Tricare is covering my homebirth 100%!

[jlizgar]

YAY! I am so excited...at first tricare didnt want to cover the birth at all so I was told to go to my primary care physician and get a referral, so thats what I did and today I got a call from my midwives office saying the homebirth was covered 100%!
WOOOHOOOOO!
I had heard soooo many horror stories of Tricare not wanting to cover homebirths and I thought I was going to have a major fight on my hands but it was really pretty simple and painless...so there is hope for you all out there that have tricare through the military!

OH, I am in Maryland and using Evelyn Muhlhan through Alternative Birth Choices for my care and birth! She is WONDERFUL!

Liz

[roadfamily6now]

Great job! They HAVE to cover a homebirth, but it is important that you go through the right channels! Congrats and good luck!

[sarahb44]

Originally Posted by jlizgar

YAY! I am so excited...at first tricare didnt want to cover the birth at all so I was told to go to my primary care physician and get a referral, so thats what I did and today I got a call from my midwives office saying the homebirth was covered 100%!
WOOOHOOOOO!
I had heard soooo many horror stories of Tricare not wanting to cover homebirths and I thought I was going to have a major fight on my hands but it was really pretty simple and painless...so there is hope for you all out there that have tricare through the military!

OH, I am in Maryland and using Evelyn Muhlhan through Alternative Birth Choices for my care and birth! She is WONDERFUL!

Liz

: Good for you!! That is great!

Originally Posted by roadfamily6now

Great job! They HAVE to cover a homebirth, but it is important that you go through the right channels! Congrats and good luck!

NO so true, if your MW isn't um, legal per state laws they don't

[Shelsi]

Originally Posted by roadfamily6now

Great job! They HAVE to cover a homebirth, but it is important that you go through the right channels! Congrats and good luck!

In states in which midwives are licensed yes. If they are not licensed however then they would be paying someone to practice medicine without a license which of course is illegal and is not going to be covered.

I think Tricare has gotten easier. Their new handbook just says they cover homebirth. The old one said it had to be with a CNM and I no longer see that stipulation. A year ago (before the new handbook) I got my home birth partially covered under Standard, they reimbursed us $1400 plus paid for all the labs.

[nashvillemidwife]

Originally Posted by Shelsi

In states in which midwives are licensed yes...

That's not true across the board. There are certain states with "any willing provider" laws, but that's only a handful. In most places it is still up to the discretion of the company.

I think Tricare has gotten easier. Their new handbook just says they cover homebirth. The old one said it had to be with a CNM and I no longer see that stipulation.

Someone told me this too, which gave me hope I could become an approved Tricare provider. Someone from this board put me in touch with a CPM and LM who have been through the process, and so far they've replied that Tricare has dropped them from the system and, when they called to re-register were told they would only approve CNMs.

[Changed]

Everything I could find said they only cover nurse midwives. At the very least here, you have to pay 100% up front and then they may or may not reimburse. They decided to stop paying the MW i'd hired after paying her for years out of the blue.

[Rylins mama]

Awesome! Where did you start with it?? Im with tricare too and Im still trying to talk hubby into a homebirth. I think with tricare remote they have to cover though. I cant remember.

[apelilae]

: YAY Liz! I'm so happy for you! I'm with Evelyn too and I'm loving them.

[lisa_nc]

I think you are out of luck if you live in a state were CPMs are illegally attending homebirths and there aren't any CNMs in your area who are willing to attend. Gah! Such complete BS!

Congratulations to OP though! That rocks!

[Kim919]

YAY!! I live in NYS & have preferred care helath insurance & I had the same experience.

I needed to go to my primary care 1st and get an out-of-network referral, and the health insurance gave me approval no questions no arguments. I was so geared up for a fight I didn't know what to do with all of my built up energy!

My policy has no co-pays on maternity care so I don't have to pay a penny out of pocket. My midwife is a CNM, but she is not an in-network provider. If my insurance company had an in-network provider who attended home births(they don't) and was taking new patients I would have had to use that provider.

I'm so glad our health ins. companies are starting to come around!! (besides they're saving themselves a small fortune for each one of us they approve...)

[jlizgar]

Originally Posted by Rylins mama

Awesome! Where did you start with it?? Im with tricare too and Im still trying to talk hubby into a homebirth. I think with tricare remote they have to cover though. I cant remember.

Well, at first I just went to my apppointment with Evelyn and when her office called Tricare for approval they denied the claim...so I personally called tricare and told them what I wanted and asked how to go about making it happen (the guy was very helpful). They told me to get an appointment with my PCM and have him or her write me a referral and then it would be covered. Sure enough, I got the referral and within a couple days, Evelyns office called to let me know that tricare approved the claim and its covered 100%!
It was MUCH painless than I was thinking it was gonna be, I was just so stressed over it because im already at 30 weeks and some change so I was getting afraid that it wouldnt work itself out in time.

[jlizgar]

Originally Posted by apelilae

: YAY Liz! I'm so happy for you! I'm with Evelyn too and I'm loving them.

Thats neat! Have you had a homebirth before? This will be my first AND its a VBAC too!
I had heard SO many great things about her and had her recommended to me by several doulas and moms in the area so i trust that ive chosen the correct provider
Ive only had 1 appointment with her but feel in love,she is just so sweet! My next appointment is in a week or so and I cant wait!

Liz

[nashvillemidwife]

Have you talked to the midwife about whether or not Tricare is going to cover 100% of what she actually charges, or just 100% of what they consider "usual and customary" for an in-network provider (which could be as little as half of her actual fee)? Granting her approval for your case is not the same as her becoming an officially authorized Tricare provider, and unless she signs a contract agreeing not to do so she may bill you for the balance.

[jlizgar]

Originally Posted by nashvillemidwife

Have you talked to the midwife about whether or not Tricare is going to cover 100% of what she actually charges, or just 100% of what they consider "usual and customary" for an in-network provider (which could be as little as half of her actual fee)? Granting her approval for your case is not the same as her becoming an officially authorized Tricare provider, and unless she signs a contract agreeing not to do so she may bill you for the balance.

I asked the office if that means that 100% of my costs (ALL costs) would be covered and they said yes...her fee is 3500. BUT I do have to pay the birth assistants fee because it isnt covered by any insurance and that is 645 but that is OK with me, it was the midwives fee that was going to be hard to pay out of pocket...but turns out I dont have to!

[nashvillemidwife]

I can guarantee you that Tricare is not going to pay her $3500. She must be eating the rest of it if she has agreed not to charge you the balance.

[jlizgar]

Originally Posted by nashvillemidwife

I can guarantee you that Tricare is not going to pay her $3500. She must be eating the rest of it if she has agreed not to charge you the balance.

I assume you are military right? Have you had a bad experience with tricare not paying or something? You sound awful pessimistic about the whole thing...im telling you what tricare and the midwives office told me...they are a small close knit office so im sure lines arent getting crossed and info mixed up...I made a BIG deal when I asked if that mean EVERYTHING was covered because I cant afford to pay out of pocket for the birth...and they said YES! Im sure they made sure when they spoke with tricare because, well, they want to get paid
I guess I can let you know for sure in October
but im going to continue with my plans as normal and not stress over it, it wil all work itself out one way or another without me freaking out over it.

[Shelsi]

Originally Posted by jlizgar

I assume you are military right? Have you had a bad experience with tricare not paying or something? You sound awful pessimistic about the whole thing...im telling you what tricare and the midwives office told me...they are a small close knit office so im sure lines arent getting crossed and info mixed up...I made a BIG deal when I asked if that mean EVERYTHING was covered because I cant afford to pay out of pocket for the birth...and they said YES! Im sure they made sure when they spoke with tricare because, well, they want to get paid
I guess I can let you know for sure in October
but im going to continue with my plans as normal and not stress over it, it wil all work itself out one way or another without me freaking out over it.

Actually she's right, they aren't going to get their full fee out of Tricare. Just like if you went off base to an OB they wouldn't get their full fee either. Have you ever had to go off base for anything to a civilian provider? Afterwards you should have gotten a statement in the mail detailing what the provider charged tricare and what tricare actually paid them. It doesn't mean you owe the difference, it just means that that provider is willing to accept what tricare gives them instead of what their actual fee is. This actually goes for most insurance companies, not just tricare.

If you want to do a lot of searching there's a place on the tricare website to see how much your mw will get for the maternity global fee. A few years ago it was $1800 I believe. I had to dig deep to find it and that was on the old website so I don't know where it is on their new updated site.

ETA: in the end though of course it doesn't matter if they are paying your mw $5 or $3500, she agreed to accept the tricare reimbursement and not charge you the difference and that's all that matters for you.

[Rylins mama]

Originally Posted by Shelsi

Actually she's right, they aren't going to get their full fee out of Tricare. Just like if you went off base to an OB they wouldn't get their full fee either. Have you ever had to go off base for anything to a civilian provider? Afterwards you should have gotten a statement in the mail detailing what the provider charged tricare and what tricare actually paid them. It doesn't mean you owe the difference, it just means that that provider is willing to accept what tricare gives them instead of what their actual fee is. This actually goes for most insurance companies, not just tricare.

If you want to do a lot of searching there's a place on the tricare website to see how much your mw will get for the maternity global fee. A few years ago it was $1800 I believe. I had to dig deep to find it and that was on the old website so I don't know where it is on their new updated site.

ETA: in the end though of course it doesn't matter if they are paying your mw $5 or $3500, she agreed to accept the tricare reimbursement and not charge you the difference and that's all that matters for you.

Everything we do (except my hubby) is offbase and they cover everything 100%
I dont know how homebirths work. The midwife I found said that they wont but Im going to try tomorrow. Shes only charging $1,000 so Im hoping they will!

[mbhf]

Originally Posted by nashvillemidwife

I can guarantee you that Tricare is not going to pay her $3500. She must be eating the rest of it if she has agreed not to charge you the balance.

While it's true that the office and Tricare could be having a miscommunication (tricare says they will cover it 100% but they mean they will cover 100% of their allowable charge, which is probably less than the actual fee) it is possible to have Tricare pay the full fee. You just need to bill Tricare for each visit as well as the birth, instead of just the flat fee. For example, my last HB Tricare paid $1400 for the actual birth, plus $300-ish for each visit. Whatever the allowable rates were in my area. That didn't quite cover everything, but I paid very little out of pocket.

OP- When your MW agrees to accept payment from Tricare, she is agreeing to not charge you for any remaining balance. This is all well and good, but your MW may not realize this, so make sure she does. In my opinion, your MW is entitled to her full rate, and you should be prepared to pay her any remaining balance.

[Changed]

Originally Posted by jlizgar

I assume you are military right? Have you had a bad experience with tricare not paying or something? You sound awful pessimistic about the whole thing....

She's a midwife. I'm sure she's seen a lot of women come here thrilled to be told it'd all be covered only to be let down and in debt. I was told it was all covered 100% myself just a few short months ago. Didn't happen.

Like everyone said, what's important is that your mw has agreed to take what they pay her and not bill you for the remainder. If she's not a certified NURSE midwife, there's always a good chance they could stop paying her or deny the claims.