Tricare/home birth

[noahs.mom06]

Has anyone ever managed to get Tricare to cover a home birth? If so, can you let me know what you did? Thanks! :)

[WifeofAnt]

I wish I could help you!  I'm on Tricare and they won't cover the local birth center either.

Tricare will cover a home birth with a CNM (if you jump through the right hoops).  The problem with that is most women don't have access to CNMs who will do home births.  There is a movement out there (just actually talked about this is a community gathering last night) to force Tricare to cover CPMs but it might be years before anything changes.

Most of the non-CNM homebirths I heard about being covered were an 'oops' on Tricare's part.

[AFWife]

Originally Posted by WifeofAnt 

Most of the non-CNM homebirths I heard about being covered were an 'oops' on Tricare's part.

And I've heard of them demanding their money back afterwards...

Being on Tricare is the EXACT reason I'm paying out of pocket! There are MWs at the base hospital...but apparently they're treated like extra nurses...

[~Adorkable~]

might go ask this question in the military thread within "finding your Tribe", it comes up every so often.

part of it has to do whether you are on prime or standard and part has to do with the letters after your midwifes name as has been said by the other responses.

my home birth midwife is a CNM and is an in network provider for tricare, since most of her practice is home birth, clearly tricare covers homebirth within the right circumstances 

[noahs.mom06]

Thanks for the responses! There is one CNM in our area who does homebirth (at least there used to be), but I am pretty partial to our CPM... I don't think I could/would switch just to get Tricare to pay for it.

[HappyMamaBeth]

Originally Posted by noahs.mom06 

Thanks for the responses! There is one CNM in our area who does homebirth (at least there used to be), but I am pretty partial to our CPM... I don't think I could/would switch just to get Tricare to pay for it.

It sounds like you plan to pay out of pocket for your CPM if Tricare won't cover it?  If so, you could always submit the claims for reimbursement.  It's worth a shot?? :)  Good luck!  I switched to Tricare Standard after getting tired of dealing with the runaround from the base clinic.  They have midwives here, but I couldn't get past the front door/administrative stuff it seemed (I think they're very poorly staffed/understaffed at the military treatment facility here), so I decided to switch to Standard so I could be seen by a civilian provider. 

[boogiebearlove]

I don't think they will cover home birth at all. They will cover the birth center we have local (attached to a hospital and run by OB's), but only if we switch over to standard care for the year instead of prime. I'm TriNorth by the way, and I know that each region has slightly different rules on things. The only thing you can do is call to ask, but in my experience I called 5 different times and got 5 different answers about what was covered and what my cost would be. Good luck! If you are able to get it covered please let us know!!

[HappyMamaBeth]

Originally Posted by boogiebearlove 

I don't think they will cover home birth at all. They will cover the birth center we have local (attached to a hospital and run by OB's), but only if we switch over to standard care for the year instead of prime. I'm TriNorth by the way, and I know that each region has slightly different rules on things. The only thing you can do is call to ask, but in my experience I called 5 different times and got 5 different answers about what was covered and what my cost would be. Good luck! If you are able to get it covered please let us know!!

UGH don't get me started on their phone customer service.  I also got different answers every time I called (and my questions were simply about switching to Standard.. something you think they'd deal with ALL. THE. TIME.).  I DO know women who had homebirth covered by Tricare, but in most cases, they had to pay up front and then submit claims for reimbursement.  However, I noticed that the one homebirth midwife in our area who is a network provider with Tricare has a company that does her insurance billing for her, so I wonder if that would be different. 

For me, I chose to switch to Standard and Tricare will cover whatever hospital/facility with which my provider is affiliated.  In my case that is a birth center attached to a hospital (sounds similar to what you have), but there is also a stand-alone birth center that is covered.  Originally I had planned to use either the homebirth midwife that is Tricare contracted or the stand alone birth center that is Tricare contracted but after doing some more research I decided those two providers/facilities weren't for me.  But I do know they're covered! :)  I also know that every area is different.  Frustrating if you move around frequently eh? :(

[MomtoJunebugs]

I did it. We were in Germany, and it was 7 years ago, so I have no idea how much that made a difference. I tried going the get permission route while pregnant, but after months of that I said forget it and did it anyway. Catriona was born on Ramstein Air Base with a German midwife. Afterwards I went to the Tricare office, figuring they'd at least pay for 50%, which they say they will for out of network things. They paid the whole thing, with a note at the bottom saying to get permission next time. Again, I don't know how much had to do with my being overseas. The tricare person didn't want to send in the paperwork at all. I had to ask her to send it specifically cause the plan says they'd cover 50%. 

Good luck! 

[~Katie~]

My midwife successfully bills Tricare after births. She's a CNM. I have to pay up front and will get reimbursed after the birth, they'll currently reimburse me $16-1700 of the $4000 out of pocket cost. I have Standard. 

[noahs.mom06]

I have Tricare Standard, and we will pay out of pocket if Tricare won't cover our midwife. It would just be nice if we didn't have to! I have called around for a doula client of mine, and none of the CNM's attached to the hospitals here will even take Tricare, so I'm wondering if that could make a difference in getting it paid for, since there aren't apparently any midwives in-network anyway... I'll be having my family doctor handle any medical testing we do (most likely just the beginning bloodwork and an u/s at 28 weeks or so) to make it easier to get the insurance to pay for that stuff. I know my CPM does have a company that does billing, so we might at least try to have it reimbursed...

[~Katie~]

You can submit a claim for reimbursement yourself after the birth, at least I'm pretty sure you can. There may be some extra hoops you have to jump through but I'm pretty sure you can at least get some of the cost back. 
 

Originally Posted by noahs.mom06 

I have Tricare Standard, and we will pay out of pocket if Tricare won't cover our midwife. It would just be nice if we didn't have to! I have called around for a doula client of mine, and none of the CNM's attached to the hospitals here will even take Tricare, so I'm wondering if that could make a difference in getting it paid for, since there aren't apparently any midwives in-network anyway... I'll be having my family doctor handle any medical testing we do (most likely just the beginning bloodwork and an u/s at 28 weeks or so) to make it easier to get the insurance to pay for that stuff. I know my CPM does have a company that does billing, so we might at least try to have it reimbursed...

[BirthIsAwesome]

I just had a homebirth in Italy and I had to pay my Italian midwife at the time of service and submit the receipt to Tricare for reimbursement. I had to switch to standard during my pregnancy, but E-5's and below can switch right back to Prime after the birth. E-6's and above have to remain on Standard for a year before switching back to Prime. I did TONS of research both in the States and after I arrived in Italy and it seems to be the official rules of Tricare that they cover CNM's in America and all legally licensed midwives in other countries. However, unless your CNM is in the Tricare network, you will have to pay out of pocket and then submit your claim for reimbursement. For CPM's, sometimes it slips through the cracks and if you submit your claim post-birth, you may get a partial or full reimbursement; but it's not technically legal---it is just an "oops". Also, when you submit your claim for reimbursement, whether it is a CNM, CPM, or other licensed midwife overseas, they may reimburse you 50%, 80%, or 100%. It seems to depend on who processes your claim. We are still waiting to see how much we will get back. 

[~Adorkable~]

Sadly it is is E-4 and below that can switch right back, E-5 dependents must stay on standard for a year before being able to enroll in Prime again.

Here is a nice general in for flyer I found while looking some thing us, a good one to keep around http://tricare.mil/mybenefit/Download/Forms/Summary_of_Beneficiary_Costs_Unlinked.pdf

This second one is dated 2006, I do not know if it is all still valid, if anyone has seen a newer version I would love to know http://www.tricare.mil/factsheets/viewfactsheet.cfm?id=261

[boogiebearlove]

My husband was only an E-3 when I was pregnant last time, and we were told that we would have to stay on Standard for a year.

[rebecca_n]

This is the reply I got from tricare earlier today:

I have spent most of the day off and on trying to get you answer on In
Home Delivery well finally here it is:  A certified nurse midwife can
provide care if she or he is licensed by the local licensing agency for
the jurisdiction in which care is provided and Certified by the American
Midwifery Certification Board . Must be a Registered RN who has
successfully completed educational program approved by the AMCB and
passed the AMCB National Certification Examination.  
 
You will need a referral entered into the TRICARE system requesting
delivery in home by a certified Nurse Midwife for TRICARE TO PAY since
you are TRICARE PRIME. 

[Max'sMama]

I must have lucked out.  I had them pay for my last birth actually before BCBS paid.  It is what spurred BCBS to pay.  We were with a homebirth CNM.  I did not do any pre authorization of any kind.  

[elus0814]

Tricare paid for my homebirth a couple months ago. I had a CNM and had to switch to standard (I was able to backdate my standard enrollment by a couple months which is reducing the amount of time I'm stuck with standard). My midwife charged $5000 plus we had to buy our own pool and supplies. I paid $1000 of it out of pocket in payments during the pregnancy. Tricare paid 80%. My midwife was a tricare provider. I could have seen her with prime paying 100% but her office was too far away so I had to switch to standard. I didn't have to 'jump through hoops' at all, it was pretty simple.

[boogiebearlove]

Awesome! Out of curiosity - what region of Tricare are you in?
 

Originally Posted by rebecca_n 

This is the reply I got from tricare earlier today:

                I have spent most of the day off and on trying to get you answer on In
Home Delivery well finally here it is:  A certified nurse midwife can
provide care if she or he is licensed by the local licensing agency for
the jurisdiction in which care is provided and Certified by the American
Midwifery Certification Board . Must be a Registered RN who has
successfully completed educational program approved by the AMCB and
passed the AMCB National Certification Examination.  
 
You will need a referral entered into the TRICARE system requesting
delivery in home by a certified Nurse Midwife for TRICARE TO PAY since
you are TRICARE PRIME. 

[noahs.mom06]

I guess I'm SOL... the one CNM in our state who did homebirths isn't here anymore. And like I said, there aren't even any hospital CNM's around here who will take Tricare... looks like we'll be paying out of pocket for our CPM and hoping she'll work with  us on the cost...