I just got confirmation that TC does cover homebirths with a TC authorized provider. To find out if your provider is authorized by TC, you can go to the TC website and look them up or you can call your TC office and give them your provider's name.
I called the TriCare (TC) North Region office today, Tuesday, June 16, 2009, to ask about homebirth coverage. I spoke to a woman in the management department, not just a phone rep. I was told that TC will cover a homebirth as long as it is with a TC authorized provider. As far as I know, any licensed hpc who can legally practice in your state is authorized unless there is a specific exclusion for that individual. That's where you get back to the issue of whether or not it's legal in your state for licensed CNMs and/or CPMs to attend to homebirths. If CPMs are not licensed in your state, TC will not cover a homebirth with a CPM. This applies to Prime (even ADMs) as well as Extra/Standard beneficiaries. The difference is that, if you have Prime or are an ADM and don't get pre-authorization, you will have higher out of pocket expenses, $300/individual or $600/family + 50% of the doc's fees. There is an annual catastrophic cap for each fiscal year, above which the beneficiary does not have to pay any more out of pocket. That's set at $3000, I believe. If your total medical expenses for any fiscal year, whether ADM, Prime or Extra/Standard, go over $3000, you will not have to pay for any medical care for the remainder of the fiscal year.
There are basically 3 types of TC authorized providers.
1) In-network participating providers
2) Out-of-network participating providers
These two types providers will file claims for you and charge you only your deductibles, copays/cost shares and possibly up to 15% above the TC allowable charge.
3) Non-participating providers
These providers will require you to pay their entire fee up front and you will have to file claims for reimbursement with TC. You will then get a reimbursement check directly from TC. They still cannot charge more than 115% total of the TC allowable charge once they accept you, a TC beneficiary, as a client/patient.
I called the TriCare (TC) North Region office today, Tuesday, June 16, 2009, to ask about homebirth coverage. I spoke to a woman in the management department, not just a phone rep. I was told that TC will cover a homebirth as long as it is with a TC authorized provider. As far as I know, any licensed hpc who can legally practice in your state is authorized unless there is a specific exclusion for that individual. That's where you get back to the issue of whether or not it's legal in your state for licensed CNMs and/or CPMs to attend to homebirths. If CPMs are not licensed in your state, TC will not cover a homebirth with a CPM. This applies to Prime (even ADMs) as well as Extra/Standard beneficiaries. The difference is that, if you have Prime or are an ADM and don't get pre-authorization, you will have higher out of pocket expenses, $300/individual or $600/family + 50% of the doc's fees. There is an annual catastrophic cap for each fiscal year, above which the beneficiary does not have to pay any more out of pocket. That's set at $3000, I believe. If your total medical expenses for any fiscal year, whether ADM, Prime or Extra/Standard, go over $3000, you will not have to pay for any medical care for the remainder of the fiscal year.
There are basically 3 types of TC authorized providers.
1) In-network participating providers
2) Out-of-network participating providers
These two types providers will file claims for you and charge you only your deductibles, copays/cost shares and possibly up to 15% above the TC allowable charge.
3) Non-participating providers
These providers will require you to pay their entire fee up front and you will have to file claims for reimbursement with TC. You will then get a reimbursement check directly from TC. They still cannot charge more than 115% total of the TC allowable charge once they accept you, a TC beneficiary, as a client/patient.
That would still save some money. If they want, to cover themselves from you changing your mind later, you can all sign an agreement that states that you understand that they charge X amount above the 115% TC allowable charge and that you are willing to pay that. You don't have to submit that to TC. It would just be between you and your CNMs. There is a little blurb about that in the TC Manual or Handbook somewhere. I can't remember exactly where I read it now. Anyway, TC would never know unless someone told them and I would assume you have no intention of doing that.
I don't know. It would be nice to get an answer to that but I think that's the type of thing that the TC reps either don't know or are told not to divulge. 
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