Need help with Tricare and homebirth

[boobyjuicex3]

My hubby is active duty Air Force and I am expecting my 4th boundle of joy. I want a home birth and would like Tricare to pay for it and a dear friend told me that you guys could help me with the "red tape". Thank you in advance!

[StacyL]

There have been several threads on this here at MDC, but since I just did it here's what I can tell you:

1. Homebirth is only covered by Tricare when using a CNMW - period. No CPM, direct-entry, lay MW's, etc.

2. If you are more than 50 miles away from your MTF (and are therefore on Tricare Prime Remote) then you can have your HB paid for while on Tricare Prime.

3. If you are within 50 miles of your MTF, but your MTF does NOT provide Labor and Delivery Services (for example, Walter Reed Army Hospital) then you can get a referral to a CNMW to have your HB covered while on Tricare Prime.

4. If you are near your MTF and it has the normal L & D services, the only way to get a HB covered is by switching to Tricare Standard. This is very simple - you fill out a single form and mail it in. Then you can see any CNMW that does HB and Tricare will pay for it 100%. There are no co-pays or fees associated with any care you receive related to your pregnancy.

5. While on Standard for a one year period you will be given the lowest priority for appts. on base. You can still try, but they may be hard to get. Otherwise, any medical care OUTSIDE of your pregnancy (e.g. a cold, or ER visit) will involve a co-pay. It is a one-time fee for the ER. No co-pay if you have a second ER visit in the one-year period. The cap on all co-pays for the year is $1,000. That is your maximum possible out of pocket expense for medical care UNRELATED to your pregnancy.

6. You being on Standard does not affect your newborn or other family members - they all remain on Prime.

It really is quite simple, but Tricare does not make it easy to find out this information.

I switched to Standard for my HB and did not pay a dime out of pocket, nor did I have any co-pays for any other medical care because I was never sick or injured. It worked out great!

Good luck!

[boobyjuicex3]

Thank you thank you Thank you!! I appreciate this so much!

[StacyL]

P.S. When speaking to Tricare about this topic, always ALWAYS speak to a supervisor. They are the only ones knowledgable enough to not waste your time.

[MaddieMay]

If you are having a homebirth with a CNM, what do you do in case of a hospital transfer? Can you arrange ahead of time to have all the referral stuff taken care of (at a local hospital Tricare covers)? Can they just kind of do an open referral and toss it if you don't use it? The last thing I'd want to do if I had a hospital transfer is to worry about all the referral issues. (Not that I'm pregnant yet, just thinking.)

[StacyL]

No need for a referral for an emergency transfer. You just go to the nearest ER. An emergency is an emergency.

I actually had an emergency transfer in my first HB. It was not a big deal (from the insurance perspective!)

[erin_brycesmom]

I'm still confused on this topic even after reading all the posts I could find here. CNM isn't an option for homebirth where I am, only CPM. I have heard of 2 people who have gotten $$ from tricare for a CPM attended homebirth. I just haven't had the chance to look more into it to find out how.

~Erin

[StacyL]

Please click the link and scroll down to see Tricare's chart of the covered services relating to maternity options:

http://www.tricare.mil/factsheets/vi...eet.cfm?id=261

[True Blue]

If someone got a CPM paid for, it was a slip-up on Tricare's part. Also, they have gotten more strict in recent years. I know someone who had it paid for with my LM, but there was no way in heck they'd pay for mine!!!

Also, with Standard, it is not guaranteed they'd pay for the whole thing. The CNM would have to agree to be in-network. I had a CNM for my first birth (a hospital one!!) and got stuck paying $1500 out of pocket. We signed paperwork in the beginning of care with her fee on it, not realizing it meant WE had to pay it all. Read carefully and ask before signing anything!!! Tricare and their lawyers were really nice about it, they read what we signed and tried to find a loophole for us but there wasn't one. That said, the birth went well and even though I didn't love that midwife it was still worth it since it was easier to have a natural birth. For our DD, who was a homebirth, there simply weren't any CNM's who did homebirth in the area, and even though Florida law mandates LM's be covered, Tricare would not pay. They are not an "insurance company" but rather a "government benefit" and thus do not fall under that law. *sigh* We paid the $3200 out of pocket but it was worth each and every cent! If you do wind up having to go that route, Tricare does, however, cover all your labwork, ultrasounds, etc 100% just like if they were done with an OB.

[Shelsi]

I think even if you use a mw other than a CNM it certainly won't hurt to at least try to get it covered. Like a pp, my mw is an LM and said she's gotten Tricare to cover it a few times in the past. So we're going to give it a go but of course am not counting on it or anything. We actually do have a CNM in this town but I didn't really connect with her and she told me she'd never gotten Tricare to cover her which to me means she didn't want to accept their payment.

Also if you do live near an MTF with full L&D services, before switching to standard, do see if you can get your PCM to give you a referral for homebirth. It's hard to do but I've heard of it happening and it'd be nice to stay on Prime.

[StacyL]

Originally Posted by Shelsi

Also if you do live near an MTF with full L&D services, before switching to standard, do see if you can get your PCM to give you a referral for homebirth. It's hard to do but I've heard of it happening and it'd be nice to stay on Prime.

I disagree with this as I did this. It is a waste of time.

The PCM will say no, and then your only option is to appeal directly to the CO of the MTF.

If you want to do it, then by all means, knock yourself out; but, do yourself a favor and just write a letter to the CO of your MTF requesting the appeal and do not waste a single minute talking to anyone. I guarantee the CO will refuse the referral, but at least you won't waste precious time and energy fighting the underlings.

[MotheringHeart]

I second what StacyL said. Just go to the CO. They have gotten really strict about this and will just about 100% say no. You can waste time writing a letter, or you can just switch to standard for a year (not as scary as it seems) and be MUCH better off!

[isabellasmom]

Boobyjuice is a friend of mine and we have been talking about this. In the state of Oklahoma CNM's do not deliver at home, only CPM's do. I know of at least 2 people who have been covered with a CPM AND my midwife that I have chosen (and I wouldnt' want anyone else) has done several homebirths that have been covered by Tricare. It may be by the state. The benefits link also shows that infants are covered and I am sure a good midwife would help you get around that.

[StacyL]

Well, if you know a way to get a non-CNM covered by Tricare, then more power to you. Like I said, speak to supervisors only then share what you learn here!

[jngaines]

Home births and Tricare

I have been recently researching whether Tricare pays for home births and I actualy called Tricare yesterday. The woman told me that Tricare does pay for home births under certain criteria:

A. A certified nurse midwife may provide covered care independent of a physician referral and supervision, provided the nurse midwife is:

1. Licensed, when required, by the local licensing agency for the jurisdiction in which the care is provided; and

2. Certified by the American College of Nurse Midwives. To receive certification, a candidate must be a registered nurse who has completed successfully an educational program approved by the American College of Nurse Midwives, and passed the American College of Nurse Midwives National Cretification Examination.

B. The services of a registered nurse who is not a certified nurse midwife may be authorized only when the patient has been referred for care by a licensed physician and a licensed physician provides continuing supervision of the course of care.

lll. Exclusion

A Lay midwife who is either certified nurse midwife not a registered nurse is not an authorized provider, regardless of whether the services rendered may otherwise be covered.

I am meeting with my midwife today for the first time and she's actually a Licensed Naturopathic Physician who practices medicine and midwifery. She said that in the past Tricare has not covered all costs but after reading and hearing all of the above, I think they will. I will post again when my paperwork goes through and the deal has been sealed.

Hope this helps!

[SAHMinHawaii]

I had just had homebirth and tricare paid for it. I switched to standard as soon as we found out i was pregnant. Here is the interesting part. I spoke to tricare many times before commiting to my midwife. They knew she wasn't a CNM, she is a LM. She is not a network provider. We do not have a MTF here that does births so you have to be seen my a civilian provider anyway. I would say switching to standard is the easiest way unless you don't have a MTF nearby and prime will pay. For me, there aren't any CNM near me that do homebirths. They do have a in network midwife but she is an hour from me and DOES NOT do homebirths. I had to fight with them about why i can't use her. When i spoke to tricare, every single time they said as long as she is certified in the state. yes all the info on the web site states that the midwife must be a CNM..but that isn't necessarily required for coverage. It took many many calls and speaking to the right people about this. But guess what? I got my midwife "in the network" and a few other military people have now gotten authorizations for my midwife as well! My midwife said what ever you did, or spoke to..You did it! Most everyone you will speak to will seem like they are "the law" and they make the decision. But speak to the right people and you could get lucky!

[Shelsi]

Originally Posted by SAHMinHawaii

I had just had homebirth and tricare paid for it. I switched to standard as soon as we found out i was pregnant. Here is the interesting part. I spoke to tricare many times before commiting to my midwife. They knew she wasn't a CNM, she is a LM. She is not a network provider. We do not have a MTF here that does births so you have to be seen my a civilian provider anyway. I would say switching to standard is the easiest way unless you don't have a MTF nearby and prime will pay. For me, there aren't any CNM near me that do homebirths. They do have a in network midwife but she is an hour from me and DOES NOT do homebirths. I had to fight with them about why i can't use her. When i spoke to tricare, every single time they said as long as she is certified in the state. yes all the info on the web site states that the midwife must be a CNM..but that isn't necessarily required for coverage. It took many many calls and speaking to the right people about this. But guess what? I got my midwife "in the network" and a few other military people have now gotten authorizations for my midwife as well! My midwife said what ever you did, or spoke to..You did it! Most everyone you will speak to will seem like they are "the law" and they make the decision. But speak to the right people and you could get lucky!

Ok I gotta ask: where in AZ are you? I wish I could do that but I think my problem will be that there IS a homebirth CNM in this town, although she's not in network. I just didn't click with her though and am using an LM. We were going to submit the paperwork after the birth and hope for the best.

[Baby Hopes]

My DD2 (born Dec 2005) was covered 100% through an out of network CNM with Tricare Prime. (not Tricare Prime Remote.)

I got a referral to my CNM from my family doctor, but learned after the fact that the referral was really an unnecessary step.

I know that the website explicitly declares only "CNMs" but when I was qualifying my CNM for coverage (hours on the phone) they just kept asking me "Is she certified? She has to be certified."

If that was their only qualification, it's entirely likely I could've slipped a Certified Practicing Midwife into the mix.

[SAHMinHawaii]

[QUOTE
I know that the website explicitly declares only "CNMs" but when I was qualifying my CNM for coverage (hours on the phone) they just kept asking me "Is she certified? She has to be certified."
QUOTE]


Exactly what they told me.
Rachel-I am in Sierra Vista! Not that far from you at all. Cool. Dont worry about there being a CNM near you..if she is out of network it doesn't matter anyway.I think it would really help to get the pre-approval. I wouldn't wait until after birth to submit a claim. We submitted the first claim when i was 4 months pregnant and they paid out $1479.79, then sent me an additional check for $300. I called them and asked why they hadn't paid the whole thing and they said because i haven't given birth yet. They wouldn't cover all my appointments, pitocin(i have to have), suppliest, etc.. So after birth my midwife submitted another claim and we are waiting on payment. Even if they don't pay out the rest, at least they covered some, i am happy with that. Heck if i didnt deilver so quickly i would use her even if i was in tucson. I really wanted to do an unassisted but i have hemorraging bad after birth and needed the assistance. Good luck!
BTW we should meet up sometime.

[Kontessa]

Stuck in TX

So I am in TX and have a military hospital I gave birth at two years ago just down the street. I will not go back there! I have an appointment to meet a midwife, not sure what kind, you think I would know! LOL This Thursday. She said that Tricare will cover it but that they do not bill till after the birth. She said I will have to pay monthy to meet the full amount 2400 and then I will be the one who get the money back from Tricare.

Does this sound right?