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Veteran's Affairs

post #1 of 6
Thread Starter 

Mommas...I need some help from someone who knows about getting maternity care through the VA. I'm going to be going to a birth center, which my insurance(Tricare) does not cover (they claim they cover birth centers, just not one anyone within at least 200 miles of me), so right now I will have to pay out of pocket. Luckily they do cover my midwife, just not the ridiculous facility fee. I know it's worth it, but money is tight and I've heard that the VA will cover birth centers but no one at the VA knows anything about getting it covered. (You would think I'm in the middle of nowhere- I'm actually in Boston, this so called state-of-the-art healthcare city is behind the times, at least when it comes to Tricare and VA.) I've tried google, to no avail. Does anyone have experience getting VA to cover birth center or do you know someone who did?

 

Thank you so much!

-Ashley

post #2 of 6

Honestly, my best advice is to call and beg. My guess is that because it's likely out of network, you're likely out of luck because their argument is/will be that comparable care is available at other in-network locations (i.e. hospitals). HOWEVER, it doesn't hurt to ask TriCare. If you get approval, get it in writing.

post #3 of 6
Thread Starter 

I've spent literally HOURS on the phone with Tricare, and faxes and paperwork sent back and fouth....I'm giving up on them because I get a different answer every time always teasing me along...fill out this paper, then no- that person was wrong, fill out this one, and on and on and on that went for months! I'm really hoping the VA will cover it; I found literature from a VA in PA that says they will cover "birth center of your choice" but I can't find anyone who knows how. I know I'm in the minority here- female vet, no real health insurance (Tricare is a joke, and isn't even considered an insurance company so they don't fall under AffordableCare). Hoping someone else has been through this with VA and birth center.

post #4 of 6

Sounds like you've already been through the rigamarole. :S And frankly, I can't help with any experience, BUT have you checked this out (page 6)? Sorry for the long URL, but it seems clear that they'll cover (up to) 75% of allowable costs for an out of network birthing center. That generally means that you have to file afterwards, not before.

 

(1) http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CD8QFjAA&url=http%3A%2F%2Fwww.tricare.mil%2F~%2Fmedia%2FFiles%2FTRICARE%2FPublications%2FFactSheets%2FMaternity_FS.ashx&ei=EGqNUcv1Aou50AGCz4GgCg&usg=AFQjCNGH9kzO7TDmaGvFfSsIdomun6p2dQ&sig2=I6LzWbM2O7rSeabCmZTuZQ&bvm=bv.46340616,d.dmQ

 

(2) This explains the process for getting reimbursed for the money you spend on the non-network service (though sadly not the forms): http://www.tricare.mil/GettingCare/FindDoctor/NonNetwork.aspx?sc_database=web

post #5 of 6
Thread Starter 

Ruheling...sorry it took me so long to get back to you. Yes, I know it SAYS they will cover it; however, Tricare has told me, my midwife, and our birthing center that they absolutely will not cover the fees for the birthing center. :( Notice how it says on page 6 "at a Tricare Authorized Birth Center"- that is the catch. It sounds nice on paper, but in practice, when I look up my zip code (and I've actually put in other zip codes I know around the country), the maximum radius I can look up is 200 miles- there hasn't been a single "authorized birth center" to come up during any search I've done for facilities on their website. I doubt that there is a birth center anywhere that Tricare considers "authorized." When we ask how to get our birth center authorized, each Tricare employee gives me a totally different answer- all of which we've complied with (hence the paperwork after paperwork after paperwork comment I originally made), and each time Tricare claims to have lost the paperwork, they won't accept it because the birth center isn't authorized, they don't know what to do with the paperwork...and on and on. It is so frustrating...which is why I'm trying to see if anyone knows how to get the VA to help pay for the facility....because all the VA workers I've spoken with have said they think they cover birth centers, but no one knows how to actually get it covered.

 

I'm really really hoping someone who has experience with the VA and maternity services will see this.

 

Thank you for all the help! -Ashley

post #6 of 6

Ahh, got it. That sucks. Given the normal government process, I suspect that "authorizing" a birth center would have to be done by the center itself, not a future patient.

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