FAQ Paying for Care

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

Safe, cost-effective, convenient, and personalized care is possible

The global midwifery package fee is

$4000*

Included:
ALL prenatal, birth, and postpartum midwifery care
Routine and non-routine visits
Direct access 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:
Billing service fees
Labs and ultrasounds
Medications and additional supplies
Newborn hearing screening
Your birth kit
Your birth tub rental/purchase

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.

*Fee increase and new payment plans apply to new clients starting care after January 1, 2018.  $2000 discount to clients on Medicaid still applies.

How does all this billing and insurance stuff work anyways??

If you are confused, it’s because the system is designed to make you feel that way…and then make you throw up your hands and just pay the money.

Keep reading!  It gets easier.

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

NO.

Kristin chooses to not contract with insurances simply because insurance reimbursement rates are so incredibly LOW with onerous paperwork requirements.  They add requirements weekly, change the covered services monthly, and consistently reduce payments to providers.  This means the insurance companies are driving quality providers out of business.

Insurance companies do NOT care about your health or access to care, period.

Midwifery care is based on a low-volume, high-attention style of care that does not allow for the quantity of patients to make up for the time spent.

You can request an out-of-network exception for midwifery services.  There are NO licensed midwives in the Tri-Cities, Yakima Valley, and Yakima areas that are in-network with any insurance company, except Sky Valley in Ellensburg.

How do I know how much my insurance will cover?

Since you have pre-paid the package fee directly to the midwife, you will be reimbursed by your insurance after the birth and the normal 10-16 week billing cycle.  The amount you are paid is what the midwife would have been paid.

Maternity billing is done after the baby is born because insurances like to be billed only once.  That is, all the care provided during pregnancy, labor, and the first 24 hours after birth get bundled together and one bill for all that is sent.  So your pregnancy care will be applied to your deductible during the month/year that you deliver the baby, NOT during pregnancy or when you start care.  All labwork and ultrasounds are billed at the time of service by the lab or office.

How does the payment and insurance process work?

Sunrise Midwifery and the client have an agreement:  the client agrees to pay the entire midwifery package fee prior to birth and the midwife agrees to provide prenatal, birth, and postpartum care.  The client provides their insurance information and the midwife connects the client to the billing service.  The midwife sends the bill for midwifery care 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 client 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 insurance company sends a check for the amount they cover.  (This sometimes changes from the beginning to the end of pregnancy, based on THEIR changing calculations.)
  7. Any balance owed the midwife is paid.

The financial steps for a client WITHOUT 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. Any balance owed the midwife is paid.
  4. A detailed coded invoice is provided by the midwife for submission to a Christian HSA or for your records.

How do I pay my midwife?

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

E-payment options include:

  • via invoice from Sunrise Midwifery
  • PayPal
  • Square (for credit or HSA cards)
  • United Medical Credit

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 does 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 package 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.

Does 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 financial hardship discount will be applied to your package fee or we’ll help you find the next best option for care.

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.

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.

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.