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babies-n-bloom 07-14-2011 02:10 PM

I recently read a thread that was started in 2007 re: Tricare and getting covered for a homebirth, but am hoping to get some more up-to-date information is there is any to be had.  I'm almost through my first trimester (I seriously can't wait for the nausea to stop), and am meeting with a certified practicing midwife in my area, and need to know if anyone out there has had luck getting reimbursed? I am on Tricare standard, so I don't need a referral but do I need to get prior authorization? Also, how would it work if I ABSOLUTELY had to go to the hospital if an emergent situation arises? I'm guessing that on standard I would have to pay the 15 or 20% that I do when I go to the doctor, but not sure if that is right.  I have gone through the Tricare standard booklet and there was no information about midwifes and homebirths in the maternity section or the exclusion section.


The midwife I am possible working with requires payment upfront, and I'm not sure if she bills insurance companies herself (this is one of my many questions for her).



aquafern 07-20-2011 12:51 PM

Im in the same boat. It looks as though Tricare cover about 50%. Although, I would like some more info as sell! just trying to get more attention to this thread.

Plummeting 07-20-2011 01:01 PM

Tricare is not ever, under any circumstances supposed to cover CPMs. However, sometimes they accidentally do. But are they allowed to? Nope. Not at 50% or anything else. They can only cover home births attended by CNMs, as CPMs are not Tricare authorized providers in any state, at any time. It doesn't matter if you're on Standard or Prime when it comes to this issue. They don't pay CPMs, unless someone makes a mistake. These mistakes DO happen, but you absolutely can't count on it working out for you. It's basically a crapshoot.


I'm not sure where the 50% number came from. If you use a CNM, they cover the same amount for a birth as they cover when you use an OB or a CNM at the hospital, and if you use a CPM, they cover 0. It's up to each individual CNM to decide whether she's willing to accept that allowable charge or not. The law states that if she accepts payment from Tricare, she can only accept that amount plus a certain percentage more (I think it was 15 or 30%, but I can't recall) if she accepts payment as an out-of-network provider. If she's an in-network provider, she has to accept the allowable charge. Now, if you and your CNM decide that you feel her services are worth more than that, no one needs to know. ;-) If your midwife is out-of-network, then you do need prior authorization on Prime, but I'm not sure about Standard. However, authorization will not be given for CPMs, as it can only be given for authorized providers.


My CNM works with a CPM, so my birth was attended by both, and billed by the CNM. Tricare covered 100%, since my midwives have kindly decided to accept that amount as payment.


I hope you're able to get the birth you want in a way you can afford! Good luck.

babies-n-bloom 07-20-2011 01:18 PM

Hey! I just spoke with tricare, about 3 days ago to verify whether or not they would actually cover me.  I spoke with someone who told me that they actually have some midwives "in-network", at least in my area (which is Oklahoma).  So, I specifically asked about a homebirth, just to be clear.....she said my midwife (who is actually attempting to get in-network) needed to call and request a "referral form" that she would fill out and fax back to them, so that whether she bills tricare or I pay and then attempt to get reimbursed at least 80% would be covered.  They didn't outright refuse me a midwife or a homebirth, so maybe there is promise in all of this somewhere!


All the other information I have read, kinda leads me to believe that if I were on tricare prime, I would be refused this. (something to do with the mtf's hardly ever refer to a midwife or ok a homebirth)


I was completely prepared to request to speak to a supervisor, but the benefits department was actually helpful.  My only concern is that once this "referral form" is filled out they will still attempt to deny charges or refuse reimbursement......


I will let you know how the process is going.  I meet with my midwife in another week and a half, and hopefully I will have more answers.



sarahb918 12-08-2011 01:55 PM

I was just wondering if you had gotten any more information about this. Tricare Standard covered my homebirth 100% last November, but it was with a CNM. From what I was told when I was searching for a midwife, they will not cover a CPM unless it's by accident. Just curious if something has changed :)

~adorkable~ 02-09-2012 03:59 PM


The military moms and family have a social group here on it can be found here: Military Family Life


There is a thread just about Tricare and mothering, let's pool our collective information there.

Currently and for many years there have been posts over MDC about tricare and so much info that is hard for each of us to find.

This way we can learn from each other and gather it in one place so that the next lady looking for the same info can find us and what we found!



We would love to had you!


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