Sliding Scale

[motherwise]

I was wondering if any of you offer a sliding scale or different arrangements for low-income families and how does it work? How do you decide where on the scale they fall? How much difference between you lowest and highest price?

Thanks

[MyDoulaStacia]

I have wondered that too Marilyn. I always offer a set fee, but some of the doulas in my area offer a sliding fee scale telling the parent to pay "what they can afford." That would seem to me that you could be taken advantage of.
Don't get me wrong, I do offer discounts and such but the fee is set at the begining, not whatever they decide to pay me.
I hope I don't sound harsh.

[tlcdoula]

Well I offer a sliding scale, and I let the parents choose where they fall on that scale. Basically what I did was looked at what I felt was the lowest possible amount that I could "accept" for a birth and put that as the low fee. I then set my high fee and I tell the parents that they can choose where they fall. So in my case the scale is $400 to $550. I know that doesn't seem like a very wide range and that $400 doesn't seem very low, but for many years I did lots of free births or just about free births and that affected my family and so I decided I would give a sliding scale, but not go so low that it would hurt my family. Does that make sense? LOL

[raspberrymoondoula]

i had been doing some free or very low cost births but i've had to stop doing that. price of gas and child care is way too high!! i would like to give a sliding scale, i like the 400-550 thing thats a good idea!!

[MindOverLaborDoulas]

i had decided that I would do a sliding scale starting at $250 and going to $400 depending on how much time and info was involved. But it seems like everyone that I have been getting acts as if $250 is way too much. So, the last couple that I have done and the next 2 that I have lined up are for free. How do I stop doing that and get paid w/o sounding greedy? This is a very rural area and the most expensive CBE only charges $75 that I have found and that is for a 6 week class.
Help??!!!

[DL]

1. Flat Fee
2. Sliding Fee Scale
3. Payment Plan
I do not specifically mention having a Sliding Fee Scale or Payment Plan to potential clients first; I usually let them mention hardship first before I bring up other options.

I do have a flat fee ($400). The vast majority of my clients have just paid that amount and didn't ask about the sliding fee scale.

For those who ask or voice concern over the flat fee, they can see where they might fall on the Sliding Fee Scale. The top fee on that is the same as my flat fee ($400). The bottom is $100. Only one couple so far have hit the $100 level. I chose the fees that I did because I can personally remember being at each financial level during my married life (when first married, dh was enlisted Air Force, and we would've qualified for the $100 level. $100 was A LOT of money for us at that time). The freedom of the Sliding Fee Scale, though, is that it's so easy to change the fees for what works best for you.

If the 2 lump-sum payments on the sliding fee scale (1/2 of total fee for Retainer, 1/2 of total fee 2 weeks after the birth) is still causing a financial hardship, then I *may, at my discretion* opt to work out a payment plan with them. I would rather someone hit $100 and then work out a payment plan with me than to just say "I'll do it for free", even though it pretty much feels that way to me. Doing it this way causes them to value my services more, I think.

I use the same scale as the midwifery, that I do reception for (they also have a Flat Fee, Sliding Scale, then payment plan when needed); our income scale is Based on Poverty Guidelines published in the Federal Register on February, 2002. Monthly and Annual incomes are listed, as well as family size. I haven't looked into any changes in the poverty guidelines since then (but just may out of curiosity). The midwifery and I have the same income cut-offs, but the midwifery obviously deals with larger amounts of money than I. They use a percentage scale (i.e. "this amount of income" is eligible for 10% discount off regular fee, 20% discount off, etc.). I dislike the math of that, so I just give discounts in increments of $50 & $25 (depending on how far one falls on the scale), starting at my full fee on down to $100. I can easily change the discount/fee amounts whenever I want to type different numbers in my Word doc. I don't know if any of this is making sense; so, if anyone is interested in seeing my Sliding Fee Scale chart, PM me and I'll be happy to share it. From that chart, you could easily change ANY of the fees (don't change income levels/family size since it's taken from government numbers) or otherwise modify it in any way and use it for yourself if you'd like.

The midwifery asks for 2 months worth of proof of income in order to be placed on their Sliding Fee Scale. I have done the same for instances when I was concerned that I could be taken advantage of. Since I work reception at the midwifery, though, I already have a pretty good idea of which clients are low income and which are not. Most of my clients are from the midwifery, but not all. So...for that reason, I have asked for proof of income a few times, but most times don't feel the need. I will say that I wouldn't hesitate to ask before feeling like I was being taken advantage of, though. Sorry so long...it's hard for me to thoroughly explain how I do it in writing and yet be brief at the same time!

[MindOverLaborDoulas]

Okay.. that really helps! I went to the gov. site and got the updated guideline, of course I don't know if anything has changed, but I will feel a little better if I can back-up what I am saying with the newest #s. I might need to look at your chart so that I can know how to do it!
Thanks again!
Ashley

[DL]

Quote:

Originally Posted by MindOverLaborDoulas Okay.. that really helps! I went to the gov. site and got the updated guideline, of course I don't know if anything has changed, but I will feel a little better if I can back-up what I am saying with the newest #s. I might need to look at your chart so that I can know how to do it! Thanks again! Ashley

No problem, Ashley!.....If you'd like me to get my chart to you in an email attachment, send me a PM to request it. I don't want to send a Word attachment to your email without your request. You could just edit whatever numbers are different if you want to use the actual chart (it's in the form of a table), or just use it as a springboard to come up with your own ideas.

Now that you mention it, I'll probably end up checking to see if there is any difference between the current numbers and the 2002 numbers. That's just one of those things that I keep meaning to do and then keep forgetting!

[capandcradle]

I believe that people value what they pay for and pay for what they value. I've helped a lot of low income moms but never used a sliding scale it was just free (per my employer, I was paid with grant money).... unfortunately I've learned the hard way and been taken advantage of LOTS. I think charging even the neediest moms a minimal amount makes them take it more seriously. Unfortunately they will often decide that life necessities or non-necessities like cable TV or tattoos take priority. I don't understand those priorities, but....

It took me a long time to learn that lesson. OTOH one client -- both spouses were attorneys who were completely maxed out with student loans and their modest home. I did discount my fee and they were VERY grateful and wonderful clients. So I wouldn't go on income alone. Listen to your gut too.

[DL]

Quote:

Originally Posted by capandcradle ...So I wouldn't go on income alone. Listen to your gut too.

I would have to agree with this, Anne. Looking at income does at least give a starting point, however. This is also a reason why I find being flexible enough to do payment plans with some people quite rewarding (again, go with your gut on this one as well).

[tlcdoula]

Quote:

Originally Posted by MindOverLaborDoulas i had decided that I would do a sliding scale starting at $250 and going to $400 depending on how much time and info was involved. But it seems like everyone that I have been getting acts as if $250 is way too much. So, the last couple that I have done and the next 2 that I have lined up are for free. How do I stop doing that and get paid w/o sounding greedy? This is a very rural area and the most expensive CBE only charges $75 that I have found and that is for a 6 week class. Help??!!!

Honestly when someone calls I tell them that my full fee is $550 for services and then go into explaining what those services are. If they complain then I will tell them that I do offer a sliding scale if they feel they truly need it, but I encourage them to think about what I am offering them and how much that means to them.

I think you need to sit down and think about what you are offering couples or mothers. List out what you provide so that when someone comments on how it is too pricey you can give them a break down of what you actually do. Please do not think you are greedy or sound that way for wanting to be paid what you are worth. Remember that people will always try to get things cheaper, but if you explain what they are getting for their buck and the value it will be they often change their mind.

Also you are the one allowing them to take your services for free. Plain and simply you need to just tell them no. I know that can be hard and I had to learn it the hard way. I was doing many free births for teen mothers and it hit home when my then 17 year old daughter said that maybe she should get pregnant so that her mother would have time for her. YIKES!! Talk about an eye opener and it made me realize my true worth.

[MothertheMother]

Ouch! Michelle. That must have been a real eye opener. It is easy to get caught up in the rush of what we love to do, though. I thought I might do my first birth for free but I didn't offer and the client didn't ask but I did set a much lower rate. By the time her EDD came around I realize very quickly that my time is worth much more than I was charging. I put so much of myself into what I was doing and really enjoyed it but I do think I need to be fairly compensated for taking that time away from my family.

[Stacie]

nak. i work on a sliding scale of 300-500; i ask for no proof of income or any verification. i explain i let families decide how much they can afford. honestly, most times i get paid the full 500, no questions asked. I have done births for free before, and i have done them for greatly reduced fees (100) if i know there is really a need.

The only thing I ask for before the birth is a 150 deposit. After the birth I expect the remainder of payment, whatever will be. I don't feel, in about 2 dozen births, that I have ever been cheated. Honestly, the one birth where I felt the most taken advantage of (in a bad way!) was a cert birth i did for free -- which is why now i suggest cert'ing doulas charge, even if it's 50 bucks.

i like the way this works and i haven't been burned yet, knock on wood. i also state in my contract if the client opts out, or if they don't call me and i miss the birth, the deposit is mine and they owe nothing further. i have never had the latter situation, but i know doulas who have! i did have a client move, and since it wasn't in my contract, I felt obligated to return part of her deposit although we alredy had two extensive prenatals.

but this works for me; you need to find out what works for you.

[tlcdoula]

Quote:

Originally Posted by MothertheMother Ouch! Michelle. That must have been a real eye opener. It is easy to get caught up in the rush of what we love to do, though. I thought I might do my first birth for free but I didn't offer and the client didn't ask but I did set a much lower rate. By the time her EDD came around I realize very quickly that my time is worth much more than I was charging. I put so much of myself into what I was doing and really enjoyed it but I do think I need to be fairly compensated for taking that time away from my family.

Yes, it was a very, very big ouch and a real eye opener!!! Thankfully at least now if I attend a birth my kids see it in a different light because mom brings home a paycheck, and although my children are not selfish they didn't like sharing their mother with strangers who weren't paying. I think my daughter saw it as me spending so much time with strangers and since they were teens I was putting so much more into them too (extra education, etc).

I have to admit that I do also feel much better when my clients pay. I feel like they value my service, and for those who truly can't afford it I do also offer fundraising opportunities so that no one has to go without (I sell Mary Kay typically to only family and friends, but came up with fundraising where I would allow the mother to do an "online" party and I would turn around the profit and put the whole profit towards her doula bill).

[MindOverLaborDoulas]

You guys are really on the ball! I actually asked my cousin, who is a massage therapist, what she does if someone can't pay her full price. She said that if they can only afford a 30 min but want an hour b/c of an injury or something, then they get 35 mins. She explained it that she can not take 1/2 of what she will get from a full paying client b/c her training and expenses are worth full price. I was asking her about did she feel greedy? She said the same thing as you guys.. This is her career and she can't get screwed over b/c then she isn't respectable as a professional and people will go somewhere else. And that she doesn't want to risk damaging her hands for someone that she could be getting paid full price for. So, in a way after hearing her THEN you guys... I think that you are right. If I am going to charge then I need to just stick to my guns and treat it like anything else. Sarah and I were saying that maybe we could see when we go into a house what the inside looks like to see if a sliding scale would work. If someone has a modest home, but a big screen tv, then they obviously will sacrifice to get what they really want.