Need help with Tricare and homebirth - Page 2

[SAHMinHawaii]

Originally Posted by Kontessa

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?

They will pay before you give birth, but not the whole amount. Yes you do receive the check in your name, then you pay your midwife. I did not have to pay monthly with my midwife..that is her choice. I paid an intial $350 to keep her as my provider. Then i paid her when i got the money. After i gave birth, we paid her the remaining balance. And IF tricare pays us more we will get refunded. If you don't have the monthly payment money, see if she will give you a bill so you can submit yourself.

[Baby Hopes]

Kontessa,
That is probably how your midwife is comfortable doing her billing.

With our DD2 homebirth under Tricare we did not make our first official appointment (we'd done an interview) until after Tricare faxed our midwife an approval letter. Can't for the life of me remember what it was called. I just know that once my midwife recieved that letter she was happy to bill everything directly to Tricare. We (Dh and I) did not play middle men.

This next birth, however, will be done differently. We are with a different insurance coverage that has a very high deductible for out-of-network providers. My midwife has had successes in the past getting paid through our new insurance, but we've elected to pay it all up front and then if there is an insurance check in the end, it'll come to us directly.

[VeganPregnancy]

Originally Posted by SAHMinHawaii

When i spoke to tricare, every single time they said as long as she is certified in the state.

What if you are is Germany??
How does Tricare figure CNMs "certified" in that case?

[saskiaofthewoods]

The Same Problem

Hi,

I have the same problem right now. Well, my husband is Army, but otherwise it is the same problem.

I have an appointment with Tricare next week. Since I have told them that I would rather give birth alone than in their hospital they are more willing to talk

But it is a fight. And you might have to prepare to pay some of the bill on your own. At least that is what they told me. Or change over to Standard...

I hope I can tell you more after my appointment next week!

Saskia

[Synchro246]

Originally Posted by True Blue

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.

So *that's* how they get around it here?!?!?! Geez that's lame.



Why is Tricare so anti-homebirth midwife? I don't get it.

[curlyaustin]

military homebirth????

I do not recall ever posting in the open forum, but I am wondering the same thing about tricare. Why is tricare so anti-midwife home birth? Hospitals and doctors in general are. I am just really starting to realize my patient rights.
One Patient Rep. from an Army Hospital in Colorado asked me today
have I thought about what would happen if something goes wrong during a homebirth. I said, "Yes I have and I have also figured out that no one in the military hospital gives a flip about my kinda birth anyway"
and then I got off the phone. I wish I had said, " Do you guys ever think about what if something goes RIGHT during a birth???
I mean, as if women who choose to home birth are brainless, reckless, neglectful, uneducated, or something. Oh course I have "thought about it" and I have also thought about how unnerving my last 2 hospital birth experiences were-unnerving enough to pay out of pocket for a midwife who will support me-The US is such a wealthy nation and does not measure up worldwide when it comes to birthing. I guess so much money and control are to be had when women are sliced and diced and poked and prodded. Thanks for listening.

[isabellasmom]

I noticed this has been added to so I thought I would help if I could. Boobyjuice and I now are both having Tricare covered (mostly) homebirths in Oklahoma. We had to switch to Tricare Standard and could be locked out of prime for up to a year. However, all that we have is $50 copay and 15% off all expenses. If we have to have a hospital birth for some reason it is $14 and some change per day or $25 whichever is higher. You just have to get an approval for inpatient care at a Tricare authorized hospital BEFOREHAND. Your MAXIMUM out of pocket expense per year is $1000. That means it is a total waste to pay a midwife $2600 or whatever because you are worried about switching to standard. I am loving every minute of this pregnancy (besides the puking, of course) and I was not near as happy with a doctor. There was so much pressure and just too much ugh that I hated. I just feel so natural even with prenatal care. No one's forcing me to let them look "down there" either! lol. If you have any more questions feel free to message me and I will try to answer them as best as I can!

[Baby Hopes]

What if you are is Germany??
How does Tricare figure CNMs "certified" in that case?

Tricare and overseas care is a different animal all together. When I was getting ready for DD1's birth I specifically asked our Tricare Rep about getting care at a birthing center vs a hospital. She hemmed and hawed and kept saying things like, "We prefer that you use XYZ hospital or ABC hospital." It wasn't until I left her office that I realized she never really answered my question. She just sort of pushed it off.

I know of one person who homebirthed in Stuttgart. They weren't living in base housing and weren't military. Although they were covered by Tricare. I've since lost contact with her...

One other friend of mine had midwife coverage up until delivery. Although she had to go to Heidelberg to get the coverage by a military homebirth midwife (don't ask me, I don't know the details.) Because she lived in Stuttgart she was uncomfortable making the drive for the birth and the midwife wasn't able to come down. It ended up being a mess of sorts, although I think that had more to do with the time crunch she had, vs what her resources really were.

With anything, don't take the first "no." Push for written policy as evidence.

Regarding why Tricare is anti-homebirth... honestly I think they are just anti-"unconventional." They like doing things the "standard" way and rarely educate themselves on alternative options. Most reps I spoke to were genuinely ignorant about their own policy on homebirths.

If you want "anti-homebirth" try having Aetna as insurance their policy actually STATES "no homebirth."

Gah.

[VeganPregnancy]

Originally Posted by Baby Hopes

Tricare and overseas care is a different animal all together.

I've heard people say this on MDC but it's not that different, I have Tricare Prime, same as in the states. The only big difference is dental care.

Also... if I am switching over to standard, when would be the best time to do it? Now? At 5 weeks? Or would it be better to keep seeing the OB on prime and switch later?

If I switch to standard I could also choose a German birthing center or hospital it seems... anyone know if that's an option?

The Tricare Europe site says,
"Yet even with its increased costs and reduced benefits, TRICARE Europe Standard may be the right choice for some beneficiaries who prefer to get their care directly from host-nation providers. By choosing TRICARE Europe Standard, you retain the full freedom to choose from any provider you want for outpatient care. A reminder: all beneficiaries who live near an inpatient medical treatment facility still need to check with their nearest military treatment facility for a non-availability statement (NAS) before obtaining inpatient care in a host-nation hospital."

So on Tri-Standard I'd still have to get an NAS???
Ow... my head hurts...

[StacyL]

I have had a HB covered 100% by Tricare.

I would like to say that TRICARE IS NOT ANTI-HB!! They just aren't and that is a FACT.

On the contrary, the services that Tricare covers related to HB are extraordinary compared to any other civilian insurance provider. You can have a HB, or a birth center, covered 100% on Tricare without any problems.

The people who are ANTI-HB are the MTF's! If you mention HB to any doc or OB or nurse on base - they are the ones who are anti-HB.

The problem with Tricare is that any customer service rep that you may speak to when you call is WOEFULLY ignorant of the fact that they do indeed cover HB. It is a TOTAL waste of your time and energy to talk to any Tricare phone rep and attempt to get questions answered about HB. Personally, I think it is because so few Tricare patients actually have a HB, so the customer service reps are never asked these questions.

However...

If you speak to a supervisor, they are INCREDIBLY helpful and can answer all of your questions quite easily and knowledgably.

It really is not at all complicated to get your HB covered. To switch to Standard is so simple - you fill out and sign a single form. That's it. And being "locked out" of Prime for a year is not a big deal, because that does not mean you are locked out of going to your MTF for treatment. You can stiil go to your MTF for treatment where it is 100% FREE. You are just given the lowest priority for appts.

[StacyL]

Originally Posted by VeganPregnancy

it's not that different, I have Tricare Prime, same as in the states. The only big difference is dental care.

Also... if I am switching over to standard, when would be the best time to do it? Now? At 5 weeks? Or would it be better to keep seeing the OB on prime and switch later?

If I switch to standard I could also choose a German birthing center or hospital it seems... anyone know if that's an option?

If you switch to Standard for a HB, it is best to wait until later in your pg, and continue to get your initial prenatal care on base. As you know, if you are having NO COMPLICATIONS your MTF will not even allow you an appt. for a pg until you are 12 weeks. So, you won't even go until then anyway.

Also, it is worth noting that Tricare does not cover unwarranted ultrasounds. If you want an ultrasound it has to be ORDERED by your doc. So, I actually waited until I had the u/s at 18 weeks on base (ordered by doc as I was over age 35). I then switched to Standard and began care with my CNM for my HB.

Tricare covers every configuration of birth - so yes, you could choose a civilian hospital, a free-standing birth center, or a HB.

[Shelsi]

The biggest issue with Tricare and hb is that they technically only cover it with a CNM (in the US, don't know about overseas). It's near impossible to find a CNM who does homebirths in most areas. In mine there actually is one but I'm not going to pick a provider just because they are my only choice, kwim? Besides that she told me she'd never had any luck getting Tricare to pay which to me means she doesn't want to accept their payment because it should be fairly simple to get her covered.

Right now I'm working on getting my LM covered on Standard. It might happen, it might not. One of the mw's she partners with who is also an LM got covered for one birth but then denied for the next one she did.

[NamastePlatypus]

Originally Posted by 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!

SO GLAD I STUMBLED ON THIS!!!

Originally Posted by Synchro246

So *that's* how they get around it here?!?!?! Geez that's lame.



Why is Tricare so anti-homebirth midwife? I don't get it.

: I know, if not for the sole dake that it is a WHOLE lot cheaper than any hospital birth:

Originally Posted by VeganPregnancy

What if you are is Germany??
How does Tricare figure CNMs "certified" in that case?

I had my ds in Germany: : I have told dh that I am not going to do it again unless I can go back. Since that is not going to happen in the next 5 years.. I am stuck here in shit hole AR:
I can't remember where you are excatly. I was outside landstuhl and I spend MONTHES trying to get transferred to St Johaniss, soo glad I did, it was amazing. It was perfect and totally paid for, you get alot more under there care as well, pregnacy water aerobics, accupuncture, TOTALLY natural and homeopatic. It is like having a HB away from home with the comfort of knowing that IF IF IF IF IF something were to go wrong, and they don;t jump on every little hiccup like american docs do, you are in a place where intervension is a double door and hallway away.PM me if you need to, I fought that battle and it sucks!

[NamastePlatypus]

Oh and vegan, I know a MW in the kusel area that does homebirthes and accepts tricare, my old neighbr Alexa Weber, she is AWESOME!!!

[Baby Hopes]

Originally Posted by VeganPregnancy

I've heard people say this on MDC but it's not that different, I have Tricare Prime, same as in the states. The only big difference is dental care.

I had Tricare Prime as well. My DD1 was born in Germany and the first 34 weeks of my prenatal care with DD2 was done there as well. I'll readily admit that my Tricare Prime care in Germany was 100x's nicer than my Tricare Prime care stateside. I'm sure that had a lot to do with the fact that our on base clinic essentially referred EVERYTHING out to the economy that wasn't a cold, flu, or wart removal.

You may not have to jump through the same hurdles that you would if you were stateside. Although, you may have to deal with a much heavier bias from your Tricare Rep. : (A woman who readily told me that American women are weaker, prefer having C-sections, and just can't handle birth. But defended the American c-section in the Germany hospitals as the same ratio as those of the Germans, Turks, and other nationals... I'm still figuring that one out.)

[curlyaustin]

hb coverage

[QUOTE=StacyL;7769957]I have had a HB covered 100% by Tricare.

I would like to say that TRICARE IS NOT ANTI-HB!! They just aren't and that is a FACT.



Thanks for pointing out that fact....I should have specified why I had ponderings concerning Tricare. After talking to the Supervisor, I got the understanding that Tricare is Pro-CNM with HB. The Tricare Supervisor said that they would help me in a heartbeat if I had a CNM...since no CNM will do HB in my area, she said she was very sorry the policy will not cover any part of it for other types of midwives. So in my personal case, I felt since Tricare was pro-CNM that translated to anti-hb for me and many others I know of with no access to CNM to do hb. Anyway, I am thankful for the info provided through this forum. StacyL had said talk to supervisors only, so by that advice, at least I did not feel I was being lied to or that I was wasting my time when I called to ask about HB coverage. Thanks again for all the info ladies. I hope you all have wonderful outcomes in the future.

[eightyferrettoes]

Yup, that's all correct. I had Tricare accidentally pay out for a lay midwife last year (which is the ONLY kind of homebirth midwife in my area!) and then try to deny claims because she wasn't a CNM. Duh. She never claimed to be!

It really was a mess. I had no idea they made a distinction between CNMs and lay midwives, and I had an authorization... but that doesn't seem to matter much now.

So yeah, I think that qualifies as anti-HB.

[NamastePlatypus]

if you make the switch is it all dependents or just me? WOuld my soon be standard with me or would he stay prime?

[VeganPregnancy]

Germany

NamastePlatypus,
I live right outside Kusel!!! And I saw Alexa Weber's name on another forum about her being a great midwife!!!!
I would love to have my baby in St. Johaniss, how did you get transfered there?? That was my original wish, not a homebirth actually. I'm just not sure it will "work out" if I just "hope" to end up at a German hospital.
Are there any methods which can give me a better chance of getting out of Landstuhl (the MTF)

StacyL,
I've read many of your older posts re: homebirth and tricare and I think I've got it down now!
You are the tricare/homebirth MDC goddess! I bow to you!! :

I will be seeing the doctor on the 18th (@ 7 weeks,) I don't know why. I think maybe because I conceived while using BC...? The nurse at my "educational appt" told me they may give me an early ultrasound as well to find out the age. Whatever.
Homebirth was not my original plan. The idea makes me slightly nervous... but much less nervous than an MTF!!!! And if those are my choices then homebirth all the way!! The German hospital/birthing center is REALLY where I'd like to end up. Anyone else with some advice on that?
Now I'm up in the air! If NamastePlatypus can hook me up with Alexa Weber and she takes tricare... then wow! But if anyone has advice ot get into St. Johaniss... eeek I don't know what to do! But I'm SO glad I have options now!! I was feeling so stressed for awhile!

[VeganPregnancy]

Originally Posted by NamastePlatypus

if you make the switch is it all dependents or just me? WOuld my soon be standard with me or would he stay prime?

Dependants stay prime, and your newborn will be prime (unless you choose standard I assume.)