DescriptiI partner with Innovative Medical Billing Inc. for insurance billing for PPO plans. Your first step is to sign up for a Verification of Benefits with IMBI for $55, to better understand your benefits and likely coverage. If you decide to contract with Innovative Medical Billing Inc. at the end of care, I will submit your chart to them and they will handle everything from there: applying for Gap Exceptions and/or In-Network coverage; preparing, submitting and tracking claims, managing follow-ups and appeals. IMBI fees are a percentage of what they get back for you. I highly recommend working with a biller. I consistently find that those who work with a biller get the best reimbursements. 

Alternatively, I can prepare a Super Bill receipt for you at the completion of care, and you will be responsible for submitting it to your insurance carrier and conducting all follow up. Super Bills are by request, and with no additional fee.on text goes here

HMOs, EPOs, Kaiser, and MediCal do not reimburse for private midwifery services but typically these plans have far lower monthly fees than PPOs and often the reduction of monthly fees compared to a PPO ends up making them a better deal even when paying for your midwifery care out of pocket.

Description text goeIf you have an FSA (flexible spending account) or an HSA (health savings account) you can use it to pay for midwifery care. I can provide you with a statement for reimbursement from these plans.s here

Class and economic justice are topics that lots of folks struggle to talk about in the United States because most of us aren't educated in schools or the culture at large to talk about money, access to resources, and what class actually is. Class, of course, cannot be understood as an isolated experience, but is part of the complex interactions of race, gender, ability, privilege, sexuality, and the myriad of identities we all hold. I think the sliding scale is a great way to begin a conversation about class because it frames the discussion from the standpoint of access. 

You can use your income as a starting point for your midwifery fee. Please also consider your other resources like assets, savings, 401K, pensions and other employer benefits, family support, and rent control as a part of your personal equation. Consider if your financial situation is temporary or if you expect resources to change in the future. Ask yourself if paying for midwifery care is a sacrifice or a hardship for your family.

Fee reduction is determined on a case-by-case basis. Please consider:

• Asking your family and community to contribute to support your homebirth

• Add homebirth costs to your baby registry

• Taking a look at how you currently budget to see if there are some obvious areas where you could scale back to put money aside for the birth

I ask that you and I work collectively to ensure that sliding scale fees go to the families most in need, and that midwifery is a sustainable practice available to you and others in the future. I definitely do not want to alienate families who can’t afford midwifery care. If you need help to access care, let’s talk about it. I am always happy to consider trade (we can be creative) and payment plans.

Typical breakdown of a midwifery fee:

• Assistant Midwife: $1,200

• LCs, Pelvic floor PTs: $450

• Travel, licensing/ certification fees, continuing education, supplies, equipment, medications etc: $1,475 (these costs never decline and can increase substantially when supply costs increase due to natural disasters, pandemics or due to a large car maintenance/repair bill)

Minimum average cost per client: $3,125. 

This means that when a discount is given, this comes directly out of the midwife’s pocket. 

Midwives are self-employed and do not have any employer benefits like vacation pay and sick pay. In fact, if we go on vacation or are sick, not only do we not get paid leave but we have to pay another midwife to care for our clients. Midwives pay 100% of our social security contribution, healthcare insurance/costs, disability insurance and retirement since there is no employer to contribute to these costs.

Midwifery care is a package rate, not an hourly rate, for many reasons. Most importantly, I do not want to penalize clients who have longer or more complicated childbirthing experiences by charging them more in their hour of need. Additionally, I added my rate up once after a very long birth and was so sad I vowed never to do it again! However, below I have included a very loose calculation to help you better understand midwifery care. 

(This could be simplified to say) an average of 47 face to face hours including appointments and labor/birth plus an average 15 hours of administrative work and non appointment client contact. It could also be represented by a pie chart.)

Fee of $10,000 & Midwife’s “cost of care” and hourly rate

• Direct expenses $3,125

• 62 hours of midwifery care on average

  • 31 hrs in appointments

  • 16 hr at the birth and immediate postpartum

  • 10 hrs + back office/administrative 

  • 5 hour direct communication (I actually think this is a low estimate)

This means that for an average course of care, I make about $112/hour when my client pays a $10,000 fee. I would argue that this is an incredible deal for personalized, private, concierge-style healthcare from a licensed provider! What’s incredibly valuable and not included in this “back of the envelope” calculation is the fact I am on call for your birth for up to five weeks, and I do not charge anything extra for births or postpartum visits in the first few days that fall on nights, weekends or holidays. I also drive to your home for appointments! For comparison, I pay my home-visit veterinarian $550 per visit to see my cat and my therapist $225 for a 50 minute zoom visit. 

For another point of reference the Bay Area has a single OB who provides what he calls concierge care which is essentially the midwifery model of care (long visits, individualized care and a close to guarantee of his attendance at your birth but much less postpartum support). He charges between $35,000 to $80,000 for his care up front, none of it covered by insurance. This is his rate solely for long visits, and being on call for the birth. All hospital, facility, lab, medications, other provider fees etc still apply and are paid for separately.

I strongly believe that homebirth midwifery care is the very best deal in healthcare AND I do not want what I consider to be the gold standard of maternity/birthing person care to only be available to the wealthy. If you need a reduced fee, payment plan or trade to access midwifery care or if you would like to offer a scholarship to support a low-income family to have a homebirth, please reach out to me.

Although these time estimates might be shorter for a rapid labor or a client who starts midwifery care  later in their pregnancy, it's far more typical for the figures below to actually underestimate the time your midwife will spend with you.

The average number of in-home visits is 21 (15 prenatal and 6 postpartum visits on average). Visits vary in length from 60-120 min. Let’s use 90 min for the calculation, the birth time commitment varies dramatically and ranges from a few hours to several days. For this calculation let’s use the average of 16 hrs.

Average in-home visits 21 x 1.5 hrs = 31.5 hrs

Average birth hours of 16 + 31.5 average hours of in-home care = 47.5 hours of hands-on, face-to-face care 

For all clients there is on average 10 hours of administration/office work. This includes charting, interfacing with labs/lactation consultants/pelvic floor PTs/insurance billers/pediatricians etc., filing birth certificates, filing disability claims, filing breastpump reqs and much more.

On average I spend 3-10 hours on the phone, texting or emailing clients directly over the course of their care. Lets use 5 hrs for the calculation.

$10,000-$3,125 (expenses) = $7,000 for 47.5 hrs hands on midwifery care and hours of back-office work and 5 hours outside of appointment contact = 62.5 hrs of midwife work, which = an average hourly rate of $112 for a licensed medical professional.

Please see the Page on Comparing and Understanding the Cost and Value of Private Midwifery Care for more information