You have the right to receive a “Good Faith Estimate” (GFE) explaining how much your medical care will cost.
Under the federal “No Surprises Act,” uninsured or self-pay patients must receive an estimate for medical items and services. You will receive two GFEs, one for you and one for your baby’s care. You are two separate patients and must be treated as such.
Your Rights Under the “No Surprises Act”
- Get a comprehensive estimate: You are entitled to a “Good Faith Estimate” covering total expected non-emergency costs—by CPT codes—for you and your baby, including prenatal care, delivery, postpartum visits, tests, and fees.
- Timing: All providers, including midwives, must supply this estimate in writing at least one business day prior to a scheduled clinical visit or upon request before. We automatically supply you with this GFE at your free consultation.
- Disputes and Records: You can dispute bills that exceed your estimate by $400 or more, and you should retain a copy of your estimate.
- Contact the U.S. Department of Health and Human Services (HHS), https://www.cms.gov/nosurprises or phone them at 1-800-985-3059
How Midwifery Care Estimates Work
Midwifery estimates typically outline expected standard care packages (routine visits, birth attendance, and follow-ups) but may exclude unpredictable complications or emergency transfers for you and your baby.
January 1, 2027
Beginning January 1, 2027, significant changes to maternity care billing will take effect. The American Medical Association (AMA) is replacing the decades-old global maternity care CPT codes with a new structure. We are no longer able to code or charge a global fee. These changes are designed to allow maternity services to be reported in greater detail rather than as one global service.
For midwives and other maternity care providers, this means substantially more detailed tracking, documentation, coding, and billing of the individual services provided throughout pregnancy, birth, and the postpartum period.
Most midwives did not enter this profession because we wanted to spend countless hours in the office itemizing and coding every service provided to each client. We entered this profession because we wanted to care for mothers and babies. The administrative work required by these changes can be time-consuming and costly.
We have therefore chosen to offer our clients a Bundled Fee Structure for midwifery care. By bundling our services, we can significantly reduce the amount of administrative time required to individually bill each service. This allows us to avoid or reduce the expense of additional billing personnel and pass those savings on to you. Therefore, the bundled fee is much lower than the GFE.
Our goal is simple: we would rather spend our time caring for you than itemizing every minute of that care.
The bundled fee allows you to know the cost of your midwifery care in advance while allowing us to devote more of our time, attention, and resources to providing the personalized care you have chosen.
Insurance
We are not in-network with any insurance companies. We do not want to be in-network even if we qualified. Nor do we file insurance as an out-of-network provider. We do not prepare insurance forms such as HCFA, 1500, or 1600, nor do we have them available. We do not employ insurance-trained personnel.
Insurance companies typically will not process claims from our “Quickbooks” statement because the bundled fee is divided into payments and not itemized by CPT codes. Some Co-Ops and HSAs may accept our “Quickbooks” statement.