I am kinda stumped as to where to go from here. There is only only CNM in the Nashville area who even accepts insurance period but they are not contracted with any specific insurance company.
I had my initial bloodwork done at the military hospital, and paid out of pocket for my homebirths. With DD1 I had a 20 week ultrasound that was done at the Naval Hospital, and around 21 weeks with DD2 I had a day of unexplained bleeding and went to the Naval Hospital ER (then sent up to L&D) for an ultrasound to check placenta location. I declined the quad screen and GTT, but did the ~28 week iron check and later the BS with my midwife just to avoid the hassle of going back to the NH.
|How did you get the results of the blood tests etc to the midwife? Did they send them?|
I JUST finished going through this debacle myself. Here's what I learned:
1. Most TRICARE reps have no clue what you're talking about and will automatically say no. Ask to talk to a supervisor/manager right away.
2. Prime WILL pay for hb, but ONLY when supervised by a CNM. That means no direct-entry midwives! In Georgia (my state), there are NO CNMs that attend hb- so no Prime paying for my birth. Bottom line- if you can find a CNM that attends hb in your state, you are covered.
3. If you are the dependent, switching to Standard is an option. However, if you are the military member (in my case, I am), switching is NOT an option. So for all you other military mamas out there, keep this in mind.
Here's what I've learned from working with Tricare military insurance for my homebirth. First off, our entire homebirth was covered via Tricare Prime. Even if you don't have Tricare Prime it is VERY simple to make the switch if your spouse is Active Duty which is all I have experience with. This is what worked for us, your state/situation may be different but if your willing to put in effort (and at times it's a lot of effort but totally worth it) then you should be successful in having your homebirth be covered by Tricare Insurance. Hopefully the more Tricare "sees" homebirths, the easier it will be to file a claim and why wouldn't they want to make it easier? It's a lot cheaper than a hospital birth!
Below are the very important steps to take regarding filing your claim with Tricare.
1. Your midwife/provider must be an authorized provider with in Tricare's network. If they are not an authorized provider, they will need to apply to become one http://www.humana-military.com/south/provider/provider.asp then click the quick links "join the network". I was lucky enough to find a midwife who was already in Tricare's system and we did not have to go through this process. But if you start early enough in your research and if your provider is willing to apply then do it ASAP, because it will most likely take several months before an approval is made.
*Note* Once your provider is in Tricare's network, you both should receive a copy of the "Notification of Tricare Provider Authorization" letter with the Provider ID #.
2. Once your precious little one is born, have your midwife/provider complete a Form 1500, Health Insurance Claim Form, which is standard for all insurance companies. You will be using this form to verify the services conducted by your midwife/provider and will need to forward the document on to Tricare.
3. You will also need to fill out another form, DD 2642, for you and baby http://www.humana-military.com/library/pdf/claim-form-dd2642.pdf. You must fill out two separate forms, one for you and one for your baby.
*Note* Under "condition" for which the patients received treatment put "pregnancy" for Mother and "birth" for child.
3. You will need a list of itemized charges for each procedure billed with dates. Tricare wants a "statement or bill that includes the charge and description of each service received". Include one for patient and one for the baby, you can line through Mother's billed procedure and leave the procedures applicable for baby (ex: Newborn Examination, Vitamin K injection etc). Our midwife simply put this on a letter head and we sent it in like that. If you need an example, I can provide you with one-just ask!
All forms should be faxed AND mailed as some depts in Tricare lose paperwork from time to time (it happened to us twice).
For Tricare South Region: Fax with cover page stating provider ID # on cover to: 803-462-3993
Mail all paperwork (AFTER making your own copies) to: Tricare (whatever region you are, ex: South Region) 2300 Springdale Dr. Bldg 2 Camden, SC 29020.
*Address and fax number may be different depending on your region
4. Make sure to follow up!
My husband and I just found out that I am pregnant and I want to have a homebirth. He is active duty right now but he is going reserve before we have the baby. I am not sure if we have the option to purchase Tricare Prime but we were planning on doing Tricare Reserve Select. Do you have any idea if I can use your steps to get my homebirth covered with either one? Also, we will be living in Ohio, which from my understanding is a bit of a battlegorund for homebirth midwives right now. Do you know if your steps will work everywhere or only in states where CPMs can get licensure?
First of all, congratulations! Where about in Ohio are you and I can put my feelers out for that area? I have a resource called the World Midwives Assoc and can check with them on details and possibly get you a list of licensed CPM's in your area which is all Tricare will cover according to this: http://tricare.mil/CoveredServices/SeeWhatsCovered/MidwifeServices.aspx.
I will do some research for you on the legalities for midwives/homebirths in your state and see what I can find.
Thanks for the message :)
Still waiting to here back from "World of Midwives" concerning your CPM licensing question and whether or not homebirth is legal in Ohio. In the mean time, I saw this info from a subscriber.
Cleveland has a pretty active ICAN chapter and many of those women are great homebirth resources because of the difficulty in getting a hospital VBAC in Ohio and the lack of freestanding birth centers. I would contact them, and again, I would try Choice Midwives in Columbus. They will definitely have a list of homebirth providers in Cleveland.