Homebirth through Tricare in Hawaii--HELP PLEASE!

[boomertea311]

I will be 12 weeks tomorrow, in my second pregnancy. My DS was born at TAMC out here with the midwife program. My labor was wonderful until I got to TAMC. I was calm, relaxed, working with the contractions, and in control till I gotto TAMC, then everything felt very chaotic. My labor was short luckily, and I did have a midwife, otherwise I can not imagine what it would have been like for me. Now, when I think about this delivery I get nervous thinking about what it will be like having all the people in the room, them giving me pitocin without my permission (yes they did this!) post birth, and not being comfortable.

I am talking to the lady at the TriWest office on base (Makalapa) and she is telling me I can try to get an approval through my PCM, but it has to be approved by TAMC and Tricare. Not feeling to positive about this. I have left a message at Sacred Healing Arts to ask them what their experience is with Tricare. I am waiting for their call still, but I really look forward to talking to them after all the great messages I have read about them.

My questions are:

Has anybody been in a similar situation? I hear it is different when in Hawaii than any other state.

Did Tricare cover all of your birth, WHILE keeping with Prime?

What were the pre-authorizations like?

Did you have a Global Maternity Authorization?

Any information will help. I dont necessarily trust the Tricare representatives to know all the information I want to hear about, so I believe personal experiences are the best way to learn. Thanks Ladies!!!

[MiaMama]

No advice, but I just wanted to give

My DD was also born at TAMC via their midwife program. I was induced with cytotec and augmented with Pit!

I hope you have a better birth this time around
If any other moms are enrolled in this program, all I can say is be prepared to REALLY advocate for yourself.

[Hey Mama!]

I had two births at TAMC with the midwives. One was ok(no iduction or pit, but had IV antibiotics), one was totally freaking awesome!(labored in a tub, no iv's or continous fetal monitoring, pushed in any position I wished). Anyway, my friend was trying to navigate the TriCare system to get approval for a homebirth and she gave up. Had the baby UC. She did learn that base housing would not allow a homebirth. We were Air Force if that matters, I don't know if other branches would allow a hb in their housing. Good luck!

[cathicog]

it's probably better NOT to ask about hb on base- what they don't know won't hurt you...I know Navy people who have had hbs in HI...I would talk to a local CPM....

[Plummeting]

Tricare is definitely NOT different in Hawaii than it is anywhere else. For some reason it's really common for people to think things are different in different regions, but that's not true AT ALL. The Tricare rules, regulations and laws are the same nationwide. Your problem is going to be that there are midwives available at your base. Tricare only grants exceptions for out of network providers when there are no in network providers of that type within a 60 minute drive. So if there were no midwives at your base facility, you would be able to get an exception for one out in town, as long as it was a CNM (since Tricare doesn't cover CPMs). Since there are midwives at your base hospital, it will be really hard (or impossible - I'm not sure which) to get an in network exception for a midwife out in town. That's not a Hawaii thing; that's just a Tricare thing.

You can talk to a CPM, but they are not covered under Tricare. CNMs are the only midwives considered authorized providers. Occasionally people are able to get a CPM covered, but that only happens when someone at Tricare isn't doing their job and basically just fails to notice that it's a CPM and not a CNM.

If you are able to get an in network exception, then you can stay on Prime. They will then authorize global maternity care, but on Tricare it works differently than on other insurance plans. Because Tricare patients are highly mobile (for obvious reasons) the initial referral is not for global maternity care. It's for 18 office visits. The referral will be changed to global maternity after you initiate care with your midwife and the midwife calls the 800# on your referral and tells them your EDD and place of delivery. They didn't always do it that way, but apparently that's how they do it now (that's how they did mine and that's how they explained it to me when I asked why). Pre-authorization consists of getting your PCM to write you a referral to the midwife you want. Of course, if you can't get an in network exception because of the midwives on base, then you're unlikely to get a PCM to write such a referral, and even if they do, Tricare doesn't have to authorize it. But again, I don't really know the exact rules that apply when you live where there is a base hospital with midwives, since there's no hospital at our base. Hope that helps at least a little, though.

Oh, and you're right not to expect the Tricare reps to know what they're talking about. They are SO frustrating. They generally mean well, but ugh!

[elus0814]

I don't know anything specific to Hawaii but here's what happened with me:

I first went to an in-town practice to see their midwife with the intention of using her as my hospital backup. She didn't seem too ok with it but I thought it would be fine. Two days later I received a certified letter saying that practice was discharging me as a patient. I called the practice with the only other midwife in town and explained the situation. They said they would not treat me and gave me a letter saying as much. I took these letters to the tricare office and they still refused to give me a referral to see the homebirth midwife (she takes tricare and is a cnm but is out of network because she's in another city). They said it is because of two things. First, tricare doesn't care if you are discharged as a patient for personal reasons, this is seen as your fault. Secondly, tricare doesn't care if there are no in-network midwives, they lump obs and midwives in together so as long as there are obs they will not pay for an out of network midwife. So much for having a choice, huh? After talking with the head tricare lady there she told me that I was the fourth woman to come in that week to try and get a referral for a homebirth with the same out of network midwife. She told me she had tried all the channels to get it paid for on prime (she seemed to really support homebirth and agreed that the ob options in town were terrible) but that there was no way to do it. She said the options were to a) stay on prime and pay the 50% with the point of service option or b) go on standard and pay 20% out of pocket with a $1000 catastrophic cap. I choose b. I was able to get them to backdate the standard switchover so I will be able to get back on prime just a couple months after the baby is born.

Good luck!

[Maluhia]

Of all the military Mamas I know who have had HBs in Hawaii, none have had it paid for by Tricare.

[sunflowergrrl]

Military Mamas - let's take action!!!

OK Ladies, it's time to take action against these nonsensical TRICARE rules!! Bottom line is that we SAVE the American taxpayers money by having a homebirth vs. a hospital birth.

I had a hombirth in October - paid completely out of pocket for my CPM because there are no CNMs in my area who do homebirths. I wrote a letter of appeal to TRICARE giving specific information and how I saved them money - it was denied.

Next step is to bring it to the attention of our Congressman/women - that's right -the Congressional!!! We all need to do this to raise awareness that TRICARE is WAY behind the times in covering homebirths.

Check out this mama's blog - she details her fight to get her homebirth covered and how she notified her Congressman who submitted it to the subcommitte who writes TRICARE policy. It's the only way to get the policy changed - we need to write our Congressmen.

http://www.mybestbirth.com/forum/top...06Comment53662

[Plummeting]

Originally Posted by elus0814

Secondly, tricare doesn't care if there are no in-network midwives, they lump obs and midwives in together so as long as there are obs they will not pay for an out of network midwife.

This part is absolutely not true. They might refuse your referral for the other reason, but this one is not true at all. Tricare regularly gives in network exceptions for midwives in areas where there are tons of OB's. The people running the offices in your area don't know what they're talking about, which is par for the course, but they're wrong. I had one Tricare rep on base tell me that Tricare doesn't even cover CNMs at all, ever, in any birth setting. She argued with me for 10 minutes before she'd even bother to look in her system, even as I was telling her repeatedly that I'd already used a CNM for my daughter's birth. When she finally looked, she acted like it was no big deal that she was completely wrong and she never apologized. They regularly have no idea what they're talking about and therefore regularly say stupid things. Tricare does not lump OBs and CNMs into one group, but they can refuse your referral since there are in network CNMs.

[elus0814]

Originally Posted by Plummeting

This part is absolutely not true. They might refuse your referral for the other reason, but this one is not true at all. Tricare regularly gives in network exceptions for midwives in areas where there are tons of OB's. The people running the offices in your area don't know what they're talking about, which is par for the course, but they're wrong. I had one Tricare rep on base tell me that Tricare doesn't even cover CNMs at all, ever, in any birth setting. She argued with me for 10 minutes before she'd even bother to look in her system, even as I was telling her repeatedly that I'd already used a CNM for my daughter's birth. When she finally looked, she acted like it was no big deal that she was completely wrong and she never apologized. They regularly have no idea what they're talking about and therefore regularly say stupid things. Tricare does not lump OBs and CNMs into one group, but they can refuse your referral since there are in network CNMs.

This lady seem really determined to get our out of network referrals through. Do you have a link to tricare policy that states that obs and midwives are NOT lumped together because I'll go back. I really do think they are, she pulled out the giant tricare policy binder and showed me where they ARE lumped together as "maternity care providers". If you have evidence to the contrary it would be great to know!

[boomertea311]

As of right now, I have an appointment with a midwife at Sacred Healing Arts, and she does home births. The lady I spoke to over the phone, stated that prenatal, birth and post-birth care totalled to $2500. Much better than what I was expecting. I brought this up to my PCM on base, and he stated that they may not do all the monitory tests that the midwives at Tripler do. But since I will be paying out of pocket, I can keep prime and still have any tests I decide to do, that are not provided by the home birth midwife, can be done on base for free. I still have not decided about what I want to do yet as far as tests are concerned.

Honestly, I'm sick of hearing so many people talk about the risks of a home birth. I'm making an educated decision, and I will not put my baby at risk. Just venting. Doctors and some family are just trying to push my opinions and choices aside.

Anyway, I found this on the triwest website... Basically it states
"The global maternity authorization will cover prenatal care rendered by a Certified Nurse Midwife. Prenatal care is authorized for office visits, not home visits. Home visits must be medically warranted, and receive a separate authorization.

The global maternity authorization will also cover home delivery, so no separate authorization is required for the home delivery. However, should the beneficiary change her mind and decide to deliver inpatient instead of at home, a separate authorization will be required for the facility.

Regular global maternity copays and cost-shares apply."

http://www.triwest.com/beneficiary/b...ails/maternity

I have the will, if there is a way, I will find it, and use it. I already told the lady in the Triwest office that I will fill out the paperwork and submit it ten times if that saves me $2500. I will be doing a home birth reguardless if we pay out of pocket or the fees are covered.

Thanks ladies for the advice, stories, and support!

[sanssouci]

Hi Tricare Hawaii mamas!
I'm new to the islandi and joined this site to find like minded gals. I was a Doula for 10 years, so I'm all about the homebirths! I've even approached Tripler about implementing alternative methods. (And I may need to find out what you uncover with Tricare coverage in the near future) Let me know if you're open to meeting at the park and getting the kids together.
Best to you!