Payment and Fees
I strongly want midwifery care to be accessible to those who want it, which is challenging in our patchwork system of health insurance, insufficient coverage for out-of-hospital midwives, and poor insurance reimbursement for care providers. Because I value more accessible midwifery care in our communities, I do offer a sliding fee scale, payment plans, and I am open to many kinds of trade or barter for care.
I also value and respect the deep level of time, energy, care, love, support, and commitment that we put into our work as midwives. For that reason, I ask that you thoughtfully and honestly consider where you and your family are on the sliding scale below. This is a starting point for our conversation about fees so we can come to an arrangement that will work for all of us.
Payment Plans
I am open to payment plans, and we can discuss your proposed payment plan and then decide what will work for all of us. Payment plans, including trade/barter, need to be paid in full before our care is complete. Once we have agreed on a payment plan, any proposed changes to it will need to be re-discussed to make sure it continues to work for everyone.
Insurance coverage
I am not an in-network provider for any health insurance plans, including Medicaid, and unfortunately most insurance companies will not provide reimbursement or coverage for any home midwifery services other than homebirth. Currently, the price of the malpractice insurance required of all Medicaid providers and in-network insurance providers is cost-prohibitive for my very small independent midwifery practice.
If your insurance covers standard pregnancy, postpartum, or wellness labwork and ultrasounds, I am generally able to order both labwork and ultrasounds that are covered by your insurance.
Barter and Trade
I am open to barter and trade for up to half of the total agreed upon fee for care.
The type and quantity of item and/or service you would like to offer in trade for midwifery care needs to be proposed and agreed on by all of us at the start of care, along with the timeline for when the barter payment will be completed. Some suggestions include:
milk, cheese, and other dairy products
eggs, vegetables, or fruit
preserves, pickles, jams, and other canned items
coffee and tea
certain types of meat and fish on a limited basis
acupuncture, massage and other bodywork on a limited basis
art and craft items on a very occasional basis
feel free to propose other barter items and services for us to discuss!
Sliding Scale
For some excellent further reading on sliding scale use and intentions, please check out the Worts and Cunning Apothecary article by Alexis Cunningfolk.
40% discount
Consider placing yourself in this part of the sliding scale if you and your family:
Regularly struggle to meet basic needs - food, housing, transportation, childcare, and healthcare
Will be less able to meet any of the basic needs above because of paying for midwifery care
Rely on payday loans and/or credit card debt to meet basic needs
Live paycheck to paycheck with no savings for non-essentials, extras or emergencies
Live in the lowest-rent options, stay with relatives/friends, and/or have unstable or inconsistent housing
Have limited, low-wage, and/or unstable income, or are unemployed
Don’t have relatives, friends, or extended community with financial resources who could support your midwifery care with gifts, donations, or loans
All of the above is by necessity not by choice. For example if you have access to family money and resources in times of need, work part-time by choice, and/or have a relatively high degree of earning power due to level of education (or gender and racial privilege, class background, etc.) but choose not to access that, please look at and consider the non-discounted fees below.
20% discount
Consider placing yourself in this part of the sliding scale if you and your family:
Occasionally struggle to meet the basic needs above, but not regularly
Will have to stretch your basic needs budget to pay for midwifery care, but will not have to skip or choose between meeting any basic needs as a result
Have limited financial resources for any extras or emergencies beyond basic needs
Rarely or never buy new items because they are not affordable
Have relatives, friends, or extended community with limited financial resources who could only minimally support your midwifery care with gifts, donations, or loans, or could not offer any financial support
All of the above is by necessity not by choice. For example if you have access to family money and resources in times of need, work part time by choice, and/or have a relatively high degree of earning power due to level of education (or gender and racial privilege, class background, etc.) but choose not to access that, please look at and consider the non-discounted fees below.
Listed fees
The fees as listed cover the actual cost of care. Consider placing yourself in this part of the sliding scale if you and your family:
Do not struggle to meet the basic needs of food, housing, transportation, childcare, and healthcare, and paying for midwifery care will not change this
May have financial debts, but they do not prevent you from meeting the basic needs above
Will have to cut back or budget more tightly on non-essentials and extras to pay for midwifery care, such as eating out, buying a morning coffee/tea, new clothes, or vacation
Have some amount of savings for extras and emergencies
Have relatives, friends, or extended community with financial resources who could support your midwifery care with gifts, donations, or loans
Are able to have some choice in where you live (e.g. location, quality, price, or space) because of your available financial resources
Own your home or can pay for medium or higher quality rental housing
Can afford to take planned vacations, trips, and time off from work
Donations to support sliding scale - Payment above Listed fees
If you are in a position to make a donation and pay above the listed fees, this is a vital support to for more people have access to the type of health care they want and need. Families who donate above the listed fee are a key part of what allows me to continue to offer sliding scale and bartering options to as many families as possible. Any amount you pay above the listed fees will go directly to supporting the care of families receiving discounted fees.
20% above listed fees allows me to offer families the discounted care options above and services such as free pregnancy testing for those who need it.
40% above listed fees allows me to offer families the discounted care options above and services such as free pregnancy testing for those who need it, and the potential to expand the number of families I can offer these services to.
Please consider donating and paying above the listed fees if you and your family:
Will not need to cut back on extras or make any financial sacrifices to pay for midwifery care, such as eating out, buying a morning coffee/tea, new clothes, or vacation
Own more than one home
Can choose to do part-time paid work sometimes or all the time due to savings, investments, family money, or other means
Sometimes or regularly do not need to work for money due to savings, investments, family money, or other means
Can afford to take vacations, trips, and time off from work multiple times a year without needing to budget or save up for it
Have income from investments, trusts, or family money