Tricare is covering my homebirth 100%! - Page 2

[jlizgar]

Originally Posted by Changed

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.

She is a certified NURSE midwife so there is no problem there...she accepts tricare and currently has other patients on tricare so im sure she knows the ropes by now, she has been practicing for over 20 years and was even in the air force herself for a while years ago.
I trust that they understand me when I say, that I cant afford to pay full out of pocket and I trust that when they say they contacted tricare that they asked all the necessary questions and are making sure they are getting paid what they need.
If she is not getting paid her full fee but has accepted what tricare will pay, I certainly wouldnt be the first patient she has done this for because she currently (and im sure in the past) has tricare patients under her care....im NOT trying to take advantage of her in any way....I kind of feel thats what some are trying to say, because she may not get paid her full normal fee by tricare....if she accepted this (like im sure she has done before because she is an out of network provider) then that is on HER and not on me.
I feel kind of discouraged by all these comments honestly, I know tricare can be a pain in the behind but I am hopefull that it will work out, if I have to pay some then O WELL....Im most certainly NOT going to deliver in the hospital unless it is TOTALLY necessary!

[Shelsi]

Originally Posted by Rylins mama

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!

Yes they cover everything 100% in the sense that you don't have to pay anything. Tricare does the same as other insurance companies, including things like Medicaid, and have a fee they will pay for certain services. Let's say a doc charges $100 for an office visit normally. Well, for example, Tricare might say they will only pay $70 for an office visit. As a Tricare provider the doctor is agreeing to accept $70 instead of his customary $100.

[Changed]

I wasn't thinking that at all. If she's a CNM, it should be just this easy for you. She probably bills just like an OB does. They bill more than they actually get but they know that ahead and adjust accordingly. No one is trying to kill your buzz here, it's just that getting a CPM paid for with tricare is a nightmare and most people don't find CNM's who do homebirth.

[jlizgar]

Originally Posted by Changed

I wasn't thinking that at all. If she's a CNM, it should be just this easy for you. She probably bills just like an OB does. They bill more than they actually get but they know that ahead and adjust accordingly. No one is trying to kill your buzz here, it's just that getting a CPM paid for with tricare is a nightmare and most people don't find CNM's who do homebirth.

Well Evelyn is a super special lady, I hope anyone in the Maryland/D.C./Virginia area will check her out! I am blessed to have found her!

[nashvillemidwife]

I'm sorry if you felt discouraged by my comments. I did not mean at all try imply that I think you're trying to take advantage of your midwife, I just wanted to point out that insurance terms and agreements are not always as straight forward as they may sound. This board is riddled with mommas who ended up not getting what they thought.

[jlizgar]

Originally Posted by nashvillemidwife

I'm sorry if you felt discouraged by my comments. I did not mean at all try imply that I think you're trying to take advantage of your midwife, I just wanted to point out that insurance terms and agreements are not always as straight forward as they may sound. This board is riddled with mommas who ended up not getting what they thought.

Its OK! Im sure some women end up getting screwed and hopefully that wont happen to me (but it wouldnt be the first time something went totally not as planned). Im just trying to keep a positive outlook and at my next appointment on the 4th im going to be sure to ask them about it again and discuss the "what ifs" if tricare decides not to pay as they said they would.

[Lisanne]

That's awesome! I have Tricare and am hoping for a home birth in February.

[Kim919]

I don't have tri-care but I posted earlier that my ins. has agreed to pay 100% with a referral from my pcp just like Jlizgar had to do.

The way my midwife explained it to me was that they pay 100% of what they consider "usual & customary." She charges $4000.00 global fee, but she is the ONLY fully legal midwife working in my area. The insurance company takes the average of all practicing midwives in a given area to determine the "usual and customary" fee. Therefore, she can basically set the rate she wants and get paid in full. She said she was sure that if she got unreasonable about it they would raise heck about it, but they have been paying her without argument for the past few years with a reasonable price increase every Jan 1st.

I think the NYS law actually dictates that they have to pay the going rate & can't set the reimbursement amount themselves unless they had a participating provider. Maybe some other states are the same?

[triple07]

Even when you go to an off base physician they don't cover the fees 100% (when you get the invoice... not bill but invoice... in mail it shows what the physician charged and what they actually paid and about 99% of the time it was not the full price, usually about 80%, but the physician just basically ate the rest and never charged me for the rest of the amount...).

So basically, they get paid less than they charge, but they don't charge you the balance. I am sleep deprived so if that was confusing... sorry

[Changed]

No, that's right. However, if they agree to be a participating provider they aren't allowed to even attempt to bill the balance to you. They're agreeing to take what tricare pays.

[nashvillemidwife]

But a provider can become an "approved" provider to get coverage for a specific procedure or plan of care (maternity care and home birth) without being contracted, and then she can balance bill the patient.

[StacyL]

Six weeks ago I had my second HB on Tricare here in Maryland, and again it was covered 100%. The only thing that is not covered is the MW's asst.'s fee. My MW is Evelyn Muhlhan and she's a CNM. I have to switch to Standard because my MTF (NNMC) has L&D. However, Walter Reed has no L&D services, so those people get to use Evelyn while staying on Prime and it is also fully covered.

And, no - we don't get billed for the difference between her rate and the govt. rate of reimbursement - she accepts Tricare's reimbursement.

[jlizgar]

That is who I am seeing and as I understand she has been accepting tricare for a while, she herself was in the airforce years ago so im sure she understood how that systme of insurance worked and was still willing to become a provider that accepts tricare, so, I do NOT expect to be getting any bills in the mail from her afterwards!
I was being seen at NNMC but my hubby is stationed at Walter Reed, I didnt have to switch but just get the referral, maybe because we werent officially stationed at NNMC? I dunno about that for sure.

SO, how did your birth go with Evelyn? Im getting very excited, I have my homevisit in about another 3 weeks or so!
Congrats on your new little one too!

Liz

Originally Posted by StacyL

Six weeks ago I had my second HB on Tricare here in Maryland, and again it was covered 100%. The only thing that is not covered is the MW's asst.'s fee. My MW is Evelyn Muhlhan and she's a CNM. I have to switch to Standard because my MTF (NNMC) has L&D. However, Walter Reed has no L&D services, so those people get to use Evelyn while staying on Prime and it is also fully covered.

And, no - we don't get billed for the difference between her rate and the govt. rate of reimbursement - she accepts Tricare's reimbursement.

[StacyL]

Yes, Evelyn was an Air Force MW for many years. She's been practicing for 22 years total.

This was my second HB with Evelyn. She attended the birth of my son two years ago, as well. She barely made it both times - arriving about 30 minutes before the babies were born each time. I guess I have short labors and don't gauge my timing very well, haha! But, it was a good thing she was there because I had mild shoulder dystocia with my over-ten pound son. My daughter's birth was completely uneventful - no SD.


Evelyn is great - I can't say enough good things about her!

[wombat]

Evelyn was my MW also, and under Tricare PRIME you're 100% covered. It's true Tricare doesn't pay her whole fee, but she accepts the meagre Tricare payments. Evelyn is pretty experienced with Tricare patients in this area.

It's the Tricare PRIME that makes you 100% covered. It's part of the Prime contract that you pay nothing.

That's great news you got the referral. That's the hardest thing on Prime.

Just be careful about ultrasounds if you do them. You still need a referral from your MW to a Tricare authorised ultrasound place. But you can use the MTFs. I went to NNMC for my ultrasound. LOL, that was fun - they couldn't understand why my OB records weren't in their computers. And you can still use the MTFs (ie NNMC L&D) in case of OB related emergencies. Eg. if after consultation with Evelyn, she says you need to go to an ER (I had bleeding), you can go to the MTF. They might try to refuse you, because you "opted out" of their system, but get Tricare head office on the phone if they give you any hassles. NNMC got real snarky with me and tried to tell me to go to Shady Grove. Tricare will make them take you.