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#1 of 21 Old 01-07-2009, 11:58 AM - Thread Starter
 
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Hello ladies,

Has anyone had or will have a homebirth using Tricare as your health insurance?

How did you did it, did you switch to standard or can be done with prime? Did you have to pay out of your pocket your midwife or did it cover it all. Did you contact tricare directly?

We are planing a homebirth with a nurse midwife but has been a little crazy trying to get US and bloodwork done I would like to be prepare and get all the info before hand.
Thanks for any info!

Marta
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#2 of 21 Old 01-07-2009, 01:46 PM
 
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Prime will not cover a HB. We were on prime when DS was born and we paid the MW out of pocket (it was still less than co pays at a hospital) I believe that Standard will cover some HB but they are pretty strict about it, I think. (for instance, I think it has to be a CNM, etc etc etc) We are now on reserve select, and will pay the MW out of pocket again with the new baby.
Good luck!

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Jay-my precious boy 2/20/08 & Caroline-my beautiful HBAC baby 8/22/09 :
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#3 of 21 Old 01-07-2009, 02:41 PM
 
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I paid out of pocket for my homebirths. I had my initial bloodwork done at the Naval Hospital, with DD1 I had a 20 week ultrasound done at the Naval Hospital, then when I had some bleeding during my pregnancy with DD2 I went to the ER at the Naval Hospital and they sent me up to L&D for an ultrasound.

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#4 of 21 Old 01-08-2009, 12:45 AM
 
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I am considering a homebirth and called Tricare to check on the coverage. They told me it would be a $300.00 deductible and then 50% of the allowable costs (whatever that is-they couldn't tell me). Anyway, I'm prime and that's what they told me. Is this not correct? Is this the standard plan coverage?
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#5 of 21 Old 01-08-2009, 01:10 AM
 
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From everything I've read on midwives regarding Tricare is that they only cover CNM although a midwife under M.D supervision could qualify. this is what I found on their website:

The TRICARE Policy Manual Chapter 3, Section 3.11, states:
“A. A certified nurse midwife may provide covered care independent of physician
referral and supervision, provided the nurse midwife is:

1. Licensed, when required, by the local licensing agency for the
jurisdiction in which the care is provided; and
2. Certified by the American College of Nurse Midwives. To receive
certification, a candidate must be a registered nurse who has completed
successfully
an
educational program approved by the American College of
Nurse Midwives, and passed the American College of Nurse Midwives
National
Certification
Examination.
B. The services of a registered nurse who is not a certified nurse midwife may be
authorized only when the patient has been referred for care by a licensed
physician and a licensed physician provides continuing supervision of the course
of care.
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#6 of 21 Old 01-09-2009, 06:33 PM
 
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I guess it's a little different overseas because I was told they would cover everything but the transportation costs of the midwife and I have Tricare prime. My little one is due in a month and we'll see how it all goes.

military wife to Eric, mommy to Ani 11/06 and Emi 2/09 and our angels angel1.gif 12/10, and angel1.gif 2/12 and our newest addition Izzy 4/13

 

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#7 of 21 Old 01-10-2009, 02:01 AM
 
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I had to pay out of pocket for my homebirth. Hawaii doesn't acknowledge or certify midwives, so Tricare wouldn't cover it. It was worth it, and I would do it again in a heartbeat! The Naval Hospital on island is HORRIBLE!!!
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#8 of 21 Old 01-13-2009, 01:53 AM
 
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Quote:
Originally Posted by handzfull View Post
I am considering a homebirth and called Tricare to check on the coverage. They told me it would be a $300.00 deductible and then 50% of the allowable costs (whatever that is-they couldn't tell me). Anyway, I'm prime and that's what they told me. Is this not correct? Is this the standard plan coverage?
This is what I was told. It is called the Point of Service (POS) option. You can choose ANY care provider for a service that is covered (like global maternity), you pay the deductible and after that they pay 50% of the allowable costs (and honestly, I don't know what happened but they actually paid for the entire first visit with my homebirth midwife and didn't ask me to pay a deductible or anything--weird, but I wasn't going to complain, but then I had a m/c so we didn't have any more visits). Anyway, with POS what they typically do is have you pay the bills and then they send you a check to cover their portion.

But, if you live in an area where CNMs do homebirths (which is rare I know) you can actually get it 100% covered by Prime. You should be able to add ANY CNM to the prime care provider list. You'll just have to call them and arrange it. But I know in most places it is CPMs or DEM that do homebirths so it's not possible. But you still should be able to use the POS option with CPMs and other midwives.
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#9 of 21 Old 01-13-2009, 05:45 PM
 
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Railyuh~ I am currently on Tricare Standard at 28 weeks. Could I use the POS option? Do I need to call someone and get it taken care of or just send in the bill at the end? My midwife said she had a lady get half of her costs covered by sending in the bill at the end, however when I inquired about this they just said that my midwife wasn't covered. Sigh, worth a shot I guess

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#10 of 21 Old 01-13-2009, 05:51 PM
 
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It really depends on where you are and which Tricare region you fall under, each region has different things that they will and won't cover. Tricare Europe WILL cover homebirth (which is what we're doing). I think it may have something to do with what state your in. Give your regional tricare a call and find out what they will cover. Worse comes to worst, write them a letter to let them know how much they would be saving with a homebirth vs a hospital birth... sometimes saving money will motivate Tricare to make a special exception.

Either way, good luck!

Army wife and sahm to: Aime(20), Jordan(17, birthmom), Morganne(16), Sami(5), Kasi(4), Madi(1)
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#11 of 21 Old 01-13-2009, 10:42 PM
 
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Quote:
Originally Posted by jojobean View Post
Railyuh~ I am currently on Tricare Standard at 28 weeks. Could I use the POS option? Do I need to call someone and get it taken care of or just send in the bill at the end? My midwife said she had a lady get half of her costs covered by sending in the bill at the end, however when I inquired about this they just said that my midwife wasn't covered. Sigh, worth a shot I guess
I'm not sure. I think POS is only for Prime, but I'm not positive. Honestly, the best way in my experience to figure things out with Tricare is to keep calling back and talking to different people until you find someone who knows for sure.

I have also heard of a lot of people on standard getting some of the costs covered by sending in a bill at the end, but it's hit or miss. It seems like some get it covered and some don't.
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#12 of 21 Old 07-02-2009, 06:32 PM
 
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Originally Posted by bsideu4ever View Post
I had to pay out of pocket for my homebirth. Hawaii doesn't acknowledge or certify midwives, so Tricare wouldn't cover it. It was worth it, and I would do it again in a heartbeat! The Naval Hospital on island is HORRIBLE!!!
My husband and I will be getting stationed at Hickam this winter and are wanting to start trying for another baby then too. I've been trying to find midwives online for the area and am coming up pretty empty handed. Could you help me and recommend someone?
Thanks so much!
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#13 of 21 Old 07-02-2009, 07:09 PM
 
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We have Triwest (Tricare for the West region of US) and they are covering part of our homebirth. I am on Standard, as being on Prime I would have to get a referral from a PCM to the midwife to have it covered at all. Being that we live within 50 miles (more like 3!) of an MTF that offers L&D/OB services and has available providers for my due date they were not willing to refer me off post for my maternity care/delivery.
So I switched to Tricare Standard which has a $150 deductible and 20% cost share of allowable charges.

I am now seeing a CNM who does homebirth (rare in this area) as Tricare ONLY covers CNM, no LM, CPM, DEM. My CNM is non-network, meaning she is authorized to receive payment from Tricare but has not signed a contract with them to take whatever they pay + my 20% as full payment. Her charge is about $3500 and based on the preauthorization/verification of benefits I and her billing service did they should pay about $1800-2000. We are paying her $1750 before the birth and will owe whatever else Tricare doesnt pick up.

I was seeing a local CNM who worked in a group practice with MD's up until 20 weeks and had my USD and initial bloodwork done with them and covered no problem.

You have to make sure you are seeing a CNM for homebirth if you want Tricare to cover it all. Even with Standard it looks like they only pay $2000 or less of the fee.

Proud Army Wife, Christian, Mommy to Jackson (12/02) Jillian (12/03) and William (9/14/09). Expecting our newest blessing Aug 2010!
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#14 of 21 Old 07-03-2009, 12:58 PM
 
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I switched to standard. My midwife is a CPM but Tricare still covers it...not sure why. We paid 20% after our $50 deductible...total $750 on our part. It was totally and completely worth it.

Single mama to S ~ 6/09

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#15 of 21 Old 07-03-2009, 03:27 PM
 
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Tricare is suppose to only cover Certified Nurse Midwifes. According to a local midwife (CPM) that I interviewed, in the past tricare would *sometimes* pay 50% (the POS option) when people used her services, but more recently they have been cracking down and denying all claims that were not a CNM.

I am on Prime and I expect to pay the full amount out of pocket, but might submit a claim anyway and see if we can slip through the cracks.

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#16 of 21 Old 07-03-2009, 09:32 PM
 
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I am having the same problem and have been trying to use the Point of Service option. When I spoke with Tricare North I was told that I have to get my midwives (who are CNMs under an OB) listed as an "out of network" provider. There's a simple form on their website to do that.

Well.. .they were all set to fill it out for me, and I thought I'd be able to send in a bill after the fact for POS. But my midwife called Tricare and found out that it is illegal for her to bill more than 15% over what Tricare will cover for a homebirth. In my area, Tricare will cover about $1500, but the going rate for CNMs is $3000-4000.

So my midwives were uncomfortable with doing the form, since it would open them to insurance fraud. We're still working on it. But you may be able to get your CNM listed.

Here's the link for the form for nurse midwives:
http://www.mytricare.com/Internet/tric/tri/imglib.nsf/(WebFiles)/16A706D5B26ADF70852575830059BCC9/$FILE/group%20nurse%20practitioner_north_3_09.pdf

Here's the main website with info and phone contact (just in case):
http://www.mytricare.com/internet/tr...s_PrvdrCrtfctn
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#17 of 21 Old 07-03-2009, 11:40 PM
 
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Prime does cover homebirths, but it is not always straightforward to make that happen. I remember talking to a tricare rep when I was pregnant with my first, and she said no way. But the reps often don't know all of that stuff.

I have been given literature before that shows they do pay for homebirths, and I've also found some stuff online that says as much. However, just like it covers a hospital birth too, it won't just cover any hospital in all circumstances, and the same is true for everything, including midwives.
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#18 of 21 Old 07-05-2009, 03:00 AM
 
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Tricare policy is to only cover certified nurse midwives. Sometimes CPM's accidentally get covered, but the policy is to not cover CPM's ever, under any circumstances. (This is for the U.S. - the rules are different outside the U.S.)

You can get a CNM covered with Standard or Prime, but it will actually probably cost you more with Prime, because they'll only cover 50% with the POS option. If you switch to Standard, they'll cover 80% of the allowable charge for out of network providers, but you have to pay a copay for every visit. It's probably still cheaper on Standard, though. When you switch to Standard, you can't switch back to Prime for 12 months. The baby will be automatically enrolled in Prime, though.

The law says that they can't charge you more than 15% over the allowable charge, even though they aren't (usually) participating providers. If they do, they will be in big, huge trouble, so you have to know the allowable charge for your area (someone at Tricare has to know) and then you have to work it out with your midwife some way or another, because if she gives you a bill for more than 15% over and you turn that over to Tricare, there's going to be trouble for her. You don't want to do that, obviously.

This is what I've gathered from reading all the Tricare threads here and elsewhere.
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#19 of 21 Old 07-07-2009, 10:24 AM
 
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Originally Posted by Plummeting View Post
The law says that they can't charge you more than 15% over the allowable charge, even though they aren't (usually) participating providers. If they do, they will be in big, huge trouble, so you have to know the allowable charge for your area (someone at Tricare has to know) and then you have to work it out with your midwife some way or another, because if she gives you a bill for more than 15% over and you turn that over to Tricare, there's going to be trouble for her. You don't want to do that, obviously.
Actually no, she won't be in "big huge trouble". If you read your handbook closely, you should find the clause that says you are free to choose to pay her out of pocket more than 115% of Tricare allowable fees.

I'm looking for that documentation...
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#20 of 21 Old 07-07-2009, 11:30 AM
 
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I think it's in the provider manual, not the Tricare Handbook, which I cannot find at the moment. You can read an earlier discussion about the subject here: http://www.mothering.com/discussions...940&highlight=

Also, there is information on the internet here:
http://www.armytimes.com/benefits/he...care_glossary/
Quote:
Patients can waive this rule if they would like to stay with a particular doctor.
And here:
http://www.airforce-magazine.com/Mag...97tricare.aspx

Quote:
Military health-care beneficiaries who opt to see a nonparticipating provider, who will not comply with the 115 percent rule, have two choices. They can pay the additional amount, as well as the copayment. Or, they can mail a written complaint to the Tricare/CHAMPUS claims processor, who will send a letter to the provider stating the law and asking for a refund.

The second course would probably lead to the removal of the provider from the list of authorized Tricare/CHAMPUS providers, as well as from the Medicare list. In which case, Tricare/CHAMPUS will not pay any portion of bills from that provider.

There is an exception, however. If the CMAC rates are so low in a given area that providers refuse to participate, DoD can increase the rate for that area. But that would be an unusual exception, since in most areas a number of providers are usually willing to accept CMAC rates.
Basically you enter into an agreement with your midwife stating that you understand she does not abide by the 115% rule and agree to pay her full fee and that should be the end of it.

I'm not sure what will happen if the client decides to renege on the contract and make a complaint to Tricare. Given that they do state beneficiaries can choose to make these agreements they may laugh at them and say they should brush up on their reading comprehension skills before they enter into any more contracts. If they do intervene they will send the midwife a letter giving her 30 days to explain why she is charging her full fee or else she must refund/stop billing the client or else be blacklisted by Tricare (and possibly Medicaid). Regardless of the outcome, that would be a real sh*tty thing to do to the midwife and any future clients who will be missing out on having Tricare cover any of their homebirth.
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#21 of 21 Old 07-07-2009, 12:36 PM
 
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I am paying out of pocket, but CPMs aren't legal here. YET. Hopefully SOON.

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