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Originally Posted by nashvillemidwife  The bottom line is that however the midwife bills Tricare, she needs to bill the client the same way. If she breaks the fees up to bill Tricare, she has to break them up to bill the client also. If her fees are standard, and you see her for your entire prenatal and postpartum care, that should add up to more than her global fee.
So far, whenever discussing midwife fees or TC allowable amounts, we have generally been talking about global fees. "The midwife charges $3500 [as her global fee], the TC allowable [for the global fee] is $1800".
So the question is, what are the allowable amounts for the itemized fees versus the global fee, and are you really going to come out ahead? I was just trying to explain that "the allowable amount for the actual homebirth" is something other than what we've been talking about. It is going to be a different amount because so far all the numbers I've seen referenced have been for the global fee, or in other words, the "lump sum".
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Ok, I think I'm getting it now. So, if my MW charges $2400 for all prenatal, birth and postnatal care and gives me the option of paying it all at once, making equal payments each time I see her or making some other type of payments as long as the total is paid by the time I'm 36 weeks, she would have to send bills/claims to TC that correspond with when and how much I pay her?
As far as fees for prenatal care vs. fees for the actual birth, I know docs charge these as different events. The birth is a completely separate event and charge from the prenatal office visits, right? So, if my MW charges a global fee of $2400 for all my care but TC pays for prenatal visits separately from the birth and allows $1800 for the birth, is there a way to break things up so that she gets paid the $1800 for the birth and however much it is for each prenatal visit so that the total she (or I get back) is $2400? I guess that would work if she agreed to not get paid the bulk of her fee until after the birth? For example, I could pay her the difference between her global fee and the $1800 split up equally among the 7 prenatal visits and then pay her the remaining $1800 after the birth. Would that be ok, not fraud, since the total amount isn't more than her global fee?
Oh, and I don't go to MTFs for medical care. I go to civilian docs. That's why I have a deductible and copay. If I went to the MTFs, I wouldn't have to pay anything at all. That would be a completely different situation.
lovebug ~ CNMs don't have to be "covered" (by which I assume you mean in-network or preferred providers) by TC for you to see them. As long as they are licensed and it's legal for them to practice in your state, they are considered authorized providers. If they work at an ob/gyn clinic that TC lists as in-network, they are covered just like the docs in that practice. You have many options that will cost you different amounts depending on what type of TC you have, Prime or Standard, and/or whether or not you can get a NAS. I explained a lot of that in a previous post. If you need more help with that, PM me and I'll try my best.
One thing you need to do is ask to speak to a supervisor when calling the TC office. The random person who answers the phone doesn't really know much. You also need to look up the info yourself in the manual because a lot of times even the supervisors don't know what the rules and regs are. The last time I spoke to a TC supervisor she admitted that I knew more about the TC practices than she did. If there's anything we get stuck on, I can ask my neighbor. He's a former corpsman who now works as a patient advocate at the naval hospital here so he knows a lot that others don't (and he actually shares what he knows since that's his job) and he can find answers to things he doesn't know.
One more thing, I think TC works the same regardless of what branch of service you are in. My dh is in the Marines but I can use an army MTF in the same way that I can use a naval MTF.
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