FAQ Paying for Care

Midwifery services
Appointments
Safety and Outcomes
Paying for Care
Set up and Clean up

Our mission is to provide individualized and professional midwifery care to all families in south central Washington.  We have recently updated our billing policies in an effort to make care more accessible through increased use of insurance coverage.  However, we remain non-contracted with all insurances because we believe that contracting requires the midwife to focus on “billable codes and diagnoses” rather than on our clients.  Being a contracted provider limits the care we can provide either directly, as above, or indirectly by onerous paperwork requirements.

We value our midwifery training and experience and ask for adequate and timely payment for services.  We invest a large amount of our time and effort into each and every client and birth because we know that personal care and attention brings the best outcomes.  We do what we would like to have done for us by our own providers.

Please ask about a payment plan that works for you—we do not want money to be the reason people do not seek care.

Base rate for maternity care starts at $4200
Community birth fee $800

Included:
Free consultation with midwife
Insurance benefit check
Routine prenatal care
Birth attendance and immediate postpartum care
Direct access via phone and email to your midwife throughout care
Evening and weekend appointments
Referrals to other providers, labs, ultrasounds
Paperwork submission, such as FMLA and birth certificate

Not included:
Care from other providers or facilities
Labs and ultrasounds
Newborn care
Non-routine visits
Online processing fees

Payment methods
Cash, check, credit card, HSA, Christian HSA, PayPal, online payment processing,
or financing through United Medical Credit.

The complete Financial Agreement is available at a consultation.

How does all this insurance stuff work?

If you are confused, it’s because the system is designed to make you feel that way.  Keep reading and lots of your questions will be answered.

Are Licensed Midwives covered by private insurance?

Washington law requires insurance companies to reimburse for midwifery services from a Licensed Midwife.  Even if you have called your company and they say “What midwife?” or “We don’t cover homebirth” or “She is not a contracted provider”, they ARE REQUIRED BY LAW to cover midwifery care of your choosing.

Your policy and deductible determine how much your insurance will cover.  Out-of-network exceptions can be applied to your midwifery care, we just need to ask.

Does Medicaid/DSHS/ACA cover homebirth?

Yes, Medicaid DOES cover homebirth and midwifery care with contracted providers, as well as lab and ultrasound costs.  Most doctors and CNMs are contracted providers.

Sunrise Midwifery is NOT a Medicaid provider but does offer a $2000 discounted financial hardship fee to clients with Medicaid as their primary insurance.  All labs, ultrasounds, and medical consultations are covered by Medicaid.  We can also provide a Confirmation of Pregnancy for free in order for you to apply for coverage.

Scroll down to learn about the lack of sustainability in our current maternity care system and why Kristin does not contract with insurance companies, especially Medicaid.

Do TriCare/Military/federal plans cover midwifery care?

TriCare and other federal insurances do NOT cover Licensed Midwives.  It would require a change to federal law in order for your LM to be paid.  We checked.  However, they do cover Certified Nurse Midwives whether in the hospital or at home.

As a supporter of our troops and veterans, the $2000 financial hardship discount fee will be applied to your package fee or we’ll help you find the next best option for care.

Is Sunrise Midwifery a contracted or preferred provider with my insurance?

NO.   There are NO licensed midwives in the Tri-Cities, Yakima Valley, and Yakima that are in-network with any insurance company.

Kristin chooses to not contract with insurances because insurance reimbursement rates are so incredibly LOW with onerous paperwork requirements and contracts that limit the care the midwife can provide.  Companies consistently add requirements, change the covered services, and consistently reduce payments to providers.  This means the insurance companies are driving quality providers out of business through devaluation of our care.

Midwifery care is based on a low-volume, high-attention style of care.  This means that you get the care you want and need directly from your midwife.  You get your questions answered.  This also means that your midwife would need to have a high-volume client load to offset the lower payments from insurance in order to remain in business. This is not a business model that Kristin wants to have.

How do I know how much I have to pay?

It is always recommended to ask the midwife and/or the billing service for more information.  That’s partly what the free consultation is meant to do!

Before starting care, we run a “benefit check” that shows your plan’s current coverage, deductible, out-of-network percentage, and patient portion.  You know right away what to expect for your final out of pocket costs.  However, the client is responsible for payment of the global midwifery and community birth fees, regardless of insurance coverage or plan.  Each person’s plan is different and the plan can change over the course of your pregnancy.  You can also speak directly with the insurance biller to have all your questions answered.

All lab work, ultrasounds, or care from other providers are billed at the time of service by the lab or facility.

How does the payment and insurance process work?

Sunrise Midwifery and the client have a financial agreement:  the midwife agrees to provide prenatal, birth, and postpartum care and the client agrees to pay all midwifery fees, whether due prior to birth or invoiced after the birth.  The client provides their insurance information and the midwife bills insurance in a timely manner.

The client’s insurance company has an agreement with the client:  the client agrees to pay the premiums and deductibles and co-pays and the insurance company agrees to pay some portion of the health care.  The insurance company receives the bill for midwifery care, determines their payment, and then sends the check.  The provider must wait for that check, which often takes 2-12 months to be sent out due to the company’s changing policies.

That is exactly why Sunrise Midwifery is not a contracted provider.  We cannot stay in business if we provide care and then wait a year for payment.

The financial steps for a client WITH insurance:

  1.  The client makes payments to Sunrise Midwifery according to the Financial Agreement.  This could be one lump sum or multiple payments.  All is paid prior to birth.
  2. The midwife provides midwifery care as needed to the client.
  3. The midwife connects the client to the billing service so that proper claims submission and prior authorizations are made.  A “patient estimate of responsibility” based on your plan is provided early in care.
  4. The midwife submits the bill for care in a timely manner.
  5. The biller follows the claim through to payment.
  6. The client sends any and all insurance correspondence to the biller.
  7. The insurance company sends a check for the amount they cover.
  8. Any balance owed the midwife is paid by the client.

The financial steps for a client WITHOUT insurance or WITH Medicaid/TriCare coverage:

  1.  The client makes payments to Sunrise Midwifery according to the Financial Agreement.  This could be one lump sum or multiple payments.  All is paid prior to birth.
  2. The midwife provides midwifery care as needed to the client.
  3. Any balance owed the midwife is paid by the client.
  4. An invoice is provided by the midwife for your records.

What is an ICD10 code 59400?

This is almost as bad as doing your taxes:

59400 is the code number for what the insurance industry calls the “global maternity care”.  It consists of: routine obstetric care including routine antepartum care in the office, vaginal delivery, and routine postpartum care, but do not include: blood draws, ultrasounds, medication administration, or additional visits for complications.  Sounds easy enough.

Each individual insurance company regularly and repeatedly changes what services must be performed in order to bill the 59400, and it can be different from the start of pregnancy to the end.  It’s complex to do because it has to be billed out according to the new changes or payment is denied.  Ugh.

Additionally, the amount the company pays to the provider for all the services in 59400 changes: usually it goes down even when required number of services go up.  Double ugh.  When the provider has signed a contract to be an in-network provider with the insurance company, the provider must accept whatever payment, whenever it comes, with generally no recourse.  Worse, if the company decides to change their practices, they can go backwards in time, audit the providers, and require repayment for things they paid at that time!

This is one reason Sunrise Midwifery is not an in-network provider for any insurance company.

How do I pay my midwife?

Payment can be made by check, cash or e-payments.  Processing fees are paid by the customer.

E-payment options include:

  • via invoice from Sunrise Midwifery
  • PayPal  (midwife@sunrisemidwifery.net)
  • Square (for credit or HSA cards)
  • United Medical Credit

Still confused?

Ask you midwife for more information or clarification.  We want you to be an informed consumer of insurance coverage and health care.

Here’s another explanation of how the insurance payment and billing process works.

Why does midwifery care seem so expensive?

Did you already find out what your out of pocket costs or deductible is for having your baby at the hospital?

  • Somewhere in the $5,000-$15,000 range, depending on your coverage and what happens during birth.
  • You are paying the provider fee and the hospital facility fee.
  • We do not have $12 Band-aids or Tylenol at home.
  • The additional costs, such as billing fee, birth supplies and medications, are clearly outlined in the Financial Agreement.

Did you factor in the time you spend in the waiting room, exam room or labor check pre-admit at the hospital compared to the one-on-one time with your provider?

  • Midwife appointments are each 30-60 minutes long
  • Childbirth education with the midwife for 5 hours
  • Labor checks in your home by your midwife

Can you call or text your physician DIRECTLY and get an answer?

  • While your midwife asks you not to text or call at 10 pm to reschedule an appointment in two weeks, your midwife is available to answer questions about onset of labor or concerning symptoms.
  • Non-urgent emails and texts are answered by the midwife usually within 24 hours.

Are your appointments and birth attended by the provider of your choice?

  • We do have a call schedule (starting August 2018) to provide rest to the midwives, but you know who your midwife is and you have seen her for most of your pregnancy.

Do you even have good choices for who to get as a provider?

  • Ask anyone on Medicaid, providers accepting Medicaid are limited…and your preferred provider is often not taking patients.
  • Ask anyone on private insurance, their preferred provider is not necessarily contracted…and therefore not covered.

What if I really can’t pay?

At Sunrise Mdiwifery, we do not want money to be the reason you cannot have midwifery care.  We will work with you on a flexible payment plan or on a barter-for-service plan.  If you have a skill or product you think is valuable to the midwife, just ask her to consider it for barter!

Contact info for biller

Alternative Medical Billing
(206) 932-0870
830 31st Ave E, Seattle, WA 98112

We are happy to offer another option to clients who may not be able to pay the midwifery package fee up-front.  UMC financing helps clients get midwifery care and midwives stay in business.

Clients can choose the amount they need financed, get financing when/if they need it, and use their insurance payment to pay off the loan.

Steps:
1.  Start care with Sunrise Midwifery
2.  Complete UMC application, if needed
3.  When your insurance pays their portion, that check goes to you
4.  You pay off your loan

Thousands of patients have trusted United Medical Credit to secure affordable payment plans for their procedures. United Medical Credit can do the same for you.  Some of the benefits of choosing United Medical Credit to finance your care:

  • Extensive Network of Prime and Subprime Lenders
  • Multiple Plans to Choose From
  • Decisions Within Seconds
  • No Prepayment Penalties with Flexible Terms
  • Fast and Easy Application Process with No Commitment
  • 100% Confidential
  • Plans available for Credit Challenged Applicants

Why is Medicaid completely unsustainable?

washington-county-map

Contact your legislators

Unfortunately, we are still unable to accept Medicaid HMO and do not foresee changing this policy, regardless of the health insurance debate currently raging.  In short, the Medicaid payments to the provider do not even cover the cost of providing care, let alone any profit, and Medicaid paperwork is outrageous.  In reality, this translates to the provider being unable to pay her own mortgage and bills, buy necessary supplies and medications for her clients, and expand her practice to care for more pregnant people.

Clearly, this situation is unsustainable, decreases access to care, and burns out the providers.

We recognize that our policy reduces access to midwifery care in some cases.  Unfortunately, access to midwifery care is even more limited when midwives cannot practice due to excessive overhead costs and time associated with insurance billing!  The amount that your Medicaid HMO pays to the midwife is always much less than the cost of care, in our case, approximately $1800 (out of the $3500 midwifery fee) is paid for a course of care, then we have to pay $200 to the biller.  A small practice based on low-volume of clients with high-time involvement cannot survive on that rate.

There is more to the story.  The state pays each HMO to supervise the insurance care for each pregnant mother.  This amount is several times the cost of midwifery care package fees.  But the full midwifery fee is NEVER paid by that HMO.  Where do those thousands of dollars go??  Not to the providers.  Not to more maternity care for more mothers.

This problem exists for birth centers also.  Up to July 2017, after successful lobbying by MAWS and birth center owners, the Medicaid payments for birth in a birth center did NOT even cover the operating costs.  Not only does the birth center not make any money, it actually ends up paying for the birth to occur there!  This is not sustainable and will reduce access to care.

If you are upset by the lack of access to midwifery or maternity care, please contact DSHS, your HMO and your legislators.  Tell them this situation is unacceptable.  Tell your friends and family to tell them this situation is unacceptable.  Have them call me to find out why YOU do not have the benefit of midwifery care via Medicaid!

The DOH has studied the cost benefits of midwifery care by licensed midwives…and it is significant, millions of dollars annually.  If more midwives provided care more often to more mothers, the state would save huge amounts of money.