Okay, so here's my situation...
I live in an area that has only 1 homebirth midwife around. Luckily, she is a CNM. She is willing to become an authorized Non-Network Non-Participating Provider. Which means that she is authorized through Tricare, but she does not accept the Tricare allowable charge, and can bill more that 115% of it. I'm completely fine with this, as it is better than the 100% I was prepared to pay to have a homebirth.
Her fee is $3,600. According to the research I've done, if I stay Prime, I would have to use the POS option. Which means a $300 deductible (paid to whom? I don't know) oop to me. Then, I will pay her bill in full, and after I turn in my bill, I will get reimbursed 50% of the allowable charge (around here it's $1,600 ish for a VBAC), so around $600. The total OOP for me would be $3,300
If I switch to Standard, I will have no deductible. Insurance will pay her the allowable charge, and I will have to pay her the balance. The total OOP for me would be $2,000.
I know with standard, there are co-pays and such, but there is none for maternity care. So that wouldn't apply to my maternity care, just if I had to get seen for anything else.
I've been on here and looked at pages and pages of posts talking about this. There was a Maternity Fact Sheet that spelled out the fees, but those links are no longer available, and in the TriWest handbook online of Fact Sheets, they no longer have a Maternity one. I did find this link http://www.triwest.com/beneficiary/bolt/home.mvc/details/maternity And the only extra fees that I can find are for a per day cost when staying in a facility. So I'm assuming that they have changed their policy? That information is current as of Jan 2011.
So, is there anyone that has current Tricare homebirth information to confirm all this? If it is true, that it seems obvious that I need to switch to Standard. Of course, all of this is mostly a moot point, as I am 39 weeks pregnant now, and by the time I figure it all out, it will probably be too late. :)