Tricare/home birth - Page 2

[rebecca_n]

tricare north

[rebecca_n]

after all the different answers i had received and positive responses, we aren't getting any coverage under tricare  for this birth. even though our midwife meets their requirements since i'm on prime and there are other cnms in network (only do hospital births) they pretty much said we're out of luck. maybe this babe will come before new years and we can get some help from taxes lol we'll see. good luck to everyone else

[MarineWife]

TriCare should cover homebirths with MDs, NPs and CNMs, only. They do not cover homebirths with CPMs or LMs. If you have Prime and get a referral, it shouldn't cost much, if anything. If you have Prime and don't get a referral, you can use the point-of-service option and TC should still cover it but it will cost you more. If anyone tells you differently, demand that they show you where it is excluded in the handbook. Here's a link to the TC North Region (coverage is the same regardless of the region since it's controlled by federal law) Prime Handbook as of August 2010:  http://www.humana-military.com/library/pdf/prime-handbook.pdf The info about the POS option is on page 15.

If you have Standard, you don't need a referral at all but you have to be cared for by a TC authorized provider, that is someone with either a medical or nursing license. You also need to check the TC allowable charge for homebirth and find out ahead of time whether or not your provider will accept that as the full fee. If they are in-network, they have agreed to accept the TC payment as full fee. If they are out-of-network and agree to accept the TC payment, they can charge you up to 15% above the TC allowable charge in addition to your deductible and copays. If your provider does not accept the TC payment, you would have to pay in full up front and file your own claim for reimbursement with TC. You may end up paying a lot out of pocket even if TC does cover your birth in that case.

I just read the TC Standard handbook as of August 2010 and there was no mention of homebirth that I could find. A few years ago, the handbook said that TC covered homebirth. About a year later, it had a clause that said it only covered homebirth with a CNM. Now it says nothing. Since it's not explicitly excluded and TC does cover maternity care, it should be covered. If you are told it is not, demand to talk to a supervisor who can show you official documentation that explicitly states that homebirth maternity care is not covered.

[nia82]

An acquaintance in town switched to Tricare Standard, and paid out of pocket and later on Tricare reimbursed $1500, no more. She tried for more but they denied the bills. The CNM's services were $3500 so she paid 2K out of pocket and had to remain on Standard for the rest of the year... The only in network CNM that provides home birth lives 2 hours from us in Denver... I have heard the 1.5K number over and over from many military mamas by now. We are in Triwest, and I have heard the same for North and Humana.

So I decided to go with the birthing center in Denver that is in-network, I could stay on Prime and not pay a dime... If someone has to travel 2 hours to me or me to them, I travel myself and get it for "free"... Stinks, but better than 2K out of pocket...

[MarineWife]

$1500 must be the standard TC allowable charge.

[rebecca_n]

I am on prime and had a referral put in several times by my pcm for my cnm who meets all tricare's requirements. tricare kept rejected the referral and then authorizing me to see another cnm who delivers at a hospital. i'll read the handbook in a lil bit my kiddo wants to play

[MarineWife]

Yeah, that's a problem with Prime. TC does not have to approve you seeing a specific provider if they have someone who can provide what they consider adequate care. Back in 2003 when, even with Standard, everyone had to get all their all their maternity care at a MTF my request for a referral to a civilian provider was denied because they had OB and midwifery care and a full LDR wing at the hospital. I think it's called a non-availability statement that you have to get. I also think that the request maybe has to be approved by the head docs at your MTF. At least, that's how it was done back in 2003.

Remember, there is always the POS option. You don't need a referral and can see anyone who is an authorized TC provider. To provider may have to apply to become an authorized provider but that's not the same as in-network so they don't have to accept the TTC allowable charge as full payment, if they are worried about that. The way I understand it, basically anyone with a medical or nursing license who is in good standing with the medical community will be approved as an authorized provider. You can always call your TC office and ask about the specific provider. Just make sure they understand that you are asking about the POS option, not if you have a referral, and if the provider is authorized, not in-network. I think many of the TC reps aren't familiar with all of that stuff because most TC clients don't know about. You may have to ask to speak to a supervisor.

[MovingMomma]

I didn't think they could reject a referral in favor of a different non MTF provider.

[MarineWife]

I just came from the TC office here. After a lot of searching, one of the TC reps finally called a claims rep and was told that TC will cover a homebirth with a TC CERTIFIED provider. That's where I was wrong when I was saying authorized. Basically, anyone who holds a medical license in good standing is an authorized provider. Some covered services, such as mental health and homebirth, require extra TC certification of the provider. You can verify whether or not your provider is TC certified by calling TC with the name and tax ID # of the provider. If they aren't certified, they can get certified. They'll have to talk to a TC rep to find out how.

Maybe that's the problem with the Prime referral. Maybe the CNM who does homebirths is not TC certified. I would go to the office and wait while they got the authorization for that provider. Then if there's a problem, they can tell you what it is right then and there.

I believe TC can assign whatever provider they want. They are not required to authorize a request for a specific provider. I would hope they would do everything they can to give you the provider you want but who knows.

[MarineWife]

I just came across the cost share for a homebirth for TriCare Standard when I went to the website to look up costs of various services. Here's a link to the page:  http://www.tricare.mil/mybenefit/home/Medical/Costs.

Since I'm not sure if you can access that without having to start at the beginning and put in your info, I'll tell you what I did. After I put in AD family, US, zip code and my TC program, which is Standard. Then I went to costs and about halfway down in the chart 3 different types of maternity care are listed, hospital, birthing center and home or other setting. The cost may be different (if there is any) for TC Prime. But at least I found written proof in the TC info that homebirth is covered.

[noahs.mom06]

What CNM in Denver provides home birth?? I had been told that the only CO CNM who did homebirth moved away... I briefly thought about the birth center, but I'd rather figure out how to pay my CPM and have the birth I want than not pay and have the birth I don't want. Otherwise I'd just go to the hospital again...

Originally Posted by nia82 

An acquaintance in town switched to Tricare Standard, and paid out of pocket and later on Tricare reimbursed $1500, no more. She tried for more but they denied the bills. The CNM's services were $3500 so she paid 2K out of pocket and had to remain on Standard for the rest of the year... The only in network CNM that provides home birth lives 2 hours from us in Denver... I have heard the 1.5K number over and over from many military mamas by now. We are in Triwest, and I have heard the same for North and Humana.

So I decided to go with the birthing center in Denver that is in-network, I could stay on Prime and not pay a dime... If someone has to travel 2 hours to me or me to them, I travel myself and get it for "free"... Stinks, but better than 2K out of pocket...

[jmille525]

Where at in Italy are you? I am currently in Vicenza and trying to figure out where to even start with a homebirth!! Any help would be super appreciated!! Thanks

Originally Posted by 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.