How Did Midwives Advantage Get Started?
Stacy Carruth, CPM delivered her first child in a hospital in 1983 and had the rest of her children at home with midwives. She started her midwifery education in 1992. Stacy has been the administrator of two state-licensed birth centers and attended well over a thousand deliveries over the last 30 years.
Stacy used several highly recommended third-party billers to file insurance claims, and the results were the same: "Homebirth or birth centers are not a covered service. Midwives are not recognized as healthcare providers." The list of reasons to deny claims goes on. It wasn't fair that insurance would pay for a hospital birth but refused to pay for birth centers or home births. Stacy had personal experience with the injustice of insurance and homebirth. Her husband was a federal employee, and they had excellent insurance. If she had delivered in a hospital, her co-pay was $200. Since she delivered at home, Stacy paid thousands to her midwives, and the insurance paid nothing. Someone had to conquer this injustice; as a mother and a midwife, Stacy was the perfect person for this mission.
In 2009, Stacy was introduced to an attorney that won a $180M settlement from United Healthcare and a $120M settlement from Aetna for underpaying out-of-network claims. After that, physicians wanted him to terminate their in-network contracts because of the low-paying fee schedules. He formed Edge Medical Solutions, Inc. to submit out-of-network insurance claims for orthopedic surgeons, obstetricians, physical therapists, surgical first assistants, and family practice doctors. Shortly after they met, he told her about an upcoming meeting to negotiate out-of-network agreements for Edge Medical Solutions with several hundred insurance companies.
Stacy knew this was something she needed to be a part of and was the first midwife to join Edge Medical Solutions. Stacy had tried everything else to get claims paid; this was worth a try. The attorney didn't have high expectations for the claims, even with his Edge Medical agreements. She filed several claims for deliveries, and to their surprise, big checks started rolling in. After seeing the money Stacy was making, the attorney asked her how many midwives attended home and birth center deliveries. He was surprised when Stacy told him there are thousands of midwives, and out-of-hospital births are very popular. The attorney had a brilliant idea for a new company, and National Birth Centers, Inc. was born.
They incorporated his knowledge from years of experience as an attorney and Stacy's knowledge from years of experience as a midwife. They formed a nationwide business that focused solely on getting birth centers and home birth midwives paid by insurance companies. Through their system, midwives become contracted providers of National Birth Centers. They submitted claims to the insurance company with the midwife as the attending provider, and these claims were paid under the company's established agreements.
They built National Birth Centers, Inc from 2009 until 2011. In the Fall of 2011, the attorney called Stacy into his office and told her he wasn't making the money he had anticipated with the midwifery billing venture, and he was closing the business. They had come so far in billing for midwives, and Stacy knew more midwives needed this service. She couldn't let the momentum die. With his blessing, Stacy continued the business, and she has continued to a unique realm of billing for midwives.
Today, Stacy Carruth, CPM is proud to say that midwives in 38 states have realized the benefits of getting paid the Midwives Advantage way!