tricare- how do hospitals get more than the "allowed amount" - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 3 Old 04-13-2011, 11:52 AM - Thread Starter
 
breachaplin's Avatar
 
Join Date: Jan 2007
Posts: 70
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Ok I know there are lots of threads on tricare and homebirth I have been weeding through them for a week. I want to know how hospitals can get paid more than the "allowable rate" and it seems that midwives are only geting the measly 1500. I happened to save all my statements from when my first son was born at a cilivilan hospital with a cnm on prime. just the hospital (not prenatals or pedi for baby) charged tricare over 7000 and tricare paid over 5k of it. this was a compleatly drug free birth and i only stayed 24 hours after birth. some of the services listed were semi-private room 680$, pharmacy 130$, supplies183$, delivery room 1979$ nursery 575$ more supplies and labrotory 402$..tricare paid all of those billed amounts in full.one other bill from an MD that I dont know (may have been th one overeseeing my MW charged 3050$ for the birth but was only allowed 1458$. so I am wondering since the tricare website says that it will pay1746.31 for vaginal hospital MD delivery with pre and postnatals how do they get away with so much more. the numbers I found were just the birth not my prenatals, screenings or u/s

 

 

breachaplin is offline  
#2 of 3 Old 04-13-2011, 07:42 PM
 
meesh933's Avatar
 
Join Date: Sep 2009
Location: Texas
Posts: 453
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

My understanding was that there is an allowable charge for "in-hospital birth" and a separate charge for any "out-of-hospital birth". Those charges vary by geographical area, too, so if you lived in a different area that might make the difference. When I was trying to push to get my first homebirth covered (didn't work, BTW), the person I talked to told me that they base the allowable charges off the Medicare allowable charges. Why a health service for people over 65 even has an allowable charge for birth services is beyond me. From the threads I've read on here and my personal experience, the allowable charge for home birth is no where near what midwives charge. I was told  that if I went on Standard, I'd get $993, and my midwife would be expected to write off the rest of her $3200 fee.

 

Tricare is so backwards as far as homebirth is concerned, though. I have no idea how any of it works.


Mom to blahblah.gifDD (5/07), diaper.gifDS1 (02/10)h20homebirth.gif and babyboy.gif DS2 (11/11)h20homebirth.gif !

meesh933 is offline  
#3 of 3 Old 04-14-2011, 07:13 AM - Thread Starter
 
breachaplin's Avatar
 
Join Date: Jan 2007
Posts: 70
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

talked to tricare and they said that it all has to do with the billing codes and of course the place in charge of those TMA does not take phone calls only letters if you have a question. the tricare webiste says the same amount for south dakota as for iowa 1500 for homebirth and 1700 for hospital Dr birth. I know that they should at least pay the 1500 since I will be on prime remote and the midwife is a CNM but I wish I could get more because we would have to pay the rest of her 3000 fee ourselves..along with the birth assistant fee and birth kit. hospital birth would be compleatly free. I think that the hospital just has creative billing codes, my midwife has a billing company do her insurance claims but I dont know if they would just settle for the 1500 or take the time to fight for more. will call tricare again to see if i can find answers.


 

breachaplin is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off