Alba Birth Center

Review: Billing and collection process is not detailed, it is inconsistent, and is different for people with insurance. Collection for said billing is unprofessional. Insurance is billed more than what it would be out of pocket. When your insurance doesn't cover it, because they are out of network, (and they tell in the beginning that insurance will cover nearly all of their services) they get nasty and threaten legal action, when they themselves are late sending you a bill. Our services ended with them three months prior to actually receiving a bill from them. At which point they demand full payment within 30 days. Also, we left their service area due to career advancement and they penalized us for leaving their service. It is not recommended that you seek their services unless you can afford out of pocket cost, which incidentally is cost less than if you have insurance.Desired Settlement: Our bill should be cut in half of what they are actually attempting to charge us. I would like it to reflect that.

Business

Response:

6/11/2014

RE: Complaint ID [redacted]

Dear Representative of Revdex.com of Wisconsin:

Our billing practices are legal and ethical, and additionally we have a good track record of working with clients who claim a financial hardship, as long as they are making good progress towards paying off their bills with us.

In regard to this specific complaint, we have been trying to explain and work with this particular client, and so the complaint is quite surprising. We understand that many times a pregnancy is one of the first instances in which a young family uses their health insurance, and so there is a learning curve in regard to how medical billing works.

We charge a global fee for uncomplicated prenatal care, labor, delivery and postpartum care. We combine all of these services into one global fee. If a client has complications, it is both legal and appropriate to bill additionally for those complications, both for self-pay and insurance pay clients.

If a client is self-pay, we ask that they pay their entire global fee by one month before their due date. In the event a client is insurance pay, we cannot bill their insurance until they have been provided service. Because of this, the self-pay global fee is somewhat discounted because it is an advantage to us to have the services paid for as we are providing it. We understand that this is customary among many medical practices to offer a discount for payment up front.

If either a self-pay or an insurance pay client transfers out of our care, for any reason, prior to actually birthing with us, we can only bill for the services that we have provided to them up until that point. In this particular case, we billed the client’s insurance for an initial prenatal visit that occurred on 12/12/2013, plus three follow-up visits (dates of service 1/16/2014-3/11/2014). The amounts billed were $450 for the initial, and $400 for each follow-up. The insurance company allowed all billed amounts as usual and customary charges for services rendered.

Of the total $1650 billed, $500 processed to the client’s deductible. The insurance company deemed $1597.15 patient responsibility, and the insurance company paid $52.85 in the form of a check to the client. This check is legally only to be used for payment of the care provider, and we have not had any payment from this client toward her bill.

Once we have billed our care to the insurance company, we balance bill the client, and the balance is owing in 30 days. In this case, I offered a 20% discount on the bill if it could be paid in full in 30 days, or a payment plan of $275 per month for 6 months. I did not assess financing charges for the payment plan offer. So, I am willing to wait a full year beyond the date that initial services were provided for the bill to be paid in full with no finance charges. This seems to me like a very reasonable and fair option.

We have not been nasty, and have not threatened legal action towards this client. All of our communication about past due accounts is polite and professional. We do submit client accounts to a collections agency if we cannot work out a reasonable payment plan with a family, but we have not gotten to that point with this case. We have been in recent communication with this client over the last week regarding helping her to understand her bill and offering a pay in full discount and a reasonable payment plan, free of finance charges.

If you need further documentation from us, such as the client's signed financial agreement, we would happily provide that. We look forward to swift resolution in this matter.

Sincerely,

Appleton Community Midwives, LLC

We decided to try using Alba Birth Center (formerly Appleton Community Midwives) for the birth of our second child. After an initial consultation and three follow up appointments, we decided that we were more comfortable with our previous midwife and decided to transfer out of care.

When I first met with the midwives I was told that their private pay fee was approximately $3,900 and that they could also bill insurance-whichever was less expensive. They assured me multiple times that midwifery care was always less expensive than going with an OB.

When I transferred out of care I had already paid them my global fee of $2000. They billed my insurance and charged me $450 for the first apt and $400 for the other three, for a total of $1,650.

I am sure they are well within their legal right to do this, but it is absolutely not an ethical practice in my book. The one appointment I went to with an OB was only $181 as opposed to the $400 Alba charged me.

I believe I was taken advantage of because I was leaving their care, and they wanted to keep as much of my money as possible. If their goal was truly to provide affordable and quality maternity care, they would not have trumped up their charges the way they did. At $400 an appointment and 14 prenatal visits, that would turn out to be $5,600 before labor and delivery were even accounted for! -After they assured me they would work it out so that I would only be paying the $3900 we discussed in the beginning.

Regardless of their legal rights to charge what they charge, it simply isn't the right thing to do.

I have worked with Anja and Andi from Alba Birth Center twice now, for the births of both of my daughters. I birthed both my girls at home. Both Anja and Andi made me feel very at ease during all my prenatal appointments and answered all my questions, never making me feel stupid or silly for asking anything. When it came time for my labors, they came quickly and were very supportive and helpful. They didn't pressure me or try to hurry my labor along, they just let my body do it's thing. My first labor was VERY long and not once did they try to push me into transferring to a hospital, they just encouraged me and sat back while I labored. I felt very comfortable with their knowledge of births and how to handle any situation. I also felt comfortable with them and as I got to know them both and they know my girls, I felt as though they are part of my family. I would highly recommend these ladies, they are fantastic, professional and very knowledgeable.

My experiences with Alba Birth Center (formerly Appleton Community Midwives) have all been lovely. These midwives have attended the births of all three of my children. [redacted] and [redacted] and their assistants are all very knowledgeable, respectful, and kind. They are very compassionate caregivers, and take time to listen to any concerns. They look out for the mental and physical health of the mother, as well as providing excellent care for baby. The women at Alba Birth Center work very hard to support the mother through labor, however long it takes, or difficult it may be. I highly recommend these ladies if you are looking for high quality out of hospital care.

Review: We suspect Appleton Community Midwives (ACM) are overcharging us and our insurance company to recoup costs due to us leaving their care before our baby was born. They quoted us a global fee of $3500 for ALL prenatal care, birth, and postpartum visits unless we left care before term (which we did); in that case, we would be billed for services rendered only. We left their care before our baby was born, so our bill should be significantly lower than what they are asking us to pay (*breakdown below). They have told us they are only charging us for services rendered; however after looking at what they have billed us and the insurance company, they appear to be adding all of that cost back into our bill by increasing the costs of the prenatal visits we did receive with them. They offered us a 10 month payment plan but ONLY if we allow them to auto-bill a credit/debit card - however an insurance claim is still pending, in addition to other insurance payments and a hearing screening refund not being credited to our invoice - these things make us extremely hesitant to hand over a credit card number! They have threatened to charge interest or send us to collections if we do not make our payment by the beginning of September. ACM has billed our insurance company, but according to the insurance company, it requested additional information to complete coverage but ACM has not yet resubmitted requested information. Instead ACM is claiming insurance has denied the claims and we are required to pay the balance. Their payment contract states they will work with families with financial hardship - they have refused to do this for us ($220+/mo is NOT reasonable on our income).

* Payment/services breakdown: No less than 8 prenatal visits, homebirth attendance, no less than 2 postpartum visits = $3,500.00. ACM is charging us $400-$450 PER prenatal visit - the math just does not add up and they have refused to tell us how they arrived at the $3,295.20 ($2,995.20 after one insurance payment). Our insurance has sent more than $300 that is not being reflected on our invoice, and we paid for a hearing screening that was also not shown on our invoice.

It is worth noting that upon entering into their care, we sat down and discussed the finances and weighed our payment options regarding paying cash or paying with insurance. They told us they'd check our benefits and tell us which option would result in the lowest out of pocket price for us. They said paying with insurance would be less expensive to us than the $2,500 cash pay price. We did not even receive most of the care in that package and are now being charged far more than if we had paid cash. We feel like they deceived us intentionally to get more money from the insurance company and still charge us on top of it.Desired Settlement: We want to see a fully itemized invoice for the $3,295.20 they claim that we owe (we have no idea how they came up with this number, it does not match up with anything else they have sent us), WITH correct insurance payments and hearing test credits. We would like a reasonable payment plan that we can actually afford for the actual amount that we owe for services rendered.

Business

Response:

Attached please find all financial documents relating to [redacted]'s care with Appleton Community Midwives, LLC. Ms. [redacted]'s insurance has been billed for the care that was provided to her, and the insurance company has accepted the charges as usual and customary for the care that we have provided. Please note that we cannot bill Ms. [redacted]'s insurance for Global Obstetrical care, because the CPT code for that item includes the delivery of the baby, which we did not do. The invoices as attached have been sent to Ms. [redacted] at least twice, and they reflect what the patient has also received from her insurance company to date. Please note that insurance companies often request medical records for claims that are filed, and this is not evidence of wrongdoing on the part of our billing department. There is, to date, one claim that has not been processed by the insurance company, and we may yet see some payment on that claim.

As of today, August 19, 2014, Ms. [redacted] has only made on payment of $20 toward her balance. This was for her newborn hearing screen, which was performed at the hospital. I have credited her account for the hearing screen, and applied this payment toward her outstanding balance, as evidenced by her Customer Report, which is attached. Any other payment we have received on Ms. [redacted]'s behalf has been from her insurance company.

We are offering Ms. [redacted] a 10% discount on her total outstanding balance of $2995.20 if paid in full in 30 days (no later than September 19, 2014). She may also choose an interest free payment plan of ten payments in the amount of $299.52. If she would like to finance her care over a period longer than 10 months, we will charge a 12% APR interest on the principle. If Ms. [redacted] is interested in financing her balance through our office, we are happy to set that up for her, and she may respond via the Revdex.com to arrange this. Please note that if we do not have a response and a suitable payment arrangement made with this patient, we will be sending her account to collections, as stated in her signed financial agreement which is attached.

Our payment plans are set up as recurring charges on credit or debit cards, and you can rest assured that all of our computer systems are HIPPA compliant, and therefore secure for handling credit cards. If Ms. [redacted] prefers to make monthly payments via cash or check, she may do so, but we ask that a credit card be placed on file to secure her account. We will charge the credit card on file for any missed payments.

We look forward to hearing Ms. [redacted]'s plan for paying the balance of her bill.

Sincerely,

Appleton Community Midwives, LLC

Consumer

Response:

The amount of money they want keeps increasing, according to our insurance company from what they have paid ACM and giving for discounts the amount should be less, there is also $1200 still processing from the insurance company and UHC has requested information on the appointments twice from ACM but they have not responded. The 2 ultrasounds were denied from the insurance company because they were listed as frivolous and not diagnostic, those both need to be resubmitted as diagnostic since the first was used to check to see if the baby was developing correctly and the second was required by the midwives so they could figure out which direction the baby was facing. Attached is the EoB for claims submitted by ACM.

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

[To assist us in bringing this matter to a close, we would like to know your view on the matter.]

Regards,

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

The $2615.20 I referenced earlier *included* the $400 check from BCBS. I believe the discrepancy lies with the $400 office visit dated 2/26/14. This bill was not accepted by our insurance; they cite a date discrepancy and have requested the claim to be resubmitted. Since they apparently have not received it, they did not include this visit in our amount owed. See screen shots for details.

Business

Response:

The [redacted]s continue to upload only EOB's from UHC. Yes, there was a claim that UHC denied, because we mistakenly billed them for care from 2013 when they were not the [redacted]s insurance carrier. That claim was submitted to BCBS, processed with $800 being the allowed amount, $400 of which is patient responsibility and $400 of which the insurance company sent in the form of a check to the [redacted]s in order to pay their provider. The family owes us the entire $800 of that claim.

[redacted] and [redacted] were our midwives for prenatal care and the homebirth of our daughter in 2012. We were cared for in a warm, professional manner. They are both competent and skilled midwives and we felt very safe in their care and confident in our decision to seek their assistance. They were available to us any time we needed them and we were always treated with respect and kindness. All decisions were discussed fully and we were well aware of the risks and benefits of all choices that we made throughout our pregnancy, birth and the postpartum period. [redacted] and [redacted] allowed us to feel confident in our own decision making and in my ability to have a normal birth. All financial aspects of our care were handled professionally and fairly. They were very flexible in setting up a schedule for us to cover our out of pocket expenses and they billed our insurance without incident. I do not hesitate to recommend that anyone seeking a natural, normal birth seek their care.