Completely understandable question! Here in the US we’re used to our health insurance system. We pay into the system – or our employer does – and we never spend another penny on healthcare!
I was there also. I was looking for a specialist and called one that came highly recommended. Then they told me they don’t take insurance. Sorry, I’ll find someone else! Unless you deal with the back-end of the insurance system, as a provider or biller, you don’t realize what else is involved.
Many large practices book patients every 5 minutes or so in order to reach the capacity needed to pay their bills and make a profit. Who suffers? Of course the patients! You’re waiting in the waiting room for an hour. Then they move you to the exam room where you wait for 30 minutes. The nurse takes your blood pressure and asks you questions. The provider FINALLY comes in and spends 5-10 minutes with you. If you ask too many questions, the provider will be running even later for his/her next patient. You’ve missed 2-3 hours of work, interrupted your day, and are exhausted when it’s all over.
It doesn’t have to be this way! As a consumer you deserve more! But yes, it costs money.
Why does a provider have to book patients every 5 minutes so they’re seeing 50+ patients a day? Because of the game insurance companies play. Let’s say your physical exam costs the office $100. Insurance has already negotiated rates with your provider and they agreed they would pay $60 for a physical exam. So the provider bills it at $150 and tries to find more things to add on to make up the difference – diagnosis codes, blood work, ultrasounds, etc. It would be so much simpler if the visit was just billed at $100 and insurance actually paid $100.
I decided to go in-network with a few insurance companies as a courtesy to my clients who find it difficult to pay out of pocket. Being in-network means that you have a contract and agree to whatever payment the insurance company says it will give you. Many people do not have out of network benefits. So if I was not in-network, their insurance would pay nothing and they would be responsible for the whole amount. But that also means I need to settle for whatever the insurance company pays.
My global fee (meaning all-inclusive) for maternity care, including, prenatal, birth, and postpartum, is $7500. My self-pay fee is discounted to $4500. CareFirst pays $1500-$2000 on average for this package. Private insurance also doesn’t pay until after the baby is born. That means I work for 9 months before I can get paid. Medical Assistance also pays about $1800, although that is billed per visit, not globally.
My model of care is a small, personal practice. To attend home births, and not miss any, I only take 4-5 clients due per month. I schedule 30-60 minute visits to allow you to ask whatever you need and not feel like I’m rushing on to the next person. Your birth is an investment – one that both you and I are making.
In order to continue practicing the way I want to, continue taking insurance, and remaining financially sound, I need to charge money.
Basically you get what you pay for. If you are comfortable in large, busy practices where they spend 5-10 minutes with you and you don’t know who will attend your birth, you don’t need to pay anything. For the high quality care that I strive to offer, there is a cost.
I offer a Concierge model of care. This model is becoming more popular among providers as insurance reimbursement is becoming messier and more dismal and doesn’t allow the type of care most want to offer. “Concierge medicine (also known as retainer medicine) is a relationship between a patient and [provider] in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges.” https://en.wikipedia.org/wiki/Concierge_medicine
The retainer fee does not go towards your deductible and is regardless of what your insurance will pay. My retainer is a $2000 flat fee, payable over the length of your pregnancy, by 36 weeks..
For my in-network clients, that is all you’ll pay, unless you have a deductible or co-pays. My regular fee will be charged to your insurance. I ask for a deposit up front to hold your space in my 4-5 births/month. Then you have the rest of your pregnancy to pay the balance.
For those out of network, my self-pay fee is $4500, which includes the retainer fee. Basically, because I can’t wait until after your baby’s born to be paid. After your birth, I submit billing to your insurance and you are reimbursed whatever they pay.
I know this is a lot of money and prohibitive to some. But really it is a small amount compared to the hospital system. A vaginal birth at a hospital can easily cost $6000-10,000. Many people have high deductibles so a $4500 home birth is cheaper than a hospital birth! When I had my home birth, towards the end, I couldn’t figure out how to come up with the rest of the money due. I cried to my midwife that I wasn’t sure I would be able to continue with her because I couldn’t come up with the rest of the money. Luckily I received a gift from family to pay off the balance.
This is why I am happy to work with you financially if needed. I never want finances to be the reason you don’t have the birth that you want. But of course, I also need to make money and keep my practice small.
You get what you pay for. And that is a promise I make to you. I will provide personalized, quality care. No waiting room, no answering service, no medical assistants. I offer 24/7 availability, home visits, and a personal relationship. I guarantee (barring extenuating circumstances of course) that I will be at your birth.
Hopefully, one day our health system will be straightened out so everything isn’t astronomically priced. But until then, I offer quality care at a reasonable price.