What Is A Midwife and What Care Do They Provide
Certified Nurse-Midwives (CNMs) are educated in two disciplines: midwifery and nursing. They earn graduate degrees, complete a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME), and pass a national certification examination administered by the American Midwifery Certification Board (AMCB) to receive the professional designation of CNM. Certified Midwives (CMs) are educated in the discipline of midwifery. They earn graduate degrees, meet health and science education requirements, complete a midwifery education program accredited by ACME, and pass the same national certification examination as CNMs to receive the professional designation of CM.
Midwives are not physicians however, they are specialists in women’s healthcare possessing advanced educational degrees possessing a proven record of safety and satisfaction in the services they provide. Obstetric care provided by CNMs and CMs is the independent management of women’s health focusing particularly on pregnancy, childbirth, the post-partum period, and initial care of the newborn in meeting the needs of women. The CNM and CM practice within a health care system that provides for consultation, collaborative management, and/or referral, as indicated by the health status of the woman receiving care. CNMs and CMs practice in accord with the Standards for the Practice of Midwifery, as defined by the American College of Nurse-Midwives (ACNM) whereas OB/GYN Allopathic Physicians follow the guidelines set by the American College of Obstetricians and Gynecologists (ACOG) and OB/GYN Doctors of Osteopathic Medicine follow the guidelines defined by the American College of Osteopathic Obstetricians and Gynecologists (ACOOG). In some areas Family Practice Physicians, Women’s Health Nurse Practitioners and Physicians Assistants also provide OB/GYN services. There are other practitioners who call themselves midwives who are not CNMs or CMs; they cannot obtain hospital privileges and are not certified by the ACNM. Many non-CNM/CM providers who call themselves midwives practice under Midwives Alliance of North America (MANA) guidelines.
Another way to explain Midwifery care is that there is no health care provider who does everything, even if a physician, as we all have different specialties and areas of expertise. Midwifery care is based in wellness and seeks to empower women to enhance their health through a variety of traditional health and contemporary medical modalities, whereas physicians are specialists in pathology and focus primarily within a contemporary medical model of care which includes surgical intervention. Midwives will provide care to essentially healthy women and refer to physicians and other specialists based on the woman’s need much like a physician will refer to other physician specialists. A physician will perform a Cesarean Section if needed, but a Midwife may assist in some situations. Many teaching institutions share responsibility for education of physician residents and midwives with attending physicians and attending or faculty midwives in hospital settings.
Child Birth: ACOG and ACNM affirm our shared goal of safe women’s health care in the United States through the promotion of evidence-based models provided by OB/GYNs, CNMs, and CMs. ACOG and ACNM believe health care is most effective when it occurs in a system that facilitates communication across care settings and among providers. OB/GYNs and CNM/CMs are experts in their respective fields of practice and are educated, trained, and licensed independent providers who may collaborate with each other based on the needs of their patients. Quality of care is enhanced by collegial relationships characterized by mutual respect and trust as well as professional responsibility and accountability. ACOG and ACNM hold different positions on home birth.
Payment is due when services are rendered. We will collect your co-payment, co-insurance, or deductible (any portion not already met or the full fee for the service provided) due for care/services provided to you during your visit with the Midwife. For this reason, we encourage you to contact ‘Member Services’ with your insurance company to find out what is covered, what is not covered, deductible, deductible amount met, your co-payment or co-insurance amounts for office/home visits, the coverage and cost of laboratory tests and sonograms before the day of your appointment. This will provide information related to your out-of-pocket costs for your appointment and services provided. Your midwife may provide a service based on professional judgment at the time of your visit that your insurance company may deem a “non-covered benefit”. If your insurance company sends you a letter stating “non-covered benefit”, please call them for further explanation; however, you will still be financially responsible for the care provided regardless of your insurance company’s opinion of coverage provisions. If you have a question about the services you receive(d) during your visit, call our office for an explanation. We request your assistance in following up with your insurance company to resolve any non-payment issues.
We are pleased to accept as payment for our services: Cash or Money Orders, Travelers Checks, Cashier Checks and Personal Checks that can be processed electronically (with valid state ID). To utilize a credit card (American Express, Visa, MasterCard, Discover), the cardholder must be present and show a valid state ID.
We do not currently participate ‘in-network’ on any of the insurance plans due to low reimbursement coverage for contractual agreements that do not allow for the Midwifery model of care. We plan to accept some insurances in the future and will assist in providing information to your insurance company for reimbursement as a courtesy. This does not guarantee payment from the insurance company even if they pay for similar services with another healthcare provider.
We will do our best to provide you with an estimate of costs related to your anticipated care in advance of your visit with a Midwife upon request. Feel free to call us for further details or to schedule an appointment.
Pre-payment of Delivery Fees for Childbirth: We will contact your insurance company to verify your benefits related to childbirth delivery fees. This usually covers prenatal care, the birth of the baby, and a postpartum visit. Based on information we receive from your insurance plan, we will attempt to determine your out-of-pocket cost associated with a normal spontaneous vaginal delivery to design a payment plan. It is important to understand that the insurance company bases such fees on a hospital birth. It is an estimate and does not guarantee payment. Also, it does not cover the costs associated with laboratory tests, ultrasounds, hospital fees, anesthesia fees, pediatric fees in the hospital or by the Midwife, any medications, or other fees outside of our practice. It is important to clarify that although Midwifery care is evidence-based, cost effective, and provides individualized care, insurance companies to not have a reimbursement schedule for labor support (shown to decrease cesarean sections, decrease unnecessary interventions, as well as increase patient satisfaction with the birth experience and breastfeeding initiation) which is labor intensive on the part of the Midwife team. For this reason, many insurance companies do not cover the costs associated with home births where the staff and equipment are brought to the mother and, to a lesser extent, to the birth center. As such, costs are absorbed by the patient even though the complete care package is often less than a total hospital birth, if the insurance companies would only consider the advantages and cost savings. A payment plan for a home birth is due in full by 28 weeks gestation. Transfers to a hospital for complications needing additional care are not part of the home birth or birth center package.
Returned Checks/Insufficient Funds/Past Due Accounts: A fee of $50.00 for checks returned to My Midwife for insufficient funds will be charged to your account and due before the next visit is provided. Future services will require payment by cash or money order for your payment obligations at the practice’s discretion.
When balances due on accounts become ‘past due’, the account will become delinquent and you will be contacted to satisfy the balance owed. If your insurance company delays processing or processes your claim incorrectly, you will have to contact them directly. If you cannot meet your financial obligation, please contact our practice directly to avoid further action. Every effort will be made to work out an acceptable payment plan. You will continue to be contacted by our practice until all fees are paid in full. Delinquent accounts are subject to further collection action, including placement with a collection agency with charges added to the balance.
Disability, FMLA and Other Forms: Special forms are often required to document a medical condition or reason for a ‘leave’. Completing forms is time consuming and generally falls outside of the contractual relationship between you and your insurance company for reimbursement purposes. Our Midwives will be happy to complete your forms after payment of a $10 processing fee per form. Allow appropriate time for completion as they will not be completed the same day as an appointment.
Emergencies: If you are our current patient (seen in this practice by a Midwife within 3 years), a Midwife is on-call 24 hours a day, 7 days a week to help with an urgent problem (an urgent problem is not a prescription refill or need to schedule an appointment which will only be done during business hours, M-F, 9am-5pm). If you have a medical emergency or a life-threatening condition, call 911. If an emergency occurs during office hours, call our practice as soon as possible after ensuring your safety and the safety of your baby by calling 911 first if necessary. Prescriptions will not be filled after hours or over the weekend by the on-call provider as this is not considered an emergency. An allergic reaction to a medication prescribed by this practice is an urgent condition needing our attention; however, if there is a reaction that causes difficulty breathing, dial 911 immediately.
There are times when the Midwife will have an emergency and you will have to be rescheduled or see another qualified Midwife approved by the practice.
Late Arrivals/Missed Appointments: We respect the time of all our patients and strive to stay on schedule to avoid waiting for care. If you arrive late or are not able to maintain your appointment, every effort will be made to see you the same day but occasionally you may be asked to wait or reschedule your appointment. Cancelled same day appointments will incur a $25 charge. If an appointment is cancelled more than 24 hours in advance, there will be no charge for rescheduling/cancellation. When you do not arrive for your appointment on time, someone else who desires an appointment cannot be served as your time slot was taken and not available. When making house calls, the Midwife must arrange a schedule based on location and this also changes availability of care coverage.
There are times when the Midwife will have to reschedule your appointment due to other patient needs. In these situations, our practice will make every attempt to call you as soon as possible so as not to disrupt your schedule or have you see another qualified Midwife in lieu of the one with whom you had been scheduled to see. There may occasionally be delays in seeing patients for the same reason.
Phone Calls and Messages: We understand that there will be times that you need to speak with your Midwife or the practice staff. It is our intent to answer all messages in a timely manner; however, please allow return calls on the next business day for non-urgent messages. In an emergency or urgent situation, we make every attempt to call back within 30 minutes. If you do not hear from us, call back. Please have the reason for your urgent call and the best contact number in order to return your call. We cannot speak to relatives and will only discuss your care with you unless there are arrangements made in advance or you are able to be on the phone also. Do not be offended when we ask for the following information in order to address your needs: your full name (the patient name and not a family/friend), date of birth, a brief description of your concern/problem, any pertinent information (gestational age and problems) and the Midwife you usually visit for care. This helps us serve you better as we may not have your records in front of us at the time we answer your call.
Calling during business hours allows for access to services/appointments with our staff if needed and availability of records/information. This is important when requesting a prescription or needed consult and allows for documentation of services.
Refilling Prescriptions: When refilling a prescription, we will need the pharmacy information, name of the medication as well as dosage and frequency of use for the refill. We do not refill medications from other practices, only the ones we prescribe. Refills will be placed within 24 hours providing all necessary information is available. Please leave your contact information in case we need to clarify an order.
Laboratory Services: It is the patient’s responsibility to assure that their insurance will cover labs drawn during office visits or ordered and referred to a lab for collection.
Test Results: It is our policy to inform patients of abnormal test results in a timely fashion. It is your responsibility to inform our practice of any changes in your contact information. Most tests take 1 to 2 weeks or more for processing and receiving results in our office. We do not notify you if results are within normal limits.
Medical Records: Your medical record is confidential. You are entitled to copies of your medical records for yourself or for another healthcare provider at your request. After our practice receives the proper written authorization (Records Release consent form), we will release your records. The fee for copying records is $1 per page. There is no fee if they are released to another healthcare provider. Payment must be received prior to the release of records. Please allow 10 business days for us to prepare and send your medical record.
In situations where an electronic record exists, we assume no responsibility for the protection of your records beyond the basic privacy protection standards in place as required by law. If you give another your personal identification number (PIN) or allow access to your records, we cannot assume responsibility for any breach of information accessed. Also, there are times we must share your medical records with others, such as in cases where the health department requires information on sexually transmitted infections as this is required reporting by law. Child abuse and neglect, including harm to a fetus exposed to illegal drugs may also be disclosed as required by law. If Midwives in this office believe you are in danger of abuse, we are required to report circumstances that could endanger another person. Your privacy is very important to us and our practice is committed to protecting your healthcare information to the best of our ability and the current standards of safety available as required.
Medical records are only valuable as a tool to enhance communication and safe care if current, accurate and complete. For this reason, we require an updated registration form with visits and it is your responsibility to inform our practice of any changes (name, address, phone number, insurance coverage, medical conditions) at any and all visits. This is important for communication and we appreciate your attention to this important matter.
Referrals: It is not uncommon for some health insurance plans to require referrals to see another practitioner or specialist. If you are referred to a specialist by one of our Midwives, we will assist you and/or your primary care provider with a referral. If you need to see a specialist that is unrelated to your OB care/GYN health, you must obtain the necessary referral from your primary care provider.