1. We are stationed at Great Lakes, North of Chcicago.
2. I am on Prime
3. They do not have maternity servces on base.
4. I wanted a homebirth with a CNM who was not "certified" with Tricare.
What I did, I had my Midwife fill out the appropriate paperwork even though they told me it would take 6-9 months for her to be "certified". It actually took 30 days!
Then I had to get a referral directly to her stating there where no other CNMs in network doing homebirth.
I got my in network exception referral in the mail yesterday with NO Questions from TRicare.
I am so excited! This will be my 4th homebirth but the first one that Tricare paid anything for!!
Thanks for all of your help and good luck to all of you Tricare mommas out there. I sure wish they would make it easier!
After the birth I will let you know how the reimbursement goes. I am due MAy 15. With my 5th BOY!
Cassiopia, I'm going to PM you with an email of a friend by Dayton who may be able to help with her connections (she's been to Dar a Luz and is a LLL leader). Her husband just got out-- she had a homebirth about a year and a half ago, though she didn't end up going through Tricare, just paying out of pocket for it. Right now Ohio is dealing with a lot of homebirth turmoil so it is harder to find people out in the open doing it (as in the providers, not families). But.... either way be thankful you're not being seen on base. I was seen there in the maternity care and it's atrocious. I switched to standard and delivered at Miami Valley hospital in their birthing center (Family Beginnings). Should you be interested in any info about delivering there, just lmk and I can send you that info too as well as the midwife I saw for there. It was a positive experience both times and the nurses in there are awesome too-- very low intervention (pretty much none other than helping catch and checking my placenta after delivery if that's all you want, only doppler monitoring, no option for drugs unless you want to transfer to the maternity ward), you can leave as soon as you feel ready, etc. And tricare covers delivery there except for a $25 copay under standard completely.
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!
My husband is active duty in New Mexico right now and we are about to go reserve and move to Dayton, Ohio. I just spoke to TRICARE and they said that Miami Valley Hospital was not listed in conjunction with their insurance. You said something about switching to standard? What did you mean by that? I really want a natural birth so we are looking at all of our options. Thanks!
I don't know if this message was to me or not but I figured I would put my two sense in...You can switch to Tricare Standard by walking into the Tricare office wherever you are stationed, ours is located inside the medical clinic-.pretty sure they all are and just tell them you want to switch, it's effective immediately :)