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Choosing an out of hospital birth is a beautiful and empowering decision for many families, but it can also come with a financial barrier. Midwifery care, while often more affordable than hospital births, typically requires payment upfront, and many families are not aware of all the creative ways they can pay for midwifery services. As a midwife, you can play a key role in educating your clients about the various payment options available to help make their dream birth a reality. Here are some creative ways to pay for midwifery care that can help increase access to out-of-hospital births:

1. Cash Payment with a Discount

For clients who have the financial means or prefer to pay upfront, offering a cash discount can be an attractive option. This allows families to save money while also helping you secure full payment without waiting for insurance reimbursements or dealing with billing issues.

  • Early Payment Discounts: Consider offering a discount for clients who pay in full early in their pregnancy. For example, a 5-10% discount on the total cost of care if paid by a specific time, such as the first trimester.

  • Flexible Payment Options: Some clients may not have the full amount upfront, but you can offer flexible payment plans. For instance, clients can make monthly payments leading up to their due date, which may fit better with their budget.

2. Insurance Reimbursement (For Out of Network Births)

While midwifery services are often not fully covered by insurance, many families can still get reimbursed through their insurance company for out-of-hospital births (home birth or birth center) by submitting a superbill. Educating your clients on how to submit a claim to their insurance provider is key to making midwifery care more affordable for them.

  • Superbills: After providing care, offer a detailed superbill, which is a detailed receipt for services that includes the necessary codes (CPT and ICD-10) for the insurance company to process the claim.

  • Out of Network Reimbursement: For clients with PPO insurance plans or other types of out of network coverage, encourage them to contact their insurance company to inquire about reimbursement for midwifery services. Some insurance plans may reimburse out-of-network providers, even for home births, depending on the plan and the state’s regulations.

3. Health Savings Accounts (HSAs) & Flexible Spending Accounts (FSAs)

Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are both excellent options for families to save pre-tax dollars and use those funds for healthcare expenses, including midwifery care. Many families may not realize that these accounts can cover out-of-pocket expenses for birth-related services, even when those services are provided outside of a hospital setting.

  • HSAs: If your clients have a high-deductible health plan (HDHP), they may be eligible to contribute to an HSA. These funds can be used tax-free for qualified medical expenses, including midwifery services.

  • FSAs: Clients with FSAs through their employer can also use these funds for out-of-hospital birth-related costs. Encourage clients to review their plan to ensure that midwifery care is a qualified expense, and help them plan accordingly to use their FSA funds for prenatal, birth, and postpartum care.

4. 0% Interest Credit Cards

For families who may not have the immediate funds available but want to pay off their care over time, using a 0% interest credit card can be a smart option. These cards allow clients to spread the cost of their care over several months (sometimes up to a year or more) without paying any interest. This can make midwifery services more accessible to families who might otherwise have difficulty paying upfront.

  • Research Credit Cards with 0% APR: Suggest to clients that they research credit cards with 0% APR offers on purchases. If they qualify, this can provide them with the flexibility to pay for their care without incurring interest, as long as the balance is paid off within the promotional period.

  • Set Up Automatic Payments: To ensure they don’t miss payments and accumulate interest, clients can set up automatic monthly payments, making it easier to budget for midwifery services.

5. Fundraising and Crowdfunding

Crowdfunding has become a popular option for families to raise money for significant life events, including birth expenses. Platforms like GoFundMe, Kickstarter, and Indiegogo allow families to share their birth story and raise funds from friends, family, and even strangers who are willing to support their decision for an out-of-hospital birth.

  • Set Up a Campaign: Help your clients set up a crowdfunding campaign. Provide them with information about what to include in their campaign, such as a description of the care they need, why they’re choosing a midwifery model of care, and how their community can help.

  • Share with Community: Encourage clients to share their crowdfunding page on social media, through email, and within their local community groups. People often love supporting families in their birthing journey, and many people may be willing to contribute if they know what’s needed.

  • Offer Rewards: If clients want to make their crowdfunding campaign more engaging, they can offer small rewards for donations, such as personalized thank-you notes, birth story updates, or small handmade items after the birth.

6. Family or Community Donations

For families who may have limited financial resources, asking family and friends to contribute toward the cost of midwifery care can help reduce the burden. Midwives can support their clients by encouraging this option and offering advice on how to ask for help.

  • Baby Showers with a Twist: Suggest that clients host a baby shower or a blessingway in which the gifts are financial contributions to the birth costs rather than traditional baby gifts. This can be a way for family and friends to show their support in a meaningful way.

  • Set Up a Fund: If your client feels uncomfortable directly asking for donations, they can set up a fund with a trusted friend or family member who can act as the intermediary. This can make the process feel less awkward and ensure the funds are managed properly.

7. Sliding Scale or Payment Plans

For clients who truly want to give birth outside of a hospital but find the full cost of midwifery care a barrier, sliding scale payment plans and payment flexibility can make all the difference. Offering personalized payment plans allows families to pay for services in a way that fits within their budget.

  • Flexible Payment Plans: Offer payment plans that break down the cost of midwifery care into manageable monthly or quarterly installments. Ensure that these plans are clear, reasonable, and transparent to avoid misunderstandings.

  • Sliding Scale: If you are able to, consider offering a sliding scale fee structure based on a family’s income. This can help ensure that all families, regardless of financial situation, have access to the care they need.

Access to out of hospital birth should not be limited by financial constraints. By providing your clients with creative payment options, you can help ensure that midwifery care is accessible to a wider range of families. Whether through insurance reimbursements, HSA/FSA funds, credit cards, crowdfunding, or sliding scale payment plans, there are multiple ways to ease the financial burden of midwifery services.

As a midwife, educating your clients about these options and offering flexibility in payment methods can make a significant difference in helping them achieve the birth experience they desire, while also ensuring that your practice remains financially sustainable. Together, we can help more families access the care they need and deserve, regardless of their financial situation.

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