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Home Birth & Midwife + Tricare

KorieAngelaKorieAngela member
in Military Families

I want to have a home birth (I would settle for birthing center). I am about 8 weeks pregnant so I have some time to figure this out. I am trying to figure out how to get a CNM paid for by Tricare. I read that if it is a CERTIFIED NURSE MIDWIFE I can...If anyone knows of any CNMs in the SoCal area that they could recommend to me that would be awesome. I WILL NOT have a hospital birth if I can help it. Nor will I go to the naval hospital.

Right now I am on Tricare Prime. I will be getting referred to an OB soon but if anyone has any tips or midwives they know in the southern california area that would be so helpful.

 Also, if I can't get Tricare to pay for the CNM or Home Birth does anyone know if I can get covered by a different insurance company that allows home births? Or since I am married to a Marine do I HAVE to have Tricare?  

 

Anything anyone knows would help. I am 100% against hospital births and I don't want to have one. Thank you for the help! 

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Re: Home Birth & Midwife + Tricare

  • MilMom2BMilMom2B

    First of all, you can always supplementary insurance.

    Secondly, yes in theory with a CNM you can get a home birth covered by tricare ... in theory... Here's my experience:

     I switched to my CNM about halfway through my pregnancy. She is not in the Tricare network of providers (there are none in the network anywhere near me). I did all of my appointments through her, including office visits, labs, ultrasounds, home visits, the birth, the follow up appointments all the way through 6 weeks postpartum. I stayed on Prime. I paid $4000 OOP directly to the midwifery group and they submitted my claims and forwarded me the checks from Tricare. Tricare reimbursed me almost $2000 of it. Several other military mamas-to-be (spouses) were also having home births through this midwifery group and I chatted them up quite a bit before and after my own experiences. The ones I spoke with on Standard got reimbursed in the range of $2500-$2700 and the ones on Prime were more like me in the $1800-$2000 range. There were also 2 AD members being seen there and planning their home births but I didn't get a chance to talk $$ with them.

    I don't know about SoCal specifically. Maybe some other girls will have some good answers for you. 

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  • SoftSpotSoftSpot member

    I could recommend an amazing Midwife covered by TriCare but I'm pretty sure she only delivers at hospitals. Sorry.

    I'm pretty sure TriCare won't cover a home birth. 

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  • meltoinemeltoine member
    imageLace&Josh:

    I could recommend an amazing Midwife covered by TriCare but I'm pretty sure she only delivers at hospitals. Sorry.

    I'm pretty sure TriCare won't cover a home birth. 

    Tricare absolutely covers home birth. There are a number of ways to go about it depending on what providers are available in your area. I suggest asking your local board about midwives in the area or using the NARM website to find one. Call the office and ask if they take Tricare, then call your Tricare office and double check that the provider is in-network. Then you should be good to go.

    If you're like me and there are no in-network midwives in your area, you can pay up front out-of-pocket and then submit your claim to Tricare like PP and get reimbursed.  

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  • panicked228panicked228 member
    You can have a home birth and Tricare will pay for some of it, but not all. You will have to submit everything yourself (unless your CNM does it for you, but that is rare), which means a higher out-of-pocket cost for you initially. " If a woman is being seen by a provider for a planned home birth, the services are covered, but only if the provider can be certified as a TRICARE authorized provider, and only for the services that fit into traditional medical billing codes, since they are not authorized to bill at an all-inclusive rate for home births."
    So you will be paying out of pocket and not reimbursed for things that don't fall into the regular, normal birth billing codes. That covers quite a wide range of things, but not all of them. If you have the $ to put up front for the birth experience you want, go for it.
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  • shannon.jaclynshannon.jaclyn

    I am not sure about Tricare covering home births, but they will cover a birthing center, especially if it is in the Tricare network. We live in San Diego and I had a similar situation. The first thing you could do is try and get a referral to the Birthing Center (we go to Best Start in San Diego) from your Primary Care Doctor. If they don't approve it, which they didn't for us because Balboa had room, you need to switch to Tricare Standard. With Tricare Standard you can refer yourself to anyone you want. In network is usually covered 100% (or close), out of network will cost more. There is an annual deductible you will have to pay, but they also have a catastrophic cap ($1k or so). You can check to see who is in network on TriWest's website.

    Good Luck!  

     

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  • LeahCKLeahCK member

    I started out with Tricare Prime and switched to Tricare Standard to select my own doctors. You can call the number on the back of your card and they will show you how. It's very quick, easy and painless.

     As far as other insurances ABSOLUTELY you're allowed to have another insurance. I have Cigna and they do not like covering home births (I am told by them). HOWEVER, my knowledge of insurance companies are if you don't already have another insurance (pre pregnancy) most insurances won't accept you at this time or it will be much more expensive than if you already had insurance. Do you have a job that has insurance?

    Also, many insurance companies do not like covering home births due to the risks, so ask them up front. I am unsure of Tri Care. I have learned that when you call their 800 number and ask questions you will get different answers depending on the knowledge of the rep that picks up the phone. Don't be shy to call back to get a diff. rep and ask again. If someone on this board says that Tri Care covers home births then ask them if they had a specific experience and if they can recommend the department that they spoke to regarding coverage.

    I am in Norfolk, VA and there is a true birthing center here that is part of a hospital which is a double comfort for me. I understand not wanting to go to a Navy hospital

    Good Luck! I'm curious what Tri Care tells you. I hope that you keep us updated. 

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  • rbytsdyrbytsdy member
    I live on the east coast so I'm not a help with a recommendation but I used homebirth midwives and Tricare covers them.  I was in the hospital since i was a VBAC (state law prohibits midwives from attending HBACs unfortunately) but I know for a fact my midwives' have attended births at McGuire/Fort Dix.  They have to be CNMs.  You should be able to get reimbursement for any CNM that attends homebirths but expect it to be in the $2000 range.  You may need to switch to Standard so that you don't have to use someone who is specifically in network.
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  • KorieAngelaKorieAngela member

    I'm not sure if you ladies are still following this post but I wanted to give you an update!

     

    I had to drop Tricare Prime and am now Tricare Standard. I have my first visit with a Midwife in Fallbrook (She is a CNM and in the Tricare/Triwest network). I was told from a person on base that Tricare will cover in home births but I am required to pay 20% with a $1000 Cap. :) This makes me very very happy!!! They do make you pay a $50 fee for delivery and $17 for any day that you are admitted to a birthing center or hospital (Not too bad if you ask me...) I am so happy that I figured this all out.

     

    Thank you all for you help! If any of you are looking for a midwife near Camp Pendleton or in SoCal that is covered by Tricare I can send you information!

    I will keep you updated and let you know how the first visit goes and how Tricare handles the first payment :)

     

    Thanks again!

    Korie 

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  • MilMom2BMilMom2B
    imageKorieAngela:

    I'm not sure if you ladies are still following this post but I wanted to give you an update!

     

    I had to drop Tricare Prime and am now Tricare Standard. I have my first visit with a Midwife in Fallbrook (She is a CNM and in the Tricare/Triwest network). I was told from a person on base that Tricare will cover in home births but I am required to pay 20% with a $1000 Cap. :) This makes me very very happy!!! They do make you pay a $50 fee for delivery and $17 for any day that you are admitted to a birthing center or hospital (Not too bad if you ask me...) I am so happy that I figured this all out.

     

    Thank you all for you help! If any of you are looking for a midwife near Camp Pendleton or in SoCal that is covered by Tricare I can send you information!

    I will keep you updated and let you know how the first visit goes and how Tricare handles the first payment :)

     

    Thanks again!

    Korie 

     

    THAT IS FANTASTIC!!! Good luck and I wish you all the best in your pregnancy and home delivery. :) 

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