Financial Contract and Agreement

for home birth midwifery services with Alisha Stoltzfus

Fees 

My full fee for the base midwife package services described are $4,200, and have additional packages and/or add-ons to the final invoice (labs, additional travel costs, newborn screens, water birth, placenta encapsulation, etc.). If you are interested in contributing to scholarship funds for those who are in need of a home birth scholarship, please let me know. I offer a sliding scale if you attend childbirth educational events and/or an online class, have had a previous home birth, or are decided on an individual basis at my discretion. Repeat clients are waived the deposit.

The interview appointment is free. An initial payment of $600 is due at first prenatal visit (if not possible, please refer to alternative payment options down below); $400 deposit is required and non-refundable as it covers on-call time, health history review, client portal management, ensures due date in my calendar, etc. At each following prenatal visit, $200 minimum towards the full fee is due (unless arranged otherwise). A $200 reduction in total fee is given for payments received in full by first visit or if you are a current client under care who has received services and paid an in full midwife package in the past.

Discussion of fee compensation in other forms (services, trade, etc.) is welcomed. Only payments made in full qualify for the reductions outlined above.

Remainder paid in full by 36 weeks, and is considered overdue in two weeks (by 38 weeks). Pre-payment ensures I am available for your birth starting four weeks before your estimated due date and six weeks postpartum. If there are any additional fees, I will send a final invoice in the postpartum. I send invoices via email, you can view and customize in your client portal, or we can agree upon an alternative payment arrangement, written down below. I accept payment by cash, check, paypal, or card with quickbooks (I do have a card reader if needed).

My clients are required to be active in the decision-making process of their care, and assume full responsibility for the outcome of their birthing experience. I do not carry professional liability insurance as that would make home birth unaffordable to families and malpractice insurance is unavailable to out-of-hospital midwives.

Refund policy

In the event that your care is transferred for any reason prior to 36 weeks, I will offer a refund for the amount you have already paid, minus $200 per prenatal appointment, $100 for each event of initial history review, and $400 non-refundable deposit. 

If transfer of care is necessary after 36 weeks, I will continue to offer visits and support using the same schedule outlined. Refunds are unavailable after 36 weeks, regardless of the location and outcome of the birth. The refund amount does not change if you arranged an alternative payment, scholarship arrangement, or took part in the sliding scale since these were made as a courtesy.

Termination of care

Unless other arrangements are made in writing, failure to pay fees may result in termination of care. If other arrangements are made in writing, failure to pay fees as specified may result in termination of care. If a scheduled payment cannot be made in the event of an unforeseen circumstance or emergency, please let me know ASAP. I reserve the right to not accept late payments and to terminate your care as a result, but if these are rare circumstances I generally accommodate them.

If you are not paid in full by 36 weeks or if you have not fulfilled the obligations of your payment schedule, your care will be terminated. I will send you a letter confirming termination and if I owe you any refund, it will be mailed to you within 60 days of termination.

Alternative payment arrangement

Payment arrangements other than those outlined are made on an individual basis and are at my discretion. If we have agreed upon an alternative payment arrangement, it needs to be written down below. The written plan below are subject to the same refund policies, termination of care, including amounts withheld per completed prenatal appointment ($200), each initial history review ($100), and the non-refundable deposit ($400).

Payment plan and schedule

The total fee of ______________________ will be made by ______________________ to Alisha Stoltzfus, The Birth Servant LLC as consideration for this agreement and described services.

The following terms apply:

1. Full conveyance of total fee is conveyed concurrent with this contract.
2. Partial conveyance of fee is conveyed concurrent with this contract to include at least $400 (10% of base package) non-refundable deposit required at the first appointment with the remainder of the required fee conveyed by 36 weeks.
3. A $200 reduction in required fee is given for payments received in full by first visit or if you are already a current client under care who has received services and paid an in-full required fee in the past.

Discussion of fee compensation in other forms (services, trade, etc.) is welcomed. Only payments made in full qualify for the reductions outlined above.

Outline below payment schedule:

Please sign below indicating you agree and understand The Birth Servant LLC, Alisha Stoltzfus’ financial contract, agreement, and expectations for midwifery home birth services.

Client _______________________________________________________ Date _____________________________

Midwife _____________________________________________________ Date _____________________________