Uninsured & Hospital Stays

Here are some points for midwives to consider about hospital stays for uninsured clients:

  • Find out if your hospital will negotiate a rate for clients who are discharged early. Many clients in midwifery care are discharged straight from Labour and Delivery without accessing the postpartum ward.
  • Hospitals usually charge a set rate for any period of stay that is less than 24 hours (e.g. if a client stays for 8 hours, she is usually charged for a full 24 hours.).
  • Some hospitals charge for a second day if the client stays for more than 24 hours. Others charge for an additional day after midnight (e.g. if a client is admitted at 11 pm and leaves at 3 am, she will be charged for 48 hours). Still others charge for an additional day after 9 am (e.g. if a client arrives at 5 am and leaves at 10 am, she will be charged for 48 hours).
  • Know when the 24-hour period starts, as this may affect the time you choose to admit a client. For example, if you are admitting a client in early active labour at 11:30 pm but the 24-hour period begins at midnight, you may choose to wait (obviously this should never affect clinical care).
  • You may want to negotiate with the hospital to waive the admission fee or conversely suggest clients do not pre-register at the hospital when planning a home birth. However, some hospitals charge a reduced fee for clients who pre-register.
  • Some hospitals charge an "admission fee" for every visit to the hospital (i.e. pre-registration, all ultrasounds, blood work, NSTs, etc). If this is the case, and the fee cannot be waived, you may want to consider doing as many tests as possible outside the hospital.
  • Many hospitals will charge a fee for a client to be given Rhogam at the hospital prenatally. Hospitals may require that she be registered with the hospital to get a hospital card/number, which may also be associated with a fee. You may want to find out if you can order the Rhogam and administer it at your clinic to avoid this cost to your client.
  • Many hospitals will set up a payment plan for clients planning a hospital birth. Find out if this is an option at your hospital. If a client is planning a home birth or ends up having her baby out of hospital, find out how much of the fee will be refunded if she has paid funds to the hospital in advance.