Hi, i will be moving to cali when i am 5 months and i really want to do most of my research now since i will not have that much time once i get there. i know i have to switch to tri care standard first. everything else is not really clear. also does any one have a CNM they can recommend in that area? or even a really nice birthing center? thanks in advance
We've never been stationed there, but I googled and it looks like there's no military hospital there, so you may not have to switch to Standard. It will depend on whether or not Tricare has any in-network midwives in the area. If they do, then you have to use their in-network midwives, whether they do home births or not. If they don't, then you simply have to find a CNM who is willing to accept the Tricare global maternity fee +15% (you would have to pay that extra 15% out of pocket), and you can get an out of network exception. Then Tricare will pay for ALL of it, except that 15%. However, when I did that, the midwives I used didn't even charge the other 15%. They just accepted the standard Tricare payment.
I should probably type out some Word document and save it, because I've explained this stuff all over the internet and I forget details and occasionally just get tired of typing it all, lol, but basically the Tricare reps frequently have no idea what they're talking about and will tell you that you either can't get an out of network exception because there are in-network OBs or that you can't have a home birth covered by Tricare. Both of those are wrong. I even had a woman IN the base Tricare customer service office argue with me for 10 minutes about how Tricare doesn't cover midwives of any sort, at all, ever, in any location, and that my first birth with a midwife must have been covered on accident. I told her to at least look in her system and she kept insisting she didn't need to, because she knew I was wrong. Finally, after 10 minutes of arguing, I convinced her to at least look, and of course, there was the 'midwife' option. Such a waste of time. This is common behavior from Tricare reps. They ought to be ashamed of their horrid training, quite honestly, because the majority of them seem utterly incompetent when it comes to this issue.
Now, if you do have in-network midwives, you cannot get an out of network exception, because the exceptions are based on provider type, not the location in which they attend births. But remember, no matter what they tell you, an OB and a midwife are not considered the same just because they both attend births. Lots of reps tell people that, but it is not true. Having in-network OBs absolutely does not preclude you from getting an OON exception for a CNM. Anyway, if you have in-network CNMs, you do have to switch to Standard and pay the out of network rates. Some midwives might still be unwilling to work with you, because they are legally allowed to charge only 15% more than the Tricare global maternity fee. I haven't found that to be a problem for most people though. Usually something can be worked out.
Hopefully this will be easy-peasy for you. It actually wasn't all that difficult for me. I found the midwives, got the exception (after arguing on the phone and in person a few times) and that was that. It was annoying, but not hard. I hear all the stories other people tell of all the things the reps say, and I'm always shocked - especially because so many people just believe whatever the rep tells them.