post #1 of 1
2/12/11 at 7:58pm
Thread Starter 

Ladies, I'd like to know what specifically my referral from my PCM needs to say to get Tricare to cover my home birth.

 

I'm on  Tricare Prime - not Remote. I'm an active duty member - so dropping to Standard is NOT an option, neither is POS.  I have to try and make this work within Tricare Prime.  Luckily, my PCM is at a clinic that doesn't have OB services so I need a referral out of the clinic. My provider says that she's willing to write me one and supports me in this, so that's not the issue. An issue may be that I'm within the zip code catchment of an MTF with OB and L&D services so if an astute reviewer at Tricare catches this it will get denied however, the Tricare Rep assures me that if the doctor orders it, Tricare will pay for it. I'm not holding my breath on that though.

 

So, what should the referral say? 

 

Does it need to be to a specific provider? Would that help? I've basically got a choice between an independent CNM and a birth center, both of which have been previously paid by Tricare. So it should be easy enough to have the provider figured out before going in for the referral. 

 

Would it saying it was for a home birth help? 

 

Your help and advice is greatly appreciated.

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