San Diego Midwife Interview With Jamin Sylvada – Natural Birth Options

SYLVADA: In our care, no, there’s no need. We see our clients throughout the pregnancy. If for some reason something comes up during the pregnancy that we decide that they need to see a doctor, like for example high blood pressure or any other issues that would come up, whether maybe they were not going to be good candidates for a homebirth, then we will refer to a doctor. Sometimes we’ll do co-care, where they’ll see us and a doctor, or sometimes it’s so severe that they can’t stay in our practice and they have to go to a doctor’s practice.

THOMPSON: Okay. Who makes that determination?

SYLVADA: We do.

THOMPSON: All right. Are there some circumstances where a homebirth is not the best choice for that particular woman?

SYLVADA: Yes. Oh, yes, yes, yes.

THOMPSON: Can you give us some examples?

SYLVADA: First if she’s having twins, we don’t do a homebirth. If she has severe blood issues with blood clotting, platelet issues, where she would be at risk of maybe not clotting properly, she would need to be in a hospital setting.

THOMPSON: Is that something you would normally determine later on or early on?

SYLVADA: Pretty early. What else, I’m trying to think. Severe gestational diabetes with insulin, where she would need to be in a hospital setting, is another area. So there are different reasons, for sure, that would necessitate a woman having to leave our practice.

THOMPSON: Okay. Shifting gears just a little bit, how does the cost of a homebirth with a midwife compare to a hospital delivery?

SYLVADA: First of all, it’s a little bit different because you’re right, there’s a hospital birth and then there’s a midwife birth. We are a global flat rate for everything. I’m going to talk for La Shel and myself, our cost. It’s about the same for all the midwives. I’ll give you an example. For us, it’s a flat rate of $4,500. It includes all the care, the birth, and the postpartum care. You’d think the insurance would be like, “Woo-hoo! We’re saving money.” With women that see doctors, they have their doctor bill, and then the moment they go to the hospital, they have the hospital bill. And even in the hospital bill there’s different bills. For us, it’s just a flat rate.

THOMPSON: Yeah, I know here in San Diego County, many times for just a vaginal delivery, the range of costs depending upon the hospitals are from $7,000 to $12,000.

SYLVADA: The IV, the drugs.

THOMPSON: Just for the hospital portion of it.

SYLVADA: Exactly.

THOMPSON: How does the cost of homebirth with a midwife compare with a birthing center? Are you familiar with that?

SYLVADA: Of course. Usually birth centers are more expensive; if you’re paying cash, the fees are more. What happens is there’s a difference with insurance. More insurance will cover at a birth center. If you’re paying cash, for sure I think homebirth is cheaper, but if you have insurance sometimes being at a birth center, your insurance will cover more. So for someone who they’re really looking for financial help or with their insurance, they might just go with a birth center.

THOMPSON: Are the services that you provide as a midwife something that health insurance companies will cover?

SYLVADA: This is how it works right now in the state of California: we can only bill the insurance once the baby’s born. Actually, we can bill their first initial visit, which we work with a company called Larsen Billing and they’re our billers. They will bill that first initial visit, so it sort of opens the file with the insurance. But then we can’t do anything until the baby’s born. Once the baby’s born, then we bill, we send a global super bill to the insurance, and that’s when the insurance starts sending the money.

THOMPSON: Is that typically handled as an in-network or as an out of network?

SYLVADA: Most of the time it’s out of network, yes.

THOMPSON: Okay. I kind of thought that was going to be the case. Do you know much about health savings account health plans and whether or not they would cover midwife services? They are a PPO plan.

SYLVADA: I don’t know all the details, but I know that a lot of our clients ask for a receipt and get the money from their HSA account. So I know that a lot of our moms use that.

THOMPSON: Are there better health insurance companies to work with for alternative births?

SYLVADA: For sure, when women call me, if they have a choice between getting an HMO or a Kaiser or a PPO, I always say try to get some kind of PPO. Of course, PPOs, it depends on your deductible. When you have a small deductible, you will get a lot of money back, a refund; all the blood work and labs that we do here, I can bill with their PPO, ultrasound with the PPO. So for sure I say PPO, and then the company, it really varies year to year. It really depends.

THOMPSON: Okay. Should clients ask their insurance company what is covered if they have a midwife and a homebirth? Should clients do that?
{To see the answer to this question, click page 3 below the “More Natural Birth Information” block below}