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Discussion Starter · #1 ·
What choices are available through Tricare? If I am close to a MTF - do I have to ::shudder:: deliver there? Do I have to receive care there? How receptive are they to birth plans?

Any feedback at all?
 

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someone will correct me if I am wrong, but if you are on prime and your MTF is not full then basically your only option is to deliver there. If you are standard you can pretty can see anyone who accepts tricare and you can even homebirth as long as you see a CNM. If your MTF is full or too far away then your options are similar to being on standard.

I was prime both times and started at my MTF but switched out and got it fully covered under prime by complaining. That is really hard to do but I had valid reasons. I have heard of some people getting HBs partially covered under prime, that seems hard to do as well. Hopefully someone will chime in.

~Erin
 

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Erin has it right. If you are prime and you are w/in 50 miles of an MTF you must deliver there. You can petition the commander of the base to be released from the MTF, but that just about never happens. However, switching to standard is not hard to do and you only have to be standard for one year after you switch (if your husband is a certain rank, lower ranks don't have to be standard for one year and can switch back as soon as the baby is born). As long as you have no long term health problems then standard is a great way to go. There is a catostrophic cap, so if something does happen you are only liable for 1000 bucks out of pocket.

As far as delivery at an MTF, (IME) they aren't very receptive to birth plans/natural birthing. They claim to be, but at NNMC (in bethesda, md) like 90% of their ladies get epidurals. It isn't a very progressive environment really. I know of a very few women who have had the kind of birth experience they wanted at an MTF, but it is really a drop in the bucket.

HTH!!!
 

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Discussion Starter · #4 ·
<sigh> thanks for the answers - not exactly what I wanted to hear.

I will be going with a hospital birth since my husband will be on westpac at the time and I simply don't have the support system to pull off a home birth. I just live in fear of the Navy hospital because of all the horror stories I've heard. I might be hanging with the wrong crowd but every person I know IRL who has had a baby there wound up with a c-section. I would love to be able to go to a friendlier birthing facility...
 

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Quote:

Originally Posted by MotheringHeart View Post
If you are prime and you are w/in 50 miles of an MTF you must deliver there.
This isn't quite true as I had several major MTFs within my 40 (not sure if it's 40 or 50) mi radius. The MTF I was at didn't have L&D facilities, but the MTF 10 mins down the road did. I was Prime and I got a referral from my PCM to a CNM for a homebirth.

Also I was originally at a MTF with L&D, but after my 1st birth there I didn't like them so I switched my care over to the other MTF (without L&D) 10 mins away. I think you're allowed to go to any MTF within your 40mi radius, so just make sure you're at one without L&D.

I think in this situation it depends on the medical management team in that particular MTF and whether they will 'allow' you to go outside. But if they won't, you can just switch to Standard. But Prime can cover hb with a cnm. Tricare doesn't have any problem with moms having homebirths, I found the head office reps very helpful. It's the MTFs that try to prevent you from accessing it.
 

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If you switch to Standard they may cover birth centers in your area. I know the local birth center here is covered 100% and that would be a great option so you can avoid the hospital.
 

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I think for most people, the problem is getting your PCM to refer you to a cnm when they do have a L&D right there at that MTF. NO PCMs around here will refer you to a non-military CNM.

My problem is there aren't any CNMs in my area who do homebirth. We have one homebirth practice and she is a CPM. I don't care if I switch to standard, but I would like some kind of coverage from tricare for a homebirth with a CPM which is totally legal in my state.
 

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: I'm finding a lot of helpful information on this thread.

We do not have a MTF (just a clinic) at my base. I have a civilian PCM and would like to do a homebirth (whenever I get pregnant). Are PCMs typically receptive to that or am I going to have to put on my game face to get her to write the referral? I've already talked to a CNM and she said she's had Tricare Prime cover several homebirths, so I should be covered 100%. (YAY!)

However, I know things do happen and I want to be prepared for that. I plan on having a hospital back-up plan. How do I do that? I assume I'll need kind of an open referral, just in case. Any experience with this?

Also, the closest hospital isn't listed in the provider book the Tricare office gave me. I thought if they accepted Medicaid/Medicare (which they do), then they had to accept Tricare? Just wondering.
 

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Quote:

Originally Posted by Nicole! View Post
: I'm finding a lot of helpful information on this thread.

We do not have a MTF (just a clinic) at my base. I have a civilian PCM and would like to do a homebirth (whenever I get pregnant). Are PCMs typically receptive to that or am I going to have to put on my game face to get her to write the referral? I've already talked to a CNM and she said she's had Tricare Prime cover several homebirths, so I should be covered 100%. (YAY!)

However, I know things do happen and I want to be prepared for that. I plan on having a hospital back-up plan. How do I do that? I assume I'll need kind of an open referral, just in case. Any experience with this?

Also, the closest hospital isn't listed in the provider book the Tricare office gave me. I thought if they accepted Medicaid/Medicare (which they do), then they had to accept Tricare? Just wondering.
You won't need a referral from your PCM since they only have a clinic at your base. It's only when you have an MTF that is capable of handling your OB care and labor and delivery that you need a referral. What will happen is that once you get pregnant you will automatically get a referral to be seen off base by a civilian provider. They'll give you a list of the providers that are in-network. Lots of times the homebirth CNMs aren't on that list but that is ok. Tricare specifically states that they cover homebirth with a CNM so you'll have to call them and tell them they need to send you out of network. Since your midwife has done it before I would just refer back to her and I'm sure she knows what steps to take. Life is a lot easier though when you don't have an MTF you can use (we don't have one either thank goodness!).
 

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My first choice was a birth center, but there are none in my area so I stuck with Prime. I didn't have an awful experience with either pregnancies. The midwives I saw were very natural minded, and supported low-intervention births. Since many of them deal more with mainstream patients, you actually have to make your wishes and approach known. I know my midwife was very pleasantly shocked once I told her my wishes, especially since natural CB and alternative birthing methods aren't common practices where I delivered.

I called about a homebirth, which is covered as long as there is an in-network provider available.
 

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Quote:

Originally Posted by Semper Gumby View Post

I called about a homebirth, which is covered as long as there is an in-network provider available.
I just wanted to add some info to this. Homebirth is covered regardless of whether or not there is an in network provider. If none of the network providers do homebirth then Tricare, by law and according to their handbook, must send you out of network. The trick of course is actually finding a homebirth CNM which in many places is pretty much impossible
:
 

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Quote:

Originally Posted by Shelsi View Post
I just wanted to add some info to this. Homebirth is covered regardless of whether or not there is an in network provider. If none of the network providers do homebirth then Tricare, by law and according to their handbook, must send you out of network. The trick of course is actually finding a homebirth CNM which in many places is pretty much impossible
:
Definitely impossible where I'm at! I was sure bummed about that.
 

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I am due in about 8 weeks. I could not get the OB at the MTF to give me a referral out even though I was unable to EVER get an appointment scheduled with the same person, had access to care problems, and wanted to see a midwife. They really try to throw up barriers to referrals, INMHO. Wilford Hall has a good reputation for being natural birth friendly though. I was told only the hospital commander (note: not base commander, who would not be a doctor) can authorize an OB referral out.

Anyhow, I switched to Standard, saw an in-network provider, then switched to an out of network provider. Our annual copay is only $150 with Standard and pretty much 100% of everything else is covered (I think we have to pay $14 per day for hospitalization). No biggie. Much happier getting out of the system and it is quite easy to switch out of prime (easier than fighting for a referral).
 

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Oh Gods...

I dont know how you ladies do it really...

Canadian Military dependant here and we have all the choices the civilians have. Mostly because we are seen within the civilian system, just with the perks of having the "extras" that the civilian system doesn't pay for, paid for.

Heck, even when an AD member becomes pregnant, she's allowed to see any provider she chooses, be it midwife (if regulated and covered normally by provincial medical) or OB in the civy system and the provider bills the Canadian Military for their services. (my midwife told me this. teehee)

I can't believe the crap you ladies are put through IRT medical...

*wont even go into the other added perks we have....*
 

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Where do you get a handbook with Tricare policies? The local Tricare office on base? I'd like to go get one now so I can have all the important sections highlighted.
 

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Quote:

Originally Posted by Nicole! View Post
Where do you get a handbook with Tricare policies? The local Tricare office on base? I'd like to go get one now so I can have all the important sections highlighted.

There is a book, but I find it easier to read it online, at least you know it's up to date.

http://www.tricare.osd.mil/Factsheet...eet.cfm?id=261

The chart on the above link is useful. Scroll down to where it says:

"Professional Services Fee When Beneficiary Chooses to Deliver at Home or as an Outpatient "

Take that to your PCM. My PCM was ok (actually I just see anyone in the clinic, I don't even know who my PCM is). I was expecting an argument. Dealing with a PCM is much easier than an OB. If you're already in an OB dept, I imagine it'd be harder. (Besides, you'd already have had a referral to get to the OB dept on Prime, wouldn't you?)

However my PCM didn't have a clue about how to do the paperwork (well it was on computer actually). But I kept insisting she could do it, I showed her the papers on how Tricare will cover but how she needs to write the referral. She just got someone else in the office to help her fill out the computer stuff and I was done.


But then it goes to a medical mnmgt dept in the MTF and it needs to pass them before it actually goes to Tricare.
 

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Pandora - actually we have it better than MANY civilians have it. Civilians don't always have a lot of options either. I have never had to pay a single cent for ANY medical procedure for myself, my husband or my 2 children in the entire 6+ years I have been married. Not one cent. That includes countless check ups, sick visits, very expensive medications taken daily, multiple surgeries, MRIs, CAT Scans, etc. Can any civilian in the US say that? There are bad aspects to being military when it comes to healthcare and frankly, I feel that those aspects gives me a tiny glimpse into what it would be like to have a national health care like Canada...*shudder*.
 

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Quote:

Originally Posted by erin_brycesmom View Post
Pandora - actually we have it better than MANY civilians have it. Civilians don't always have a lot of options either. I have never had to pay a single cent for ANY medical procedure for myself, my husband or my 2 children in the entire 6+ years I have been married. Not one cent. That includes countless check ups, sick visits, very expensive medications taken daily, multiple surgeries, MRIs, CAT Scans, etc. Can any civilian in the US say that? There are bad aspects to being military when it comes to healthcare and frankly, I feel that those aspects gives me a tiny glimpse into what it would be like to have a national health care like Canada...*shudder*.
Tricare is NOTHING like Canada's system. We still have choice as to who we see. We acctually can see whomever we wish if they are taking on new patients. If we dont jive with a Dr, we can switch no problems. As long as the Dr is taking new patients.

We can go to whatever hospital we want. Heck in some provinces, we have a choice of OB or Midwifery care.

Dont have to pay a red cent either. (well some provinces have premiums for the higher income earners but hey, that cuts down on taxes)

Just have a Dr shortage here now..that's all. We have THOUSANDS of Dr's from other countries, seriously, all just sitting around doing SFA because our medical board is unwilling to recognize their certifications, and are also unwilling to lower the cost of the certification test for them to get their lisence for this country.
 

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Quote:
Tricare is NOTHING like Canada's system.
Actually, there are a lot of similarities.

Quote:
We still have choice as to who we see. We acctually can see whomever we wish if they are taking on new patients. If we dont jive with a Dr, we can switch no problems. As long as the Dr is taking new patients.

We can go to whatever hospital we want. Heck in some provinces, we have a choice of OB or Midwifery care
Pretty much the way that tricare is also.

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Dont have to pay a red cent either.
exactly

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Just have a Dr shortage here now..that's all.
yep, same with tricare. And please don't act like "that's all". That is most certainly NOT "all" that is wrong with Canada's healthcare system.

~Erin
 
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