Tricare in Texas

[WifeofAnt]

Hi. I'm new here... 8 and a half weeks pregnant right now but hating the fact that there are no CNMs in the area (besides the ones at the MTF). I'd call and ask if they did homebirth but its Saturday and I doubt it. I want a home birth but the only available midwives in the area are CPM and LM, which I've already heard Tricare doesn't cover (I'm on Prime). Currently I'm with an OBGYN (civilian because the MTF, Fort Hood's Darnall, is too full to accept me) but I haven't even had my first appointment yet because they don't see patients until 10 weeks. Does anyone know any ways to get Tricare to cover a CPM for a homebirth? I haven't called yet but I'm thinking of pretty much threatening to go UA if they won't cover one. I think I'm ballsy enough to sound convincing (if my hubby weren't totally paranoid I could probably do it anyway).

I know that even if I'm stuck using a regular hospital with an OBGYN I'm going to labor as much as possible at home before going in, preferably arriving just in time to push. If somehow I *accidentally* give birth at home then I'll at least have the knowledge that birth is inherently safe and the basics of 'emergency childbirth'.

One more thing. Has anyone ever done a OBGYN/CPM combo using the OB for prenatal care and using the CPM just for delivery? I don't think the CPM would be too fond of that... but how much do you think delivery only would cost?

[ssalulu]

I'm having a similar situation right now, but I'm in CA. (Tricare sucks!!) I've asked midwives about transferrring late and such and all of them have told me that their fees are the same no matter what point I come in the pregnancy. A whopping $4000!!! So, I'm not sure if it would be the same in your area. It wouldn't really hurt to ask. As for me, I hate the hospital that I am suppose to be delivering at and the doctor is ok. I'm going to stay home as looooong as possible. Which means I might just be "accidentally" giving birth at home unassisted. We'll see when the time comes if I feel the same. Good luck!

[Plummeting]

Tricare doesn't cover CPMs and you threatening to do a UP or UC isn't going to convince the rep you talk to on the phone, who has no control over Tricare policy anyway, to change it. No one you will talk to can change that policy, actually. The entire Tricare rule about who can be covered would have to change for that to happen, and there's no one person who can do it. Right now, Tricare only covers authorized providers. That's why chiropractors aren't covered, naturopaths aren't covered and CPMs aren't covered. None of those types of providers can be authorized providers.

I really wouldn't "threaten" to have an unassisted pregnancy, because it isn't going to help and it's just going to make you look like one of those people who thinks she can get her way by acting obnoxious to the "little guys" who have no control over those sorts of things. (Sorry, but it's true. ) Besides, it's no "threat" to them and will really make you look bad, because a person who does a UP or UC because she's educated and really believes this is best for her is completely different from someone doing it because she thinks it will prove a point. The second makes you look like you'd risk your baby's life or health just to have your way - not the most convincing way to change a government policy. After all, if you really wanted and believed in going UA, you wouldn't be arguing with them about covering a CPM. Do whatever you want, but this is guaranteed not to work and it isn't going to leave anyone with a good impression of you and will likely piss them off.

I know it really sucks, but most CNMs don't do home births anyway. The CNM I had for my first daughter's birth did not and never had done home births. And you're right in assuming that the MTF CNMs don't do home births - the only births they attend are there. There has been a campaign to change Tricare policy going on for over 5 years now. Maybe someday they'll change it, maybe not. Even if they do, many midwives just can't accept the amount Tricare pays, so you could still pay a significant out of pocket cost to cover some of the difference. There have been some people who have gotten coverage for CPMs by accident. Basically, they submit their claims and someone at Tricare doesn't realize it's a CPM instead of a CNM, so they approve it. That always happens after the fact, though. You can't get a referral to a CPM on Prime. The best you can do is see her and hope Tricare will accidentally cover her out of network or reimburse you on an out of network basis. Most people are not successful with that, but some are because the reps just don't always notice.

As a side note, having had two unmedicated, uncomplicated deliveries, one for which the midwife made it to my house just in time to catch the baby, I would still say that birth is not "inherently safe". It is "usually safe" but safety is not an intrinsic part of birth. Safety is not a guaranteed aspect of delivering a child, which is why women who do have a planned UC take care to educate themselves on exactly what symptoms or signs would indicate that they need to transfer to a hospital. They are aware that, while birth is usually safe and uncomplicated, there is always the possibility of danger to either the mother or the child. I think it's important to be aware of that, because safety definitely is not inherent to the birth process. Any mother who has lost a child during an unmedicated, uncomplicated, un-screwed-with delivery can tell you birth isn't inherently safe, but rather just that it's usually safe.

[jorona]

Originally Posted by Plummeting

Maybe someday they'll change it, maybe not. Even if they do, many midwives just can't accept the amount Tricare pays, so you could still pay a significant out of pocket cost to cover some of the difference. There have been some people who have gotten coverage for CPMs by accident. Basically, they submit their claims and someone at Tricare doesn't realize it's a CPM instead of a CNM, so they approve it. That always happens after the fact, though. You can't get a referral to a CPM on Prime.

This. I was able to find a CPM who Tricare thinks is a CNM for whatever reason - I found her by calling them and getting a listing of midwives in my area who are Tricare certified providers (which I was told isn't in their normal provider directory listing). That being said she takes care of billing Tricare and requires me to pay the difference between her fee and the amount that TriCare reimburses her. That is roughly $1600 out of pocket for us. Now some will point out that providers are not technically supposed to charge clients more than 15-20% (can't remember which one) above what Tricare sets as their allowable charge. While that may be true I'm not aware of any midwives who are going to take less than half of their normal fee whether I'm on Tricare or not. I've accepted paying that amount to have the birth that I want. Not to mention that if I had to pay her the full fee out of pocket and file for reimbursement myself (which is what it seems most people end up doing) then I'd be hard pressed to recoup the difference I had already paid after receiving whatever amount Tricare decided to give me. Just my I hope you are able to find someone!

[XOIMOM]

Hi there.

My DH is stationed at Fort Hood and I gave birth to our youngest child at Darnall. I am having a homebirth with this baby (due in Sept).

Tricare Standard will cover a HB with a CNM, but there are no CNMs in this area offering HB. The midwife I am using is a direct entry midwife. Her name is Janis Stout and she is based out of Copperas Cove. We are paying out of pocket, and she offers a military discount. The cost is $2100 plus out of pocket for u/s.

I don't know if this would be an option for you, but she is very flexible with the payment plan.

Jennifer Bennett, who owns the birth center in Killeen, might also do homebirths. I am not sure about the expense with her.

It may be different for you since you have been referred off post, but on post you do not want to mention your homebirth or your prenatal care with a midwife if you do go that route. I went on post once so they would have this pregnancy in their records in case I need to transfer, and it was a terrible experience and I was discouraged from going back to them for my pregnancy ("you don't need dual care").

IME, Darnall is somewhat supportive of natural childbirth (if that is where you end up delivering). They will still want to intervene some (continuous fetal monitoring at some points, heplock, antibiotics for GBS, coached pushing, etc) but I had a nice and peaceful birth there with my youngest daughter. Then tend to get so busy they forget about you, which is not a bad thing, LOL.

I would not attempt to threaten Tricare. I think that will get you nowhere at all.

Better would be to switch to Standard and go with a birth center or pay out of pocket for a homebirth if you really don't want to deliver in the hospital.

Good luck!

[KateDavies45]

If you are in Texas it IS possible to get tricare to cover a homebirth (I know, I did it.) Tricare, dispite being military still falls under the insurance laws in whatever state they provide your care in. Texas insurance law states that if a preferred provider insurance network doesn't HAVE the type of provider you require (all you have to do is state that you "require in-home pre-natal/birth care" you don't have to provide any paperwork "proof")  in-network and in your area, then THEY ARE REQUIRED BY LAW TO COVER AN OUT OF NETWORK PROVIDER (any kind licensed by the state, which in Texas CPM's/LM's are) IN YOUR AREA AT THE IN-NETWORK RATE. It can take time and a lot of paperwork but it is possible to get approval / reimbursement for a CPM/LM birth. If you want them to pay instead of reimbursing you, then you need to try to get an approval BEFORE your CPM tries to bill. If you're in the San Antonio Area  Alamo Area Midwifery is the only CPM I've found who works with tricare, but my MW helped me get all the paperwork straight and explained the process for getting approval/reimbursement.

It may take a few months but it IS possible.

I would also suggest getting your labs/ scans and anything like that through the MTF and just requesting a non-official paper copy to provide to your MW. You don't need to tell them that you're planning a HB. and that way it won't cost nearly as much to get them done.

If you want the actual statute numbers, let me know and I'll dig them out for you.

[AlexisT]

Originally Posted by KateDavies45  Tricare, dispite being military still falls under the insurance laws in whatever state they provide your care in.

This is completely false. Tricare (and federal employee insurance) are explicitly exempted from all state regulation and mandates.
 

The law that created and governs Tricare is found at Title 10, Chapter 55, of the United States Code (10 USC 55), as amended.  The federal regulation that interprets and implements that law is found at Title 32, Part 199, of the Code of Federal Regulations (32 CFR 199), as amended.  Your attorney may find this information useful. Federal regulations have the force and effect of law.
 
Tricare is not subject to the authority of the laws or insurance regulatory bodies of any state.  It is governed in its entirety by federal law and regulation.  For information regarding Tricare eligibility, please see Title 32, Part 199, of the Code of Federal Regulations (32 CFR 199).

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