Help with HB and TRICARE

[AllOrganicMomma]

Hello all! I am currently TTC #3! I am a mama trying for a VBA2C and wanting a homebirth. I am on Tricare Prime Remote. I called TriWest (in California) and they said that they will cover a home birth 100% as long as I have a CNM. Well, there are NO CNM's in my area. I have, however, found a LM that I am in love with.

TriWest said that I can have her send in a form for authorization and see what happens. Otherwise the LM charges $4000 which covers prental, labor and birth, and 6 weeks postpartum. But my labs, ultrasounds, etc. would be and extra.   

Has ANYONE had success getting Tricare to cover a HB with an LM and not a CNM when there were NO CNM's within a 50 mile radius? Or even partial coverage? I need all the information I can get. I want to be prepared ahead of time so that I dont end up getting pregnant and not having the extra $ to pay out of pocket, and once again being forced into a c-sectiong. Thanks so much!

[noahs.mom06]

We have ONE CNM about 30 miles from us, who practices only in the hospital (and not a hospital I would want to deliver at). I haven't called, but from everything I've heard, Tricare won't touch a CPM/LM. Our midwife charges $2900 which includes everything but labs, u/s, etc, and we are having to pay it out of pocket... One thing I am doing though is having our family doctor handle all of the medical things like the labs, u/s, etc. That way it will go directly to Tricare and never have anything to do with our midwife.

[AllOrganicMomma]

That is also my problem. Tricare said they would cover for a CNM that is out are the area but the only CNM's I have found wont attend a home birth for a VBAC, or they practice at a hospital. & I dont plan on driving hours and hours when I go into labor.

I've heard stories of people getting partial coverage, that found loop holes! We've only been AD for 5 years and I have never been a fan of the medical system so I dont have much experience working with Tricare.

For my husbands pay & the fact that we already have 2 littles, 4grand is a lot to dish out. BUT, I would be willing to do it. I just wish there was some way I could get Tricare to even partially cover it.

How do you go about doing you labs/ultrasounds with your doc? Did you just explain to him your plan? I have yet to find an OB, as we just PCS'd from Ga. I'm wondering if I go that route, if my dr. will be understanding that I want the labs, tests, ultrasounds, etc. done by him, but nothing else. & if he will even agree to do those things knowing that I'm planning a home birth.

So much adversity! I wish it were easier.

[luv-my-boys]

as long as you LM writes you the lab orders you should be able to go to any contracted provder for your testing(lab, u/s place,etc)  A network doctor does not need to make the orders.  However, some specialized testing does need prior auth. from tricare but that would also be the fact with a in-network provider.  For instance DH saw a chiro (not covered, we also have tricare prime remote) the chiro gave him the xray paperwork and he went to a in-network radiology place and had them done and sent back to the chiro.  Tricare paid it becaue the xray itself was a covered serive provided at a in network provider (radiology) and the radiology clinic did the xray because by law they only need a hcp to write out the script for it.
 

Originally Posted by AllOrganicMomma 

That is also my problem. Tricare said they would cover for a CNM that is out are the area but the only CNM's I have found wont attend a home birth for a VBAC, or they practice at a hospital. & I dont plan on driving hours and hours when I go into labor.

I've heard stories of people getting partial coverage, that found loop holes! We've only been AD for 5 years and I have never been a fan of the medical system so I dont have much experience working with Tricare.

For my husbands pay & the fact that we already have 2 littles, 4grand is a lot to dish out. BUT, I would be willing to do it. I just wish there was some way I could get Tricare to even partially cover it.

How do you go about doing you labs/ultrasounds with your doc? Did you just explain to him your plan? I have yet to find an OB, as we just PCS'd from Ga. I'm wondering if I go that route, if my dr. will be understanding that I want the labs, tests, ultrasounds, etc. done by him, but nothing else. & if he will even agree to do those things knowing that I'm planning a home birth.

So much adversity! I wish it were easier.

[noahs.mom06]

Originally Posted by AllOrganicMomma 

That is also my problem. Tricare said they would cover for a CNM that is out are the area but the only CNM's I have found wont attend a home birth for a VBAC, or they practice at a hospital. & I dont plan on driving hours and hours when I go into labor.

I've heard stories of people getting partial coverage, that found loop holes! We've only been AD for 5 years and I have never been a fan of the medical system so I dont have much experience working with Tricare.

For my husbands pay & the fact that we already have 2 littles, 4grand is a lot to dish out. BUT, I would be willing to do it. I just wish there was some way I could get Tricare to even partially cover it.

How do you go about doing you labs/ultrasounds with your doc? Did you just explain to him your plan? I have yet to find an OB, as we just PCS'd from Ga. I'm wondering if I go that route, if my dr. will be understanding that I want the labs, tests, ultrasounds, etc. done by him, but nothing else. & if he will even agree to do those things knowing that I'm planning a home birth.

So much adversity! I wish it were easier.

I found out in my last pregnancy that my family doctor is supportive of homebirth, and is willing to be the medical backup on prenatal stuff as far as needing medications/prescriptions, labs, u/s, etc. She doesn't have hospital privileges for birth/OB care, so if I have to transfer during the birth I'll be transferred to an OB doc that I don't know. So basically my MW handles all specific prenatal care, and my family doc handles everything the MW can't do, like writing prescriptions, or things that are just easier for her to do, like the labs & u/s.

Some MW's are willing to work with you on fees... ours is with us. Maybe ask about it...

[KateDavies45]

Originally Posted by AllOrganicMomma 

Hello all! I am currently TTC #3! I am a mama trying for a VBA2C and wanting a homebirth. I am on Tricare Prime Remote. I called TriWest (in California) and they said that they will cover a home birth 100% as long as I have a CNM. Well, there are NO CNM's in my area. I have, however, found a LM that I am in love with.

TriWest said that I can have her send in a form for authorization and see what happens. Otherwise the LM charges $4000 which covers prental, labor and birth, and 6 weeks postpartum. But my labs, ultrasounds, etc. would be and extra.   

Has ANYONE had success getting Tricare to cover a HB with an LM and not a CNM when there were NO CNM's within a 50 mile radius? Or even partial coverage? I need all the information I can get. I want to be prepared ahead of time so that I dont end up getting pregnant and not having the extra $ to pay out of pocket, and once again being forced into a c-sectiong. Thanks so much!

You should check the California state insurance code. I'm currently dealing with Tricare in Tx and they were saying they won't cover anything except hospital midwife. However Tx insurance laws say that because Tricare is a preferred provider network style insurance if they don't HAVE A PROVIDER of the kind I need in-network THEY ARE REQUIRED BY LAW TO COVER AN OUT OF NETWORK PROVIDER OF MY CHOICE AT THE SAME LEVEL. I don't know if that's the case where you are but if it is you can get them to pay/reimburse you. Find out and if so just take a copy of the law with you and keep going up the chain. Just because Tricare is military DOESN'T exempt them from following the insurance law in the state they're providing insurance in! It might take a while but keep at it.

Good luck!

~Kate