or Connect
Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › Homebirth › Tricare Prime and Home Births with Midwife
New Posts  All Forums:Forum Nav:

Tricare Prime and Home Births with Midwife

post #1 of 9
Thread Starter 

OK... After reading and reading and talking and talking to Tricare, this is what I have found out thus far. I personally have Tricare Prime (more on that in a bit). There are a few scenarios that can play out with Prime. Typically when someone has prime its because they are active duty and have to use the MTF. If your MTF has OB services then you have to use the base facilities. Pretty much your only option is to switch to standard so you can go off base for you home birth care (sorry, don't know a lot about standard). Switching will only affect you the mother, once baby is born, the baby will automatically be on prime. Mother cannot go back to prime for 1 year, the difference is not that huge, totally worth switching so you can have the birth you want. If your MTF does not have OB services then this is where you can get a referral from your on base PCM to a midwife. My husband was medically retired so we have prime and we do not live close to base so my PCM is civilian and I can choose my OB or midwife.

 

For Tricare to cover a home birth it has to be with a CNM (Certified Nurse Midwife) I was told this over and over. I have heard of some LM but mainly from mistakes on Tricare's behalf allowing it, there still have been a lot of confusion there with moms. Now it depends on "what kind" of CNM you get as far as Tricare goes, out of network, authorized, or in network. Out of network is just that, they are not in Tricare's system and the POS fees apply to this type and can really add up. Authorized is that the midwife, if not already, gets authorized with Tricare. The authorization is just so Tricare can be sure that they are a CNM and they can then cover her services. The midwife does not contractually agree to the way they pay, so you could still be held responsible for the remaining balance that Tricare doesn't pay, you would discuss this with your midwife on a personal basis. But this authorization would allow you to get care from that CNM. The in network is someone that has contractually agreed to Tricare's fees and then this is where the 100% covered part actually applies, no out of pocket for you. Also the midwife cannot charge you 15% more than Tricare allowed, this is that whole 115% rule.

 

The midwife that I found is not in Tricare's system and she is taking the steps now before I conceive to become authorized and I will cover the rest of the bill rightfully so, because what Tricare pays out is a joke and it is not fair to her. It is worth it to me to pick up some of the bill to get the birthing experience that I want. Im not 100%, but from what Ive read on the global fee that Tricare pays out 50-60% of the total bill and you take care of the rest. Now, In the Tricare system there is lots of CNM's in my area but they are all hospital based. Since they do not offer a CNM for home birth they "have" to approve you one, given she meets the requirements. Just be sure to state this in the referral letter that your PCM sends into Tricare for your midwife authorization. I hope this all wasn't too confusing. If anyone has any questions please ask and I will try to have the answer. 

 

~ Here is what the midwife needs to do to become authorized, call 1-800-232-2345 Ext. 4231

post #2 of 9

Wow, THANK YOU!!!!!!! My husband is being medically discharged, not retired. We are moving to a Prime area, but we will be too far from the MTF for them to require services there. I want a homebirth so badly, but didn't want to have to pay entirely out of pocket, which would cut considerably into our savings. We will be moving when I'm 5 months pregnant to the new area, and will have Prime for six months after the move, so I will have to interview with midwives long-distance so I can make sure they're covered. Joys of insurance!!!
 

post #3 of 9

Wow, thank you Organic Momma for starting this post! I'm 11 weeks, have Tri-care Prime and we just pcsed to Ft. Lewis Main, which has Madigan and it's a large MTF. I know that I'll be seen here on post for my pregnancy and probably deliver here. We can't afford to switch to Standard right now. Oh well.....but it's interesting that both you and VeryHappy are married to husbands who were medically discharged. My hubby is looking at the same scenario. But it might be awhile before he is actually discharged. It's helpful to know what will happen to our medical coverage. Hopefully it won't change in the next few years. We have 5+ kids right now and I sure hope we don't loose our Tricare when he gets medically discharged. Best of luck to each of you!

post #4 of 9
Thread Starter 

smile.gif

post #5 of 9
Thread Starter 
Quote:
Originally Posted by veryhappydog View Post

Wow, THANK YOU!!!!!!! My husband is being medically discharged, not retired. We are moving to a Prime area, but we will be too far from the MTF for them to require services there. I want a homebirth so badly, but didn't want to have to pay entirely out of pocket, which would cut considerably into our savings. We will be moving when I'm 5 months pregnant to the new area, and will have Prime for six months after the move, so I will have to interview with midwives long-distance so I can make sure they're covered. Joys of insurance!!!
 

 

Ideally it would be great if you can find a midwife that is already in-network with Tricare. That way everything will be completely covered. Like I had previously stated that if Tricare does not offer a midwife outside a hospital setting than they have to offer you a midwife outside of the hospital if that's what you're looking for. Of course though that midwife has to fit the criteria. Best of luck smile.gif

post #6 of 9
Thread Starter 
Quote:
Originally Posted by kikimamaofmany View Post

Wow, thank you Organic Momma for starting this post! I'm 11 weeks, have Tri-care Prime and we just pcsed to Ft. Lewis Main, which has Madigan and it's a large MTF. I know that I'll be seen here on post for my pregnancy and probably deliver here. We can't afford to switch to Standard right now. Oh well.....but it's interesting that both you and VeryHappy are married to husbands who were medically discharged. My hubby is looking at the same scenario. But it might be awhile before he is actually discharged. It's helpful to know what will happen to our medical coverage. Hopefully it won't change in the next few years. We have 5+ kids right now and I sure hope we don't loose our Tricare when he gets medically discharged. Best of luck to each of you!

Thank you. 

One thing to keep in mind... if medically discharged you are covered for 6 months after discharge but if medically retired then you get to keep Tricare. That is our case, my husband was medically retired. The best of luck to you and your impending sweet new addition. 

post #7 of 9

Thank you for posting the details of this!! I am 5 weeks. I have time to iron out any issues that arise and ask all the important questions on my search for a homebirth midwife. Thanks again!! This is invaluable!!

post #8 of 9

I wish I would have had this info. 4 years ago for our home birth, what a great little article! We just ended up paying out of pocket as the doctor at the MTF who used to sign off on the midwife got tired of the extra confusing paperwork that he had to go through. My husband is medically retired (for some years now) & we're on Standard. There are no in network homebirth midwives around here, but I know others will appreciate the time you put into writing this.

post #9 of 9
Fabulous! I'm definitley going to keep this in mind when it comes time for our next baby!
New Posts  All Forums:Forum Nav:
  Return Home
  Back to Forum: Homebirth
Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › Homebirth › Tricare Prime and Home Births with Midwife