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Fees and Financial Policy

Informed Choice Agreement

Fees and Financial Policy

Midwifery is a demanding commitment that requires a midwife be on call 24 hours a day, 7 days a week.  We incur many expenses and make many sacrifices in order to provide this service. 

Therefore, ESMI must be paid.

We do accept insurance, but recently, due to new financial policies among many insurance companies, most of these companies have been extremely slow in their reimbursement and others very poor in honoring their commitment to reimburse.  Because of this situation, we require that you pay 30% of the basic fee ($1365) or your deductible if that is greater than half our basic fee before 37 weeks.  When your insurance company pays us you will be reimbursed accordingly.  If your insurance company does not pay in full within 12 weeks of the birth you will be required to pay the full fee of $4550 plus any other expenses incurred during your care.

Our basic full fee is $4550. However, to encourage prepayment, we will discount our basic fee by about 25% to $3400.00 if paid in full (less $300.00 paid at the birth) by 37 weeks of your pregnancy.  The $3400.00 (less initial deposit – see deposit guide below) is paid in equal monthly installments up to the 37^th week.  You will still be responsible for non-standard lab work, RhoGam, sonograms, physician consult referrals, dietary supplements, etc.  If payment is not received before the end of the 37^th week, then you will be required to meet the full fee payment.  In very special circumstances, we will allow late payment up to the time the birth.  If these payments are not received by the day of the birth, you will loose the prepaid discount and the amount owing will revert to the full fee of $4550 plus other expenses incurred during your care with 30 days to pay.  After that late fees will be charged at 5% per month.

There is a call out fee (some midwives refer to this as an assistance fee) of $300.00 due at the birth.  This is part of your fee but just saved to be paid as the midwife is called out to your birth.  This fee is due on arrival.  In the event that ESMI has to call another midwife for assistance, then this fee will be paid to them.  Cash is preferred for this reason.

If you decide to give birth at one of the local birthing centers, there will be a facility fee of $500 - $1,200.  If you carry insurance, most birthing center will bill them directly.  If you don’t carry insurance, you will be responsible for providing the facility fee in cash at the time of the birth.

The ESMI fee includes all routine prenatal care, standard lab work, one home prenatal appointment at or around 36 wks, normal intrapartum care, labor transport if necessary, one home post natal appointment, and 6 – 12 weeks care for you and your baby, with a pap smear offered at the final appointment.  It is ESMI’s practice and intent (barring unforeseen circumstances) that there will be at least 2 qualified attendants, 1 of whom is a midwife, present at your birth to ensure comfort and safety of both mother and baby.

Formal medical consultation and referral can usually be arranged, but you will make your financial arrangements with that provider.  We will do our utmost to refer you to a physician that is agreeable to your proposed home/birthing center birth plan, but ultimately, you are responsible for obtaining services of any additional medical caregiver.

We require an initial deposit when you contract ESMI as your maternity care providers and before we can begin your care.  The amount of this deposit will vary according to when you take on midwifery care.  If your care begins:

                In your 1^st trimester                 (up to 12 weeks)                 _______________                 $400

                In your 2^nd trimester                 (up to 27 weeks)                _______________                  $550

                In your 3^rd trimester                 (28 weeks or beyond)        _______________                 $750

This deposit is not refundable.

The remainder of your bill will be paid in installments with the balance paid by 37 weeks of pregnancy.  There will be a fee of $25.00 for any returned checks.  If more than 2 checks are returned then all other payments must be made in cash or by money order or credit card.

Payment of these fees does not guarantee an out of hospital birth.

If you transfer to another care provider prior to 37 weeks we will refund any money paid in advance after the deduction of:  the deposit relating to the trimester you are currently in, $235.00 for the initial booking and history, $120.00 per prenatal consultation attended, $25 for “no show” appointments, $25 for telephone consultation outside of normal working hours, $10 for telephone consultation during office hours, and any further expenses incurred during you care.  This will be itemized in a statement.  If transfer occurs after 37 weeks, no refund can be given.  Post partum care can still be provided regardless of method or place of birth.