the u/s I brought up the fact that Ina May had actually given a way to deliver the chin lock position and, though obviously clueless about it all, she said she was all for it and didn't have a problem with this. I thought this was great but then was handed that sheet at 32 wks saying it was now undeliverable by her standards.

But it also seemed a bit odd when she spent 7 years training with midwives in Midland, Weatherford and Dallas TX. I'm from the Dallas/Fort Worth area so we knew many many of the same midwives. To have never experienced a twin pregnancy in all of those years in such a booming homebirthing area was kind of odd to me. But then I know homebirthing twins is really uncommon too so just figured it was even more uncommon than I originally thought it to be....especially since the mw coming from Midland and the mw coming from Weatherford (FW area) who she was in school with also had never been part of a twin birth. The Midland mw actually did care for a twin pregnancy but the birth ended up being a transport that ended in c/s. Not sure why. So, that was the extent of that mw's twin experience. The Weatherford mw had absolutely no twin experience in caring for a pregnancy or attending a birth. The 1 other mw she called in was from Grand Prairie and she did have some twin experience but yet I wouldn't get to meet her until the birth. And since I have massive inhibition issues..pooping when pushing and all of the other lovely bodily functions that go along with labor... this was really not very satisfactory to me. I did meet the other 2 mw's and did talk to her extensively about the fact I was not really in love with one of them and preferred her not to be present at the birth. Originally she told me she was having me meet them to give my opinon on whether i was comfy with them or not and just felt a bond or "the click". So when I didn't with one of them she proceeded to tell me they were my only options and if I didn't like her than there wasn't much else she could do. She had to be there for manpower purposes. Now looking back I'm thinking she just really really wanted her best friends and fellow comrades to experience this with her. She also stated around the 30th week that there would be 7 people there since she also needed 2 assistants, along with the 3 other certified mw's, a student and herself. I did kind of throw a fit about this so she took out the 2 assistants in the deal and scaled it back to the 5...which was still too many for me. The student she took on also did not exist until I was in my 30th week. Then suddenly she had a student coming to the birth in her birth team. Anyway...all reasons we chose to discontinue care. My main thing was just the prices of the individual services and if they were even realistic...if some mw's truly charged these fees and people actually pay them. I definitely know that if this had been presented to us at the beginning when we signed the contract there's no way we would've ever signed.


But yes....she's REALLY new. I was invited to her graduation party that was thrown for her in June after she passed the certification test. She had taken over my care in April before pasing the test. All of her current clients came to the party along with her friends and family. She had her 1st client due in Aug that she was caring for during that time before being certified knowing she would be licensed by her EDD...which she was. Now thinking about it...I'm not even sure that's legal. She didn't attend any births before being certified but she was caring for clients before she was officially licensed. She does have in the initials after her sig that she's an LM, CPM. So, maybe this was under lay midwife care? I never really thought about it before.

Blessed wife of a firefighter/paramedic and mom to 10...including 2 sets of very surprise twins!....with a sweet tiny boy welcomed into heaven at 14 wks gestation in 9/09
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#12 of 29 Old 10-01-2010, 02:29 AM
 
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The whole "providing prenatal care (as a mw, not as an assistant or apprentice) before the actual obtaining of a license" thing also sounds illegal to me.

I would highly recommend that you report her...for forgery/fraud, and also for the providing prenatal care prior to her certification if that is indeed illegal. Seriously. This is clearly someone who should NOT be practicing. It sounds like a disaster waiting to happen.

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#13 of 29 Old 10-01-2010, 03:51 AM
 
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That is crazy. And no, it wouldn't stand up in court whatsoever.

FWIW, LM is Licensed Midwife, typically meaning licensed in the state. CPM is Certified Professional Midwife, a certification through NARM. Some states (like mine) license on the basis of passing the NARM and becoming a CPM. Sort of redundant, then, but most MWs here list both LM and CPM as both are accurate. I have no idea if prenatal care without licensing is permitted, but most (if not all) licensing requirements will surround the actual birth, so it may not be out of line.

I definitely would find out what you can do about filing a complaint, though. That's just an awful lot of big red flags. I understand if she's new she may not have everything worked out yet, but to change a contract after the fact is simply illegal. She should take the "loss" and be better prepared next time.

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#14 of 29 Old 10-01-2010, 11:13 AM
 
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Good lord. I am going to show this to my DH (attorney). It is so fraudulent and mean-hearted, it's nearly funny. Nearly...

I am glad to read that you have a good handle on this situation.

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#15 of 29 Old 10-02-2010, 03:09 PM
 
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My midwife has some broken down charges on the contract that we signed. We did get a hard copy and also an electronic copy from her. I believe she has a $400 non refundable deposit. Prices for prenatals is $200 for a home visit and $100 for an office visit. (Total midwife fee is $4,000 cash, $4,400 to go through insurance.)
Use of her lending library is included with her general fee. She has a birth tub that she is going to lend to us but I am unsure if she's going to charge us anything for that since the tub was given to her by a client who had purchased it for her birth and considered renting it out. There was nothing in her contract about additional charges for phone calls. I believe calls are simply a part of "standard care".

My midwife is also newly certified and was still a "student midwife" when we began care with her.

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#16 of 29 Old 10-02-2010, 03:35 PM
 
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And tracymom1..since UCing twins is highly controversial I left that out. But to answer your question....we terminated my prenatal care with her to UC. We UC'ed our 7th baby and it was an absolutely life changing experience. Since he's a paramedic, I studied and attended as many births as I did and we have now had 8 chidren we are not fearful. Our UC birth was by far the best of all of our children. I am soooo excited!! We orginally had planned to UC our last pregnancy but after a loss at 14wks I was really wanting the reassurance of a midwife and access to a u/s for this pregnancy. The more all of this went on, the more she changed the plans and added people and the closer I got to birth the unhappier I became with all of it....especially all of the extra fees incurred. Our heart's desire really came out and we realized how badly we just wanted to UC. So, we'll have my closest friend, who also happens to be a doula, attend...if she makes it into town in time....to help with fetching and clean up and stuff and it will be kept at that. We are all very very at peace with this and entirely excited. It finally feels like I can be excited and really embrace the upcoming arrival of these babies.


And the mw gave us a list of things we needed to gather for the birth..the comfort items as you mentioned....but then she also handed us the birth kit list we had to order for 70.00 that included all of the things she did not provide.[/QUOTE]

Mama, I have had twins twice. I support your decisions to do UC if you feel you must (maybe you could just talk to that midwife that did have twin experience instead?), but if I can just suggest that as a grand multipara and twin mama you do what needs to be done to eliminate risk of hemmorhage after birth. Take Alfalfa starting in the second trimester and eat lots of vit K rich foods. Drink your RRL tea religiously in the third trimester. Have Angelica tincture on hand to take to help placenta come after the second twin is born and Shepherd's Purse for after. Homeopathic Sabina can also help placenta come and uterus to contract well even when distended. Also, I attended a twin birth as a helper once (have been to four other twin home births as well) and the midwife had me hold the second twin in a vertical position as the first twin was coming out so that it did not go transverse after first twin came out. I held the baby gently on the outside of mama's belly until it came into the birth canal. I wish you well, I think you will do great!
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#17 of 29 Old 10-02-2010, 10:13 PM - Thread Starter
 
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Mama, I have had twins twice. I support your decisions to do UC if you feel you must (maybe you could just talk to that midwife that did have twin experience instead?), but if I can just suggest that as a grand multipara and twin mama you do what needs to be done to eliminate risk of hemmorhage after birth. Take Alfalfa starting in the second trimester and eat lots of vit K rich foods. Drink your RRL tea religiously in the third trimester. Have Angelica tincture on hand to take to help placenta come after the second twin is born and Shepherd's Purse for after. Homeopathic Sabina can also help placenta come and uterus to contract well even when distended. Also, I attended a twin birth as a helper once (have been to four other twin home births as well) and the midwife had me hold the second twin in a vertical position as the first twin was coming out so that it did not go transverse after first twin came out. I held the baby gently on the outside of mama's belly until it came into the birth canal. I wish you well, I think you will do great![/QUOTE]

Well....the 2nd trimester is already well over and I'm already 36 wks. I've done well this pregnancy and nutrition has been great along with protein intake and staying up on Chlorophyll, whole food supplement, omegas and such. I'm currently taking 9 capsules of Red Raspberry a day (3 - 3x's a day) along with drinking the tea. Have you ever heard of Placenta Out? How does this compare with just Angelica or Sabina? We have really educated ourselves and feel very prepared knowing how many previous pregnancies I have had along with this being our 2nd set of twins. We already have birth supplies in place and with those items are Shepherd's Purse..knowing well not to take it until after placenta is out. We're also familiar with eating a piece of placenta if emergency neccesitates it along with different techniques of uterine massage to help coax it to clamp down. I don't anticipate bleeding of any kind but we feel very prepared in the event that it does occur. No reason risking one's life going into it uneducated and unprepared due to wanting comfort over a "safer" facility or with caregivers I just didn't prefer. The only thing I was uncertain of was trying to decide if the Placenta Out was really needed. I opted out of ordering it but, as stated before, we do have Shepherd's Purse on hand. May go ahead and order some Placenta Out just to have on hand.

Blessed wife of a firefighter/paramedic and mom to 10...including 2 sets of very surprise twins!....with a sweet tiny boy welcomed into heaven at 14 wks gestation in 9/09
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#18 of 29 Old 10-03-2010, 09:04 AM
 
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OP, I just wanted to send my good thoughts and blessings as you near the arrival of your twins. Happy birthing!! You will be in my heart and in my prayers!

hh2.gif Proud Mama to DS1 09/07 ribboncesarean.gif, DD 07/09 hbac.gif, and DS2 06/11 uc.jpg.  Feeling more and more blessed with each day!

 

 
 
 
  

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#19 of 29 Old 10-03-2010, 09:57 AM
 
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This whole situation makes my head spin! You would think that without having any twin experience and requesting others attend with her that she would give you a discount not jack up her service fees and forge your contract. Shouldn't she welcome the opportunity for the new experience?

Anyway....all other things aside, the idea of charging for phone calls (with on and off peak hours???) and for the use of her lending library is the most ridiculous thing I have ever heard.
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#20 of 29 Old 10-03-2010, 01:20 PM
 
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This whole situation makes my head spin! You would think that without having any twin experience and requesting others attend with her that she would give you a discount not jack up her service fees and forge your contract. Shouldn't she welcome the opportunity for the new experience?
No, I can see exactly why there wouldn't be a discount. Each person who comes to the birth is another person the midwife has to PAY to be there to help her. That can get expensive and eat up the entire global birth fee pretty quickly. In fact, some of the experienced midwives may have such high prices for their expertise to come in and help on these sorts of situations that suddenly a midwife is looking at either needing to charge the family more or actually have attending the birth cost her more than not taking on the client at all.

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#21 of 29 Old 10-03-2010, 01:29 PM
 
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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.

Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

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#22 of 29 Old 10-05-2010, 07:51 PM
 
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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.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#23 of 29 Old 10-05-2010, 11:45 PM - Thread Starter
 
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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.

Blessed wife of a firefighter/paramedic and mom to 10...including 2 sets of very surprise twins!....with a sweet tiny boy welcomed into heaven at 14 wks gestation in 9/09
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#24 of 29 Old 10-06-2010, 02:26 PM
 
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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.
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#25 of 29 Old 10-06-2010, 06:35 PM
 
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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.
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#26 of 29 Old 10-06-2010, 06:54 PM
 
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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.

- Emy . Single mom to DS nut.gif Ezra (15.12.05), angel2.gif Thames (reincarnated 18.04.08) and DD rainbow1284.gif babyf.gif Allora (11.02.11) and dog2.gif Hoppylactivist.gif  novaxnocirc.gif  waterbirth.jpg fambedsingle2.gif bfinfant.giffemalesling.GIFcd.gif

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#27 of 29 Old 10-06-2010, 10:14 PM
 
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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.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#28 of 29 Old 10-07-2010, 03:37 AM
 
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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.
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#29 of 29 Old 10-07-2010, 02:06 PM
 
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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
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