Need help with Tricare and homebirth - Page 3 - Mothering Forums

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#61 of 366 Old 04-20-2007, 11:19 PM
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My experience (from friends) is it depends from mom to mom. Every situation is different, and they can agree to pay different amts to different people. It's like everyone has their own interpretation of the regs. Very confusing and frustrating to say the least. So don't let anyone tell you "don't even try"! UNLESS homebirth isn't regulated in your state (like mine). But if it is, there's a chance that you can fight your way for a homebirth that is covered in some way by tricare. Good luck!!! In some ways, I'm glad I don't even have the option to fight w/ tricare over this birth. I'm not sure if I would. But it sounds like StacyL has had some very positive experiences, and that's great!
I don't know if you meant me but I felt I should clarify my post According to public law, active duty members may not switch to Tricare standard. So it's not a matter of a work-around unless congress is willing to convene and consider making an exception for one person

I think this law is meant to protect service members from co-pays or something but it actually ends up punking those who want options for childbirth. Actually the law allowing dependants to change to standard to choose their care provider in pregnancy is very recent- it began during my first pregnancy in 2003.

So, I didn't mean to discourage, only to let her know what the law says. I am thinking a referral will be the best option. If it were me, I would doctor/CNM shop at the ob clinic a little bit to find someone willing to refer me. CNM's will probably be your best route if they have them, many MTFs do. If not, maybe talk to the patient care representative at the MTF about your options. I also find the MTF Tricare representatives very helpful in most cases. Worst case, congressional inquiry if you think they would be sympathetic of homebirth (but keep in mind the effect that could have on you if you are planning a career).

It's really sad that active duty members do not have the same rights as dependants. To the poster (Bonnie?) I wish you the best in getting the care you need.

If I can be of help in any way I would love to.
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#62 of 366 Old 04-20-2007, 11:26 PM
 
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I wasn't refering to anybody in particular, just that it seems really daunting and discouraging in general! But if it's what you want, go ask for help and fight for your rights! I love what someone else said "if you don't like the answer you get, ask someone else!" It's sooooo true....

Good luck, mamas! It seems that several people have been successful, and that's so encouraging!
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#63 of 366 Old 04-21-2007, 07:06 AM
 
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I think this law is meant to protect service members from co-pays or something
Actually, it very obvious why the rule is there... why would the government want to pay for a birth somewhere that it would cost them $ (even an HB) when they have the facilities set up to deliver and FREE working military docs to deliver? It's not like "Major So-and-So" is billing tricare when you deliver.
With AD people who are "owned" by the government why give them a choice? Plus, if that AD person was injured in the surgery/delivery/(whatever treatment is being given) the government could sue/prosecute the entity who provided the standard treatment for damage to gov property.

I'm surprised they even let dependants out (to Standard) at all!
Since 2003 you say? Hmm... well that makes sense... this is probably only due to the fact that they need more MTF space and military doctors avalible for certain "events" (*ahem* you know, going on since 2003) which have made MTF space and docs needed. Like the over 26,000 wounded military members...

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#64 of 366 Old 04-21-2007, 01:16 PM
 
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Hi, the way it was explained to me about why Tricare does not like to cover homebirths is because the MTF's operating budget depends a great deal on the money they get from maternity care, when a woman is "champused out" then that MTF looses a lot of money in their eyes.

Here, this is the message that I saved from the alternativemilitaryfamily yahoogroup concerning tricare paying for homebirth (and also if homebirth is "allowed" in housing). Obviously this may not apply to areas that don't have a MTF that does births, but it is still good to know.

I have full permission to share this with others so I don't believe this violates the posting rules:

"FIRST, please understand that tricare "manages" funds for dod
medical facilities. That means that every "claim" that is made
results in the funds/money being transferred to your "home base"
medical facility. THAT is how your base hospital and clinics get
operating funds.

So, it is a fact that for each pregnant woman, tricare issues a
payment of $12,000 to the residing medical facility. In some cases,
this may be to a contracted civilian such as a civ OB/hosp, but in
MOST cases it is to a base hospital. Now, when a woman wants to use
a mw for a homebirth and makes a claim through tricare, the residing
hosp/clinic "loses" $12,000. BUT to make matters even WORSE (for
the hosp) The hospital/clinic has to pay the mw fees out of its
tricare "operating patient account".
This "account" is the tricare funds that have already been paid to
the facility and are used each time a civilian "consult" is brought
onto the scene or when new equipment is purchased. It is also often
used to pay for full/part time civilian employees.

SO....When a patient uses a tricare "allowed" mw and a claim is
granted, the mw payment comes out of this "operating patient
account". So, in the "opinion" of the hospital command, a
HOMEBIRTH "COSTS" them $12,000(lost potential cash) PLUS the mw fees
which are on average $4000 (for cnm). Total "LOSSES" in their eyes
are $16,000. Now WE know that this is all malarky and a paperwork
game, but nonetheless, it is the truth!

There are many military hospitals that COUNT on a certain number of
births per month just to keep them operating! I know of one in
particular, in which there was a rash of mw attended hb, that became
quite cocerned because the budget was so "tight" that they literally
could not AFFORD to "lose" $16,000 for each Homebirth. They claimed
they could not afford to lose that amount even ONCE!

It doesnt help that there are still many docs and administrators who
adhere to many myths regarding homebirth and midwives. When there
is a desperate financial situation, which is the norm NOT the
exception with military medical facilities, it just makes it that
much more likely that hostilities and roadblocks toward hb will
arise.

Unfortunately, it is the basic care that suffers at the hand of the
almighty dollar! This is where we need to be accutely aware of our
rights and HOW the system works. By being "in the know" and
standing up for ourselves, we keep the doors open, if only a crack,
for ourselves and those to follow!

Finally, I do want to clarify that many base hospital commanders
have gone out of their way to see that NO homebirths happen within
there catchment area by joining forces with the local base command
and establishing "illegal" base regulations forbidding homebirth.

By "illegal" I mean that even though military bases and all their
onbase facilities ARE subject to federal laws FIRST. They also have
to conform to the state laws in which they reside, as long as there
is no fed law that over-rules the state law. So, as far as
homebirth on base, there is NO state in which homebirth is "illegal"
as well as NO fed law stating so. So NO base command can "forbid"
homebirth in and of itself.
With this in mind, it is important to realize that the base has to
follow each states OWN laws regarding mw practices. So, if it is
illegal in a state to use or be a lay midwife, then you "could" be
in for trouble if you were caught using one of these "illegal
midwives" in base housing. BUT they cant stop you from using any mw
that IS "legal" within the state law, THis INCLUDES using NO
midwife, as in unassisted birth, since it is legal to uc in all 50
states.

Therefore, it is technically classified as an "illegal order" for
any command to issue a post regulations stating HOMEBIRTH is not
allowed in base housing.

I have been involved in prosecuting a few of these colonels and even
a general who issued such illegal orders. All 100% successfully
prosecuted, the general, by act of congress. It is a very difficult
and time consumign thing to do and they count on the general public
NOT going the distance it takes to succeed!

If you live on a base where such an order has occured, first, *I*
would like to know (via private email) which base and hosp
commanders name as well as base commanders name. SEcond, dont
forget that if you decide to go against such an order/reg and are
found out....literally NOTHING can be done to you or your hubby! The
command KNOWS this too. They just count on you NOT knowing this.
ALSO if threats are made in your direction regarding this issue, get
in touch with me. I may be able to put you in touch with the
correct authority to stop such empty threats. Teh BAD thing is,
that often the local command(ie unit command) doesnt even realize
that the prohibition is an illegal one, so they go right after it if
told to do so.

I will get off my soapbox for now.....please read this again and
again until you really understand it and arm yourself with the TRUTH
and FACTS! Stand tall and strong for what is RIGHT and what is TRUE.

Emm....
(I have her last known email address if it is needed)."


One of my dreams is to get Tricare to cover direct entry midwives (being a student midwife and military spouse myself) but I am still in the process of figuring how to go about it/getting the guts to fight, my dh said to start a petition because then they may actually have to consider it, I suppose having about 10,000 signatures would be a bit convincing of the demand for HB with a DEM that there is and would be hard to just ignore. I should really start looking into this more..lol.

Here in Maine/the Northeast we have an alternative insurance provider (US Family Health Plan/Martins Point) that, from what I understand, was created by an act of congress and I wonder if it would really take an act of congress to get DEMs covered under Tricare....I know most insurance companies policies are made up by the board of directors, and they are often times made up of doctors (I am sure you can see where I am going with this), so lots to think about in this reguard and probably so totally off topic, sorry! :

Unfortunately I didn't even bother with Tricare for our HB, though I probably should have, I met someone on the net about a year after my hb and she got a CPM covered at the same MTF that I go to (her PCM refered her!), really made me regret not trying. The worst thing anyone can say is "no." And like a pp said, just ask someone else until you get the answer you want, that also seems to work in some cases.

So glad I came across this thread, it has really shed some light on a lot of things for me.
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#65 of 366 Old 04-25-2007, 05:30 AM
 
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Posting in this thread because the ladies here seem to be the Tricare homebirth gurus!!!

I am not currently pregnant; DH and I have been trying to conceive for several months now.

My DD was born via c-section at the military base in Heidelberg. I am 99% certain it was a doctor/intervention-caused c-section.

Naturally, I'm terrified of having another baby in Heidelberg and I will.not.do.it. Fortunately, we're actually *stationed* in Darmstadt, which has no obs/gyns, etc...everything is handled by a general practitioner. So if I don't go back to Heidelberg, I *should* be referred to someone on the economy anyway, since I'll be considered high-risk due to my last pregnancy being high risk, right? (pre-eclampsia, c-section, hospitalized for a week due to insanely high blood pressure)

I asked an OB in Heidelberg the last time I was there about a VBAC, and she said I was a good candidate for one; I mentioned that I would like one at home, and she immediately backtracked and said that a VBAC at home would result in my death. :

So anyway...1) can a German midwife perform a homebirth after a c-section? 2) What would be the best way to find a midwife willing to do a homebirth? 3) How do I get Tricare to pay for it? 4) Who do I talk to, and what questions do I ask?
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#66 of 366 Old 04-25-2007, 08:15 AM
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Posting in this thread because the ladies here seem to be the Tricare homebirth gurus!!!

I am not currently pregnant; DH and I have been trying to conceive for several months now.

My DD was born via c-section at the military base in Heidelberg. I am 99% certain it was a doctor/intervention-caused c-section.

Naturally, I'm terrified of having another baby in Heidelberg and I will.not.do.it. Fortunately, we're actually *stationed* in Darmstadt, which has no obs/gyns, etc...everything is handled by a general practitioner. So if I don't go back to Heidelberg, I *should* be referred to someone on the economy anyway, since I'll be considered high-risk due to my last pregnancy being high risk, right? (pre-eclampsia, c-section, hospitalized for a week due to insanely high blood pressure)

I asked an OB in Heidelberg the last time I was there about a VBAC, and she said I was a good candidate for one; I mentioned that I would like one at home, and she immediately backtracked and said that a VBAC at home would result in my death. :

So anyway...1) can a German midwife perform a homebirth after a c-section? 2) What would be the best way to find a midwife willing to do a homebirth? 3) How do I get Tricare to pay for it? 4) Who do I talk to, and what questions do I ask?
Try posting in the finding your tribe forum. I have a friend who found a homebirth midwife in Germany that way a few months ago. From what I understand it is pretty simple to have a homebirth paid for there, but I am not sure if having a VBAC would complicate it. Good luck!
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#67 of 366 Old 04-26-2007, 02:23 AM
 
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lol, I did post in FYT, and was referred over to this thread.

I guess I'll just call Tricare and do all the legwork myself instead of trying to sponge off of others' previous experiences.
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#68 of 366 Old 04-26-2007, 07:57 AM
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lol, I did post in FYT, and was referred over to this thread.

I guess I'll just call Tricare and do all the legwork myself instead of trying to sponge off of others' previous experiences.
Sorry! Great minds... LOL. I know Tricare usually gives out a list of providers if you ask. Maybe they include midwives. Good luck- I think it is actually fairly straightforward in Germany, especially since you are on the economy anyway.
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#69 of 366 Old 04-26-2007, 11:49 AM
 
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3) How do I get Tricare to pay for it? 4) Who do I talk to, and what questions do I ask?

Tricare doesn't care at all what your medical status is (e.g. are you a good "candidate" for a VBAC). You are in charge of your actions. If you want a HB, and you are a good candidate for it, all you need to do is switch to Standard to have Tricare pay for it. Or, as previously stated, if your MTF has no L&D, you can stay on Prime.

People are making this issue FAR more complicated than it is.

Tricare Standard exists SOLELY so that you can CHOOSE your medical provider. If you want to take advantage of this fact, you are entirely free to do so.

As for finding a CNM who is willing to bill Tricare in Germany, I would just pick up the phone and start calling the CNM's in your area and ask them.
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#70 of 366 Old 04-26-2007, 11:51 AM
 
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I guess I'll just call Tricare and do all the legwork myself instead of trying to sponge off of others' previous experiences.
Do yourself a favor and only speak to a supervisor. In fact, call the one I listed upthread - she is very helpful.

ETA: Here it is..

Veronica (916) 985-5772
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#71 of 366 Old 05-05-2007, 02:33 PM
 
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#72 of 366 Old 05-09-2007, 04:02 PM
 
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Does anyone know if Tricare covers homebirth??

Just that simple. I called the 877 Tricare number and they said they do. Then I talked to my rep at the mtf to try to get the referral and she said tricare DOES NOT cover homebirth at all. She said they cover CNM but only for a hospital birth. I have so much more I could type about our conversation but right now I am too to discuss it and I would just ramble too much.

I guess I just want to start with the basics - is there a tricare link or something that says they cover homebirth??

Also, StacyL - can anyone just call that supervisor at the number you listed?? Or is that person region specific??

~~Mama to DS1 6/05 and DS2 12/07~~
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#73 of 366 Old 05-09-2007, 04:12 PM
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Here you go:

http://www.tricare.mil/Factsheets/vi...eet.cfm?id=261

I didn't have a chance to read it in depth but it definitely has at home delivery on the chart. It drives me crazy that people don't know what they're talking about. I wish I could get away with that in my job... on second thought, I'm an OB nurse, LOL. I guess people do that all the time in my line of work. Good luck! It IS covered.
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#74 of 366 Old 05-10-2007, 08:34 AM
 
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Thank you SO much CEG.

I just don't understand why this has to be so difficult.

Now they are saying because my PCM is at the MTF then they may not authorize my CNM *eventhough* CNM are covered!!! The tricare rep said it was a pet peeve of hers but is just a fact of life. I am still waiting to hear back. I feel like something must be able to be done since it they are covered, right??

~~Mama to DS1 6/05 and DS2 12/07~~
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#75 of 366 Old 05-10-2007, 08:50 AM
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Are you on prime or standard? To my understanding you may have to switch to standard if OB care is available at your MTF. Then you should have no problem getting something approved as long as your provider accepts Tricare. Good luck.
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#76 of 366 Old 05-10-2007, 01:55 PM
 
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I am currently prime but on the verge of switching. They DON'T offer ob care at the MTF - that is what is so crazy about it. According to the rep they only approve ob's because "you are going to have to deliver in a hospital and that means an ob." It makes NO sense to me!!! So . . . . . if it isn't approved she advised switching to standard. But now I look at the fact sheet and see the same thing you did - it totally mentions homebirth and if I switch to standard I may end up paying more.

I am waiting for lunch hour to be over to talk to the rep again - specifically about what it says on the fact sheet and how can she still tell me homebirth isn't covered!!

Why do I have to do their job for them?!?!?!?!?! :

~~Mama to DS1 6/05 and DS2 12/07~~
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#77 of 366 Old 05-11-2007, 11:16 AM
 
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I am currently prime but on the verge of switching. They DON'T offer ob care at the MTF - that is what is so crazy about it. According to the rep they only approve ob's because "you are going to have to deliver in a hospital and that means an ob." It makes NO sense to me!!! So . . . . . if it isn't approved she advised switching to standard. But now I look at the fact sheet and see the same thing you did - it totally mentions homebirth and if I switch to standard I may end up paying more.

I am waiting for lunch hour to be over to talk to the rep again - specifically about what it says on the fact sheet and how can she still tell me homebirth isn't covered!!

Why do I have to do their job for them?!?!?!?!?! :
That's the "fun" of dealing with Tricare on base.

But why are you worried about paying if on Standard? You don't pay for your pregnancy and birth on Standard.

Yes, anyone can call that supervisor. I believe she was in CA, but it doesn't matter which region you are in. I'm in North region, and she was the one I was given to talk to when I called. I just talked to her a LOT when this happened to me - LOL.

I don't think you should waste your breath talking to a Tricare rep on base about the referral to a CNM. You have to get the referral from your doc (PCM). And that should be pretty easy if your base has no L&D services, because that means the docs are having to write referrals OUT for every pregnant woman they see. WHat does your doc care if you're going to see a CNM for your pregnancy?
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#78 of 366 Old 05-11-2007, 02:54 PM
 
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That's the "fun" of dealing with Tricare on base.

But why are you worried about paying if on Standard? You don't pay for your pregnancy and birth on Standard.?
That is actually what the tricare rep (the same one that said hb isn't covered) said to me. So I was planning to switch to standard and assumed I would. the rep wanted to push the authorization through (it didn't actually go to my pcm and I didn't see the pcm - don't know why) because it was a pet peeve of hers that they aren't getting authorized at this mtf. Well, it looks like she kind of talked around to the tricare referral person (not really sure who this person is) and that person didn't even try to get the mtf to approve it - she just did it - she has sent it on to health net who, it seems, kind of rubber stamps it. : So now I am on prime and I have a referral to a cnm and another to her backup ob. Not really sure how or why but I am not going to ask any more questions about that.

So back to the issue of hb. So I was looking at the fact sheet and it said that the professional service fee for delivering at home is totally covered under prime but for standard is only 80% covered. The global fee for delivering in a hospital is 100% covered for prime or standard. So I wasn't sure.

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Yes, anyone can call that supervisor. I believe she was in CA, but it doesn't matter which region you are in. I'm in North region, and she was the one I was given to talk to when I called. I just talked to her a LOT when this happened to me - LOL.
Thanks - I think I will give her a call - I am in the North region also. In fact, dh and I were talking and we actually have contact info for another supervisor who is working with issues from my ds's birth (2 years ago!!!)

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I don't think you should waste your breath talking to a Tricare rep on base about the referral to a CNM. You have to get the referral from your doc (PCM). And that should be pretty easy if your base has no L&D services, because that means the docs are having to write referrals OUT for every pregnant woman they see. WHat does your doc care if you're going to see a CNM for your pregnancy?
So who makes the decision if the bills are paid??? This tricare rep has me so nervous and unsure. She kept talking about how the 877 tricare people are always giving out incorrect info, etc. I am so frustrated.

~~Mama to DS1 6/05 and DS2 12/07~~
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#79 of 366 Old 05-11-2007, 04:44 PM
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So back to the issue of hb. So I was looking at the fact sheet and it said that the professional service fee for delivering at home is totally covered under prime but for standard is only 80% covered. The global fee for delivering in a hospital is 100% covered for prime or standard. So I wasn't sure.

.
that is so irritating to me. I mean, homebirth is cheaper for them but they pay less of it. Hospital birth is more expensive (and you're more likely to have expensive complications) but they pay it all?!? Makes no sense.

So it sounds like the person you are talking to is trying to help you not have to pay out of pocket if I read that right? I hope that's what it is. Otherwise if what she's doing doesn't work you can try switching to standard later. Keep us posted.
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#80 of 366 Old 05-12-2007, 12:04 AM
 
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and that person didn't even try to get the mtf to approve it - she just did it - she has sent it on to health net who, it seems, kind of rubber stamps it. : So now I am on prime and I have a referral to a cnm and another to her backup ob. Not really sure how or why but I am not going to ask any more questions about that.


Thanks - I think I will give her a call - I am in the North region also. In fact, dh and I were talking and we actually have contact info for another supervisor who is working with issues from my ds's birth (2 years ago!!!)


So who makes the decision if the bills are paid??? This tricare rep has me so nervous and unsure. She kept talking about how the 877 tricare people are always giving out incorrect info, etc. I am so frustrated.
Why are you frustrated?? You're done! That's all you needed was the referral and now you have it. You're still Prime, and so it won't cost you a thing. Sit back and relax!

Your CNM will bill Tricare directly in most cases and so you aren't involved in the billing at all. It will be a cakewalk. But do call that supervisor if you have any questions. The base reps are not generally any better than the typical customer service reps when you call Tricare - that's why you have to speak to a supervisor.
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#81 of 366 Old 05-17-2007, 02:28 PM
 
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I posted my update in the other tricare thread but this thread is really more relevant to my situation so here is my update:

Just thought I would update my situation. As it stands now I got the tricare rep at the mtf to say homebirth IS covered no matter what. She could not find an exclusion anywhere and she called a claims supervisor and they didn't even bat an eye - it is covered. Tricare has also approved my cnm even though she is not in network but she is the only one in the area who does homebirth. I am still waiting to hear about her backup ob. Apparently I need a separate referral for the ob - I am not sure if he is in network or not (depends on who I ask) so I don't know how that will go.

So to recap - I am Prime, hb is totally covered, the out of network cnm is approved. : Still waiting to hear about approval of the backup ob. Moral of the story - keep calling back!!!! Thanks for all your help ladies.

CEG - I wouldn't say she was actually trying to help me - I just kept bugging her so she kind of had to.

I feel so much better now that everyone I have spoken with says hb is covered. The rep scared me because she seemed so sure. I just didn't want to end up getting screwed in the end. I just hope the ob approval goes through. I am a little nervous because if he isn't in network then they may want to send me to someone who IS in network but I kind of need this ob since he is the cnm's backup, yk.

~~Mama to DS1 6/05 and DS2 12/07~~
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#82 of 366 Old 05-20-2007, 12:39 PM
 
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ISo to recap - I am Prime, hb is totally covered, the out of network cnm is approved. :
Hooray! And you didn't even have to switch to Standard - congratulations!
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#83 of 366 Old 05-20-2007, 02:34 PM
 
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So far I haven't had to switch to Standard but I am still waiting to hear about the backup ob. I fear it isn't going to be easy. I guess I will have to tackle that next week. As if I don't have enough to do . . .

~~Mama to DS1 6/05 and DS2 12/07~~
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#84 of 366 Old 06-24-2007, 08:53 PM
 
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What have people gotten Tricare to pay $-wise? I live in NYC and the fees are $5000+. Last I knew, Tricare paid about $1800 to the homebirth midwife. Depending on the arrangement with the midwife, I could be required to pay the difference (it happened to me once with a hospital mw, I signed a contract without realizing what exactly it meant). I don't mind paying 20% (I'm on Standard), but I don't want to pay the $300) Tricare may not cover, and I'm not sure yet if the midwives will take what Tricare pays or if they will want their full fee in the end.

Amy, USCG wife and homeschooling, ebfing, homebirthing Mama to M (8), L (6), L (2.5)
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#85 of 366 Old 06-25-2007, 12:20 PM
 
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Yeah, TriCare only paid our mw's about $1000 for dd2's birth...and told them that they could not bill us for anything more. We were soo mad. Of course, we couldn't afford to pay anything else then, because we hadn't planned for it. I think the mw practice wrote the rest of it off.

This time, we're using a different mw (our primary mw from dd2's birth moved out of the country) and we decided to just pay her full fee out of pocket and then try to get reimbursed after the birth. I seriously cannot deal with the anxiety of dealing with TriCare's bs. We took out some home equity to cover the cost.

But,...the lab did bill them for my bloodwork and I'm still waiting to get a statement for that. (I switched to standard for dd2's birth because that was supposed to make everything covered...while giving me the choice, etc. Whatever...)

Anyway, I think I want an ultrasound and I'm trying to decide how to get that covered, etc. We were planning not to have one...but, we were also planning not to birth anymore children! I'm having a really difficult pregnancy with hyperemesis, stress, etc and I still haven't felt much movement at all. Baby's heart rate has been good by doppler. It's not so much that I think something is wrong...I'm just worried...and I kind of need a bone, so to speak. Maybe that's silly.

I'm thinking of going to a TriCare covered OB in the next town...but I'm worried about getting someone else involved in my business, kwim? Could I really just go in for a 20 week appointment, say that I'm looking for a new provider, get an ultrasound and then just not go back for any more appointments? Would it be that simple?

Thanks in advance for any advice, suggestions, etc.
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#86 of 366 Old 06-25-2007, 12:52 PM
 
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So far I haven't had to switch to Standard but I am still waiting to hear about the backup ob. I fear it isn't going to be easy. I guess I will have to tackle that next week. As if I don't have enough to do . . .
Congratulations on getting through the military homebirth maze! I'm Prime, in the same area, got the referral, and had it all paid for on Prime. My MTF also didn't have OB facilities.

I didn't have to get any backup OB approval though. My CNM had a backup OB but I never had to see him. Maybe this practice varies depending on the midwife's arrangement with the backup OB?

BTW when your CNM starts billing Tricare, you'll receive billing statements from Tricare detailing all the costs.

Be careful if you choose to have an ultrasound. My CNM doesn't do US and gave me a referral to a ultrasound place but when I double checked it, I found it wasn't in the Tricare approved network. So just because your approved CNM gives you a referral, don't assume Tricare will pay for it. I could find no Tricare approved radiologist to do a Level II ultrasound in my DC/MD/VA area. So I got my CNM to write my referral to the MTF. MTF didn't like that, but I checked with Tricare and basically the MTF HAD TO take me. Tricare/Healthnet head office was incredibly supportive and actually proved an ally against the MTF in my case.

I also had a situation later on in the pregnancy where I was bleeding and during a phone consult with my CNM, she told me to go to the ER. I have a civilian ER and a MTF ER nearby. I went to the MTF ER (better the devil you know kinda thing) and they sent me directly to the birthing area for assessment. MTF didn't like that either, tried to deny me care. I was standing there 8 mo pregnant and bleeding and they tried to tell me to go to a civilian ER. They were very pissy about it. Tricare/Healthnet again supported me, and told the MTF on the phone they had to take me. So just because you have that CNM referral for a homebirth, don't let them tell you you can't access services at your MTF.

Basically I wouldn't believe a thing anyone at the MTF told me about Tricare services. Always check it with Tricare/Healthnet head office.
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#87 of 366 Old 06-25-2007, 01:43 PM
 
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I never had any problems with the labs, they were always covered 100%, even with our LM since the labs were in network. Of course, now maternity care is only covered 20% on standard, those bastards. I'm actually considering switching to Prime if they will pay out more money to the midwife, leaving less for me to pay out of pocket (if they only pay the $1800 I'm expecting, and I have to pay 20% of that, then I'm stuck paying like $400 plus the difference in mw fees...but on prime they should pay the $1800 in full then I just have to pay the difference, kwim?

Also, luckily,we are Coast Guard and not near any MTF's!

Amy, USCG wife and homeschooling, ebfing, homebirthing Mama to M (8), L (6), L (2.5)
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#88 of 366 Old 06-25-2007, 03:53 PM
 
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Anyway, I think I want an ultrasound and I'm trying to decide how to get that covered, etc. I'm thinking of going to a TriCare covered OB in the next town...but I'm worried about getting someone else involved in my business, kwim? Could I really just go in for a 20 week appointment, say that I'm looking for a new provider, get an ultrasound and then just not go back for any more appointments? Would it be that simple?

Thanks in advance for any advice, suggestions, etc.
Yes, it is that simple. I know I did it.

Even if you have switched to Standard, you can go on base for care at any time - you are just given a very low priority for appts.

Tricare does NOT cover U/S unless it is ordered by your PCM, but it sounds like your PCM would order you one pretty easily since you sound like you are having a rough pregnancy. And as wombat said, it will be done on base at your MTF.

DO NOT have your MW order you an U/S or you will be stuck paying for it. The authorization has to come from your PCM.
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#89 of 366 Old 06-25-2007, 03:54 PM
 
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Quote:
I have been recently researching whether Tricare pays for home births and I actualy called Tricare yesterday. The woman told me that Tricare does pay for home births under certain criteria:

A. A certified nurse midwife may provide covered care independent of a 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 Cretification 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.
lll. Exclusion

A Lay midwife who is either certified nurse midwife not a registered nurse is not an authorized provider, regardless of whether the services rendered may otherwise be covered.
I was wondering if this was from the website? Link? I think I can get away with it because of the red part.

Living DAIRY AND GLUTEN FREE for my SPD and Aspergers Little Man.
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#90 of 366 Old 06-25-2007, 04:02 PM
 
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What have people gotten Tricare to pay $-wise? I live in NYC and the fees are $5000+. Last I knew, Tricare paid about $1800 to the homebirth midwife.
I highly doubt that your MW will charge you the RETAIL rate ($5,000) when you are using insurance.

They know that insurance reimbursement is MUCH LESS than retail rate, and they also know that Tricare (govt. rate) is the lowest rate of reimbursement (about $1,400-$1,600).

So, even though Tricare's range of reimbursement may be less than other insurance plans, they most likely would not expect you to make up the difference between the reimbursement and $5,000.

Make sure you negotiate the rate before you sign anything! You may have to pay a little bit, but even if you had to pay, let's say, $1,000 that is still better than $5,000!
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