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Need help with Tricare and homebirth - Page 17

post #321 of 366
CPM's are out - Tricare does NOT cover them. There have been a couple of 'accidents' of CPM coverage talked about here, but don't waste your time pursuing it.

You say CNM's are legal in your state - CNM's are covered for HB or birth center-delivery by Tricare, so all you have to do is find one willing to bill Tricare and accept their rate.

Since you are active duty, and therefore Prime only, it is actually to your advantage that your MTF does not have L&D. You can have your PCM write you a referral to a HB CNM, or to a birth center with CNM's. It should be quite simple. You shouldn't have a problem getting your PCM to write you whatever referral you want, since they have to do it for every single pregnancy at the MTF anyway. There is no need for you to consider POS.

I wouldn't worry at all about having a CNM HB on base. It's legal. But, I wouldn't run around 'advertising' it either, just so you don't get any busy-body neighbors or other people interested in your business.

You might want to say what base you are at here on the thread, and also in your Tribal area on MDC so that someone may help you find a CNM.

If you happen to be at Walter Reed, it will be easy.
post #322 of 366
Dig a little deeper for the maternity details for active duty. A few years ago (I think in 03) it was required of Tricare to allow even AD members to choose their care provider and location of delivery for maternity care I am pretty sure. I remember reading about it when I was pregnant with my middle daughter and had been looking into the different Tricare options for maternity care/delivery.
I'm not sure how they would be able to prevent you from delivering at the birthing center if you desired. Even as an out of network provider, they do pay a percentage. And if you wanted to have a homebirth and pay for it out of pocket, they certainly can't prevent you that I know of. That's what I'm looking at needing to do as a dependant since the one CNM locally is taking the spring off.
post #323 of 366
I can find no CNM willing to HB here. There used to be one about 5 minutes away, but she recently went into Ob practice and delivers only in hospitals now. The CNMs in the birth center are 2.5 hours away. Is there a limit on how far away a provider can be for a referral?

Also, the HB on base would NOT be with a CNM, but with an illegal CPM.

I would rather not post where I am, just in case they are watching! *looks over shoulder*
post #324 of 366
Quote:
Originally Posted by Pirogi View Post

If I were to obtain shadow care with a CNM who does hospital deliveries and be secretly seeing an illegal CPM concurrently, and if I had a birth in my on-base house with said CPM, could I get into trouble? How about the midwife - is she more at risk on a military installation than anywhere else in the state? (Sorry, that is more a legal question, but I thought you ladies may be able to give me some insight.)
Just wanted to answer my own post here, since I found one of the answers I was looking for. I spoke with a JAG officer and found out that if an AD member contracts for illegal services, they could be charged with conspiracy to commit a crime. So, even though giving birth in any form is not illegal, it IS illegal for me to seek out a non-CNM midwife (since that is all I have access to) to attend illegally. Also, if this occurred on the military installation, the midwife could be facing federal charges instead of just state charges, even though there is no federal law prohibiting her from attending a birth.

So, it seems my options just got a little fewer.
post #325 of 366
Quote:
Originally Posted by Pirogi View Post
The CNMs in the birth center are 2.5 hours away. Is there a limit on how far away a provider can be for a referral?
That is a question a supervisor at Tricare would be able to answer.
post #326 of 366

Grrr

Well we are tricare prime in Virgina, LAFB area. (MTF with L&D) I just spent an hour on the phone with tricare, and worked my way all the way up to speaking with the medical management supervisor, sandra. She point blank told me Tricare will not cover a homebirth. No exceptions. I asked if we could switch to tricare standard and she again said tricare will NOT cover a hb. POS, Nope tricare will not cover a home birth. I am extremly fustrated and refuse to give birth at a MTF but can not see myself being able to afford the 2-5,000 dollars to HB with no insurance.... Someone help. We do not have a hand book and I do not know what i need to argue here. My husband is active duty E5 in the Airforce. I'm 8.5 weeks pregnant and have seen a midwife on base I have all of my labs back and my first ultrasound. Healthy healthy healthy. I feel like iw ould be safer birthing unassisted than dealing with the MTF, so many unneccesary C/S and inductions leading to C/s. Help me PLEASE! I am due May 10th 2009 and want to figure things out way before I'm ready to deliver.
thanks for any help
post #327 of 366
Quote:
Originally Posted by jyeargin View Post
Well we are tricare prime in Virgina, LAFB area. (MTF with L&D) I just spent an hour on the phone with tricare, and worked my way all the way up to speaking with the medical management supervisor, sandra. She point blank told me Tricare will not cover a homebirth. No exceptions. I asked if we could switch to tricare standard and she again said tricare will NOT cover a hb. POS, Nope tricare will not cover a home birth. I am extremly fustrated and refuse to give birth at a MTF but can not see myself being able to afford the 2-5,000 dollars to HB with no insurance.... Someone help.

Well, regardless of who you spoke to, you were told incorrectly.

Tricare DOES cover HB - both on Prime (under specific conditions) and on Standard. In your case, you will have to switch to Standard, which is very simple. You fill out a disenrollment form and mail it in. Simple. The hard part is finding a CNM that does HB's and bills Tricare in your area. But, you can get help with that here at MDC in your Tribal area. Are you at Langley? My MTF is NNMC in Bethesda, so I know this area well.

THere is a phone number to a certain supervisor in this thread that you can call if you need better help.

Veronica (916) 985-5772 (found it)

Don't be discouraged by that lady and don't let her buffalo you - she is wrong. Don't waste another minute talking to her or calling her back if you happen to have her extension number - speak to ANY other supervisor!

Here's the chart of Tricare's maternity coverage under Prime and Standard, that lists homebirth and birth centers. It is the last block at the bottom of each chart in the lefthand column, and it is called "outpatient delivery" NOT "homebirth" in case you were confused:

http://www.tricare.mil/factsheets/vi...eet.cfm?id=261
post #328 of 366
What Stacy said. It does have to be done with a CNM not a CPM, however, which may be your biggest challenge finding a nurse midwife who does home deliveries.
And if you have a Tricare office at your MTF, you can drop the form off there, you wouldn't have to mail it if that helps. You can specify what date you want standard coverage to begin, and since your husband is enlisted not officer, you can reenroll in Prime at any time if you were to need to do so for any reason. HTH!
post #329 of 366
I am in the LAFB area. Tricare will only cover a CNM. I could not find one in the area. I am paying for my HB (any day now I hope) out of pocket. There used to be a homebirth friendly doc at Langley but he is gone . He made a good point- women with fertility problems spend a lot out of pocket to get pregnant with no insurance . For me this was important enough to spend the money. I figure the money issues will be resolved in months but the birth experience will be with me forever. The HB CPM's that I am using let you pay as you go too. I think they take credit cards now too. I have been going to Langley and seeing the midwives - I drove them nuts but finally ( it will be my first vbac) found a midwife there who respects that I made an informed decision and am taking a calculated risk (small in my belief). You may get more support if you are not a VBAC. I declined GBS testing and vaginal exams. I hope that all works out for you and you get the birth you want.
post #330 of 366

Skjslp

Who are you using? How much are their fees?Tricare is stupid, they cover CPM's at the MTF's but not for a much cheaper HB.. blah I hope everything goes smoothly for you. My first son was a vaginal delivery with too many hospital interventions! I am seeing a midwife on base right now, my next appointment we are going to discuss the use of water as pain relief in labor and see if we can get the ball rolling to get langley on board with the use of a birthing tub. (if only for labor if nothing else)(nov 6th) I dont have high hopes but i can be pretty persistant. She knows that i am going all natural and thinking about a home birth. I hve only met her once but she is really nice. Anyone there you would not reccomend we see? Oh well, I guess i will keep looking for a CNM and hope i find one before next year.
post #331 of 366
Quote:
Originally Posted by jyeargin View Post
Who are you using? How much are their fees?Tricare is stupid, they cover CPM's at the MTF's but not for a much cheaper HB.. blah I hope everything goes smoothly for you. My first son was a vaginal delivery with too many hospital interventions! I am seeing a midwife on base right now, my next appointment we are going to discuss the use of water as pain relief in labor and see if we can get the ball rolling to get langley on board with the use of a birthing tub. (if only for labor if nothing else)(nov 6th) I dont have high hopes but i can be pretty persistant. She knows that i am going all natural and thinking about a home birth. I hve only met her once but she is really nice. Anyone there you would not reccomend we see? Oh well, I guess i will keep looking for a CNM and hope i find one before next year.
we are having a hb with a LM. we are paying out of pocket, however, we are meeting with our LM 4 times and doing the rest of our maternity care at naval with the CNM. they are working along side one another and our LM gave us a big discount as we dont see her for primary care and tests.
post #332 of 366
Ok, here is my issue lately. I am 41 weeks today HOPEFULLY going to deliver any day now!! I went to bethesda up until 21 weeks and then stopped and found my midwife (a CNM out of network provider who accepts tricare)....I didnt start going to her until I was 30 weeks...I DID get a referral from my PCM at walter reed to be seen by my midwife and have a homebirth with them and she was supposed to have sent a copy of the referral to tricare and she gave me 2 copies....a few days after this my midwifes office called and said that tricare WAS approving the homebirth so as of that moment I thought ALL was well, then recently the midwifes office was asking for a copy of the referral because tricare was saying they wouldnt pay without it...HUH??? They were supposed to already have one! BUT, I gave them a copy and as of yesterday she faxed it in and we are waiting to hear back from them.

Im TERRIFIED that all of a sudden they are going to deny the birth and then im up the creek We do NOT have the money to pay for it out of pocket and ive done everything that tricare told me to do and first they were saying that they would pay NOW I dont know whats up....a lady on another online forum im on says that tricare is trying to deny her (she is tricare NORTH and she said everyone is telling her that north no longer covers it but other regions do, I am also on north).

Anyone know whats up????? What can I do at this point, im seriously overdue and will have the baby any day SO its too late to switch to standard right???? Oh GRRRRRRR! HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!










Quote:
Originally Posted by StacyL View Post
Well, regardless of who you spoke to, you were told incorrectly.

Tricare DOES cover HB - both on Prime (under specific conditions) and on Standard. In your case, you will have to switch to Standard, which is very simple. You fill out a disenrollment form and mail it in. Simple. The hard part is finding a CNM that does HB's and bills Tricare in your area. But, you can get help with that here at MDC in your Tribal area. Are you at Langley? My MTF is NNMC in Bethesda, so I know this area well.

THere is a phone number to a certain supervisor in this thread that you can call if you need better help.

Veronica (916) 985-5772 (found it)

Don't be discouraged by that lady and don't let her buffalo you - she is wrong. Don't waste another minute talking to her or calling her back if you happen to have her extension number - speak to ANY other supervisor!

Here's the chart of Tricare's maternity coverage under Prime and Standard, that lists homebirth and birth centers. It is the last block at the bottom of each chart in the lefthand column, and it is called "outpatient delivery" NOT "homebirth" in case you were confused:

http://www.tricare.mil/factsheets/vi...eet.cfm?id=261
post #333 of 366
You can switch to standard at any point. All you have to do is go into your local tricare office and fill out a form stating that you want standard care to start on x date.
post #334 of 366
OK, but im 41 wks, say I go into labor tonight or tomorrow by chance and dont even get the paper work turned in until after the birth, could I then still claim the birth costs under standard and have them paid???? My hubby is thinking not.



Quote:
Originally Posted by LinzluvsGJ View Post
You can switch to standard at any point. All you have to do is go into your local tricare office and fill out a form stating that you want standard care to start on x date.
post #335 of 366
I'm not sure. I'd call your Tricare office and ask if you are able to backdate paperwork for switching to Standard. I switched to standard during my second pregnancy at 32 weeks or so along.
post #336 of 366
Why don't you get your PCM to fax you a copy of the referral and you can send a copy to whoever cares to see it? Problem solved. You should already have a copy of the referral anyway, as it comes to you in the mail from Tricare when your PCM makes it.
post #337 of 366
Well, when I got the referral the PCM said she was sending one on to tricare via the web and gave me two, one I should keep and one for the midwife (which they now have) so im just confused as to why tricare was saying they didnt have one...but the one that I gave to the midwife has since been faxed to tricare.
I spoke to them today and the receptionist at the midwife told me not to stress and worry that it WILL be approved they are just trying to get the technicalities straightened out...im still nervous, if they up and decide not to cover it im in a world of hurt, and I told her this and she still told me not to stress so I hope I can trust that she is right!




Quote:
Originally Posted by StacyL View Post
Why don't you get your PCM to fax you a copy of the referral and you can send a copy to whoever cares to see it? Problem solved. You should already have a copy of the referral anyway, as it comes to you in the mail from Tricare when your PCM makes it.
post #338 of 366
So is there anyway to get around the "certified" requirement? Tricare says they will not pay for my CNM unless she is certified by them but if she does that then she can only charge 15% above Tricares maximum allowable which I believe is about $2000.

She doesn't want to do this because her fee is $4000.

Any advice would be greatly appreciated.
post #339 of 366
Well... you could always work out a fee with her of what you are willing to pay in addition to Tricare. That is essentially what we will be doing if Tricare covers any of ours (still waiting to find out)-- our midwife charges $3,000 for her care, she bills the insurance, and we cover whatever the balance of what they didn't cover.
post #340 of 366
That's exactly what I was going to say - we had an agreement with our CNM to pay in full by whatever week (34 if I recall correctly), and basically get reimbursed by tricare with however much tricare reimbursed.

FWIW, we just got all the statements from tricare, and we're getting ~1800 back, and that's with switching to standard AND going out of network. so if we would have been able to get a referral, we would have gotten back more. (we're in triwest, btw)
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