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!
Thanks for sharing. I think this one works if your midwife is a CNM though :( Unfortunately here in Hawaii literally NO CNM's do homebirths so my midwife is a CPM. Therefore I can't get it covered...boo.
Also did you pay your midwife up front and then get reimbursed by tricare? Just curious.
A Christian, crunchy, homeschooling southern wife to D and mama to A (5) who loves ( , ,, and )
My understanding is that the only real difference for her being in or out of network is that in network she just agrees to their max allowable charge. Out of network she can charge me an additional 15%.
It's looking like I'll be out of pocket about $1600. Which is hard to swallow when my last two, hospital delivered, babies cost a grand total of $60.
Can we appeal somehow? As far as it's written, it is what it is. It's just so frustrating that, even if they paid her full fee ($4500,) they'd save tons of money over a hospital birth and yet we have to pay MORE out of pocket!