Home Birth with Tricare? - Mothering Forums

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#1 of 21 Old 05-04-2009, 12:41 PM - Thread Starter
 
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I was curious if any of you ladies have ever had a home birth with Tricare and how to go about doing that... The closest MTF doesn't have a birthing center and when I spoke with the Tricare representative earlier, he said to look at their list of providers. Well, I did and the only nurse midwives are associated with Vanderbilt and aren't going to do a home birth.

I am kinda stumped as to where to go from here. There is only only CNM in the Nashville area who even accepts insurance period but they are not contracted with any specific insurance company.

Any ideas?
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#2 of 21 Old 05-04-2009, 02:38 PM
 
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We are on tricare prime and are doing a homebirth with a CNM.
She's giving us almost half off (military discount I guess?) and we did a payment plan, which we payed off a couple of months ago.
We are going to file for a reimbursement and she's giving us the codes that we need.
I guess she used to accept tricare, but they got too difficult to work with.
Don't know if that helps any....
We just figured that even if we don't get any money back it's worth it to have the homebirth.
Kind of silly that tricare will cover a 30,00 dollar hospital birth but not a few thousand dollar homebirth, huh?
Good luck!
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#3 of 21 Old 05-04-2009, 02:59 PM
 
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I'm using a free-standing birthing center, covered by tricare. I have heard of tricare covering homebirths, but I think depending on where you are, it's not always easy.
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#4 of 21 Old 05-04-2009, 03:14 PM
 
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Quote:
Originally Posted by odiaramor View Post
I am kinda stumped as to where to go from here. There is only only CNM in the Nashville area who even accepts insurance period but they are not contracted with any specific insurance company.

Any ideas?
Could you do POS (point of service) you would be out the deductible but than get it covered. oh course that being if the provider will bill insurance for you. You might want to see if another provider will allow you to set up a payment plan or work with you regarding billing your insurance or help you with the needed codes to seek reinbursement. That I have learned from hear that some providers dont *advertise* they accept insurance but are willing to work with patients to get them the care needed. I believe (this is 2nd hand info) that you can get it covered IF they are CNM and depending on your states laws. Some states do not allow a CNM to attend a *homebirth* or risk losing their license but I believe Tricare will only pay a CNM vs. a midwife regardless of the states laws. We had an old neighbor who did POS with her CNM, she submitted the receipts and proof of credentials and tricare sent her reinbursement (oh course it was their reinbursement rates) but its better than nothing. good luck
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#5 of 21 Old 05-04-2009, 03:25 PM
 
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When I asked Tricare about a home birth a few years ago, they immediately told me no. (I'm assuming you are in Middle Tennessee too?) When I looked here for a birthing center/home birth, etc., I had no luck. Here's wishing you good luck!

Charlize, married to DH 4/12/04. Mom to DD1 (4/2005) dust.gif, DD2 (3/2007) blowkiss.gif, and DD3 (10/2009) bouncy.gif, and DD4 (6/2011) energy.gif.
 
 

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#6 of 21 Old 05-04-2009, 03:26 PM
 
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I had my initial bloodwork done at the military hospital, and paid out of pocket for my homebirths. With DD1 I had a 20 week ultrasound that was done at the Naval Hospital, and around 21 weeks with DD2 I had a day of unexplained bleeding and went to the Naval Hospital ER (then sent up to L&D) for an ultrasound to check placenta location. I declined the quad screen and GTT, but did the ~28 week iron check and later the BS with my midwife just to avoid the hassle of going back to the NH.

There were no CNMs in my area that attend homebirths, so I opted to pay for a LM.

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#7 of 21 Old 05-04-2009, 03:48 PM
 
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It is very difficult to get a hb with Tricare. We are expecting our second child and they told us that unless the MW worked in conjuncton with a MTF we could not have one. Being in the middle of Mississippi there are no MTF for miles accept in Pensacola FL, which is to far to drive for check ups. My suggestion is to find a birthing center that accepts Tricare in your area.

Good luck with this one, if it turns out you get a HB let me know
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#8 of 21 Old 05-04-2009, 03:53 PM
 
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I just found this, it was another person asking about hb and tricare
http://www.mothering.com/discussions...d.php?t=598835

It has some great information!! Hope it helps
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#9 of 21 Old 05-04-2009, 05:07 PM
 
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We have paid out of pocket for our homebirths. It is truly worth it - both to have the homebirth and NOT to have to deal with Tricare!

Our last birth was at Campbell. If you would like the names of the midwives we used, feel free to PM.
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#10 of 21 Old 05-16-2009, 11:36 PM
 
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we had two homebirths in virginia that were close to 50% reimbursed. we switched to standard, though, as she was not an in network provider.

Jenn, wife to John
Mama to Kayleigh (6), Ethan (4), Norah (1), & Charlotte coming 11.09
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#11 of 21 Old 05-16-2009, 11:41 PM
 
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Quote:
Originally Posted by Charlize View Post
When I asked Tricare about a home birth a few years ago, they immediately told me no. (I'm assuming you are in Middle Tennessee too?) When I looked here for a birthing center/home birth, etc., I had no luck. Here's wishing you good luck!
they immediately told me no, too. so i just switched to standard & sent them the bill afterwards. two weeks later they sent me a check for about $1500.

Jenn, wife to John
Mama to Kayleigh (6), Ethan (4), Norah (1), & Charlotte coming 11.09
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#12 of 21 Old 05-17-2009, 02:30 AM
 
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I'm going to look into this. Unfortunately I have not found any midwife in this area. Having another military hospital birth scares the crap out of me...

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#13 of 21 Old 05-17-2009, 03:48 PM
 
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Originally Posted by Red Sonja View Post
I had my initial bloodwork done at the military hospital, and paid out of pocket for my homebirths. With DD1 I had a 20 week ultrasound that was done at the Naval Hospital, and around 21 weeks with DD2 I had a day of unexplained bleeding and went to the Naval Hospital ER (then sent up to L&D) for an ultrasound to check placenta location. I declined the quad screen and GTT, but did the ~28 week iron check and later the BS with my midwife just to avoid the hassle of going back to the NH.
I was hoping to do the same thing. How did you do it, exactly? Did they know that you weren't going to have your baby at the Naval Hospital? How did you get the results of the blood tests etc to the midwife? Did they send them? sorry, I have so many questions!
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#14 of 21 Old 05-17-2009, 04:38 PM
 
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When I checked 2+ years ago TriCare covered home births with a licensed HCP. You could either stay Prime and do the POS like a PP mentioned or you can switch to Standard. Switching to Standard would be cheaper because the deductible (and maybe copay/cost share) is less. You'd be locked in for a year but that would be just about enough time for your pre- and postnatal care. Then you could switch back to Prime if you wanted. Your children, including the new baby, would all still be covered by Prime if that is what you wanted.

The problem came if you were in a state where there were no licensed HCPs who attend homebirths. For example, I'm in NC and right now CPMs are not licensed in the state. Doctors can attend homebirths but I have never heard of one that does. CNMs can attend homebirths as long as they have doctor backup but, again, I haven't heard of any docs except maybe one near Ashland who provides that kind of support. So, atm, I could not get reimbursed for my home birth in NC. However, if I went to VA where CPMs are licensed, I would have gotten reimbursed.

I was trying to find where in the TriCare Handbook I had read that they cover home births. Unfortunately, that was a few years ago and they've changed everything and I'm having trouble finding it. You might want to go to the TriCare office and request a hard copy of the handbook. The only thing I found on the online handbook is, "TRICARE may share the cost of maternity care for a low-risk birth and uncomplicated birth provided by a freestanding birthing center under certain conditions." That was for my zip code. Maybe it would be different if you were in a zip code where there were licensed HCPs who attend home births.

TriCare Maternity

That would really suck if they have stopped covering home births all together.

Quote:
How did you get the results of the blood tests etc to the midwife? Did they send them?
Those are your records. You are legally entitled to them. They can't refuse to give them to you or to send them to anyone you request.

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#15 of 21 Old 05-17-2009, 07:40 PM
 
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I JUST finished going through this debacle myself. Here's what I learned:

1. Most TRICARE reps have no clue what you're talking about and will automatically say no. Ask to talk to a supervisor/manager right away.
2. Prime WILL pay for hb, but ONLY when supervised by a CNM. That means no direct-entry midwives! In Georgia (my state), there are NO CNMs that attend hb- so no Prime paying for my birth. Bottom line- if you can find a CNM that attends hb in your state, you are covered.
3. If you are the dependent, switching to Standard is an option. However, if you are the military member (in my case, I am), switching is NOT an option. So for all you other military mamas out there, keep this in mind.

Running, blogging, gardening, military mama... to Louisa Mae 9/2/09 and June Elizabeth 12/7/10. 
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#16 of 21 Old 05-17-2009, 07:51 PM
 
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Originally Posted by ein328 View Post
I JUST finished going through this debacle myself. Here's what I learned:

1. Most TRICARE reps have no clue what you're talking about and will automatically say no. Ask to talk to a supervisor/manager right away.
2. Prime WILL pay for hb, but ONLY when supervised by a CNM. That means no direct-entry midwives! In Georgia (my state), there are NO CNMs that attend hb- so no Prime paying for my birth. Bottom line- if you can find a CNM that attends hb in your state, you are covered.
3. If you are the dependent, switching to Standard is an option. However, if you are the military member (in my case, I am), switching is NOT an option. So for all you other military mamas out there, keep this in mind.
I was going to mention asking for a supervisor.

A friend of mine got her birthing center birth covered with a CPM. She's in FL. Is there a difference if it's a home birth vs. a birthing center birth with a CPM? Or are CPMs not licensed in Georgia maybe?

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#17 of 21 Old 08-08-2013, 06:32 PM
 
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Here's what I've learned from working with Tricare military insurance for my homebirth.  First off, our entire homebirth was covered via Tricare Prime.  Even if you don't have Tricare Prime it is VERY simple to make the switch if your spouse is Active Duty which is all I have experience with.  This is what worked for us, your state/situation may be different but if your willing to put in effort (and at times it's a lot of effort but totally worth it) then you should be successful in having your homebirth be covered by Tricare Insurance.  Hopefully the more Tricare "sees" homebirths, the easier it will be to file a claim and why wouldn't they want to make it easier? It's a lot cheaper than a hospital birth!

Below are the very important steps to take regarding filing your claim with Tricare.

 

1. Your midwife/provider must be an authorized provider with in Tricare's network.  If they are not an authorized provider, they will need to apply to become one http://www.humana-military.com/south/provider/provider.asp then click the quick links "join the network".  I was lucky enough to find a midwife who was already in Tricare's system and we did not have to go through this process. But if you start early enough in your research and if your provider is willing to apply then do it ASAP, because it will most likely take several months before an approval is made.

*Note* Once your provider is in Tricare's network, you both should receive a copy of the "Notification of Tricare Provider Authorization" letter with the Provider ID #.

 

2.  Once your precious little one is born, have your midwife/provider complete a Form 1500, Health Insurance Claim Form, which is standard for all insurance companies. You will be using this form to verify the services conducted by your midwife/provider and will need to forward the document on to Tricare.

 

3. You will also need to fill out another form, DD 2642, for you and baby http://www.humana-military.com/library/pdf/claim-form-dd2642.pdf.  You must fill out two separate forms, one for you and one for your baby.

*Note* Under "condition" for which the patients received treatment put "pregnancy" for Mother and "birth" for child.

 

3. You will need a list of itemized charges for each procedure billed with dates.  Tricare wants a "statement or bill that includes the charge and description of each service received". Include one for patient and one for the baby, you can line through Mother's billed procedure and leave the procedures applicable for baby (ex: Newborn Examination, Vitamin K injection etc). Our midwife simply put this on a letter head and we sent it in like that.  If you need an example, I can provide you with one-just ask!

 

All forms should be faxed AND mailed as some depts in Tricare lose paperwork from time to time (it happened to us twice).

For Tricare South Region: Fax with cover page stating provider ID # on cover to: 803-462-3993

Mail all paperwork (AFTER making your own copies) to: Tricare (whatever region you are, ex: South Region) 2300 Springdale Dr. Bldg 2 Camden, SC 29020. 

*Address and fax number may be different depending on your region

 

4. Make sure to follow up!

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#18 of 21 Old 09-16-2013, 01:30 PM
 
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hi Lukesmama44!

My husband and I just found out that I am pregnant and I want to have a homebirth. He is active duty right now but he is going reserve before we have the baby. I am not sure if we have the option to purchase Tricare Prime but we were planning on doing Tricare Reserve Select. Do you have any idea if I can use your steps to get my homebirth covered with either one? Also, we will be living in Ohio, which from my understanding is a bit of a battlegorund for homebirth midwives right now. Do you know if your steps will work everywhere or only in states where CPMs can get licensure? 

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#19 of 21 Old 09-17-2013, 12:27 PM
 
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First of all, congratulations! Where about in Ohio are you and I can put my feelers out for that area? I have a resource called the World Midwives Assoc and can check with them on details and possibly get you a list of licensed CPM's in your area which is all Tricare will cover according to this: http://tricare.mil/CoveredServices/SeeWhatsCovered/MidwifeServices.aspx.
I will do some research for you on the legalities for midwives/homebirths in your state and see what I can find.

Thanks for the message :)

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#20 of 21 Old 09-25-2013, 08:31 AM
 
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Still waiting to here back from "World of Midwives" concerning your CPM licensing question and whether or not homebirth is legal in Ohio.  In the mean time, I saw this info from a subscriber.

Cleveland has a pretty active ICAN chapter and many of those women are great homebirth resources because of the difficulty in getting a hospital VBAC in Ohio and the lack of freestanding birth centers.  I would contact them, and again, I would try Choice Midwives in Columbus.  They will definitely have a list of homebirth providers in Cleveland.

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#21 of 21 Old 09-29-2013, 07:05 PM
 
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http://narm.org/ to find a CPM in any state
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