- "You have to switch to TRICARE Standard, because Prime doesn't cover home births. And it has to be with a CNM* not a CPM*."
- "If you're on Prime, you need a referral. The military hospital doesn't like giving referrals so your request will get denied anyway."
Well, it seems the military insurance world may be starting to catch on. Women want options and homebirth with a provider they CHOOSE is one of those options. Yes, I have Tricare Prime. And you may already know, I had a home birth earlier this year with a CPM.
As of this morning, I received a check for partial reimbursement of my out of pocket cost. It's not full reimbursement, but a lot more than I expected at all. I was honestly just expecting a denial response, because I'd heard those same things above numerous times.
*CNM - Certified NURSE Midwife
*CPM - Certified PROFESSIONAL Midwife
After looking up information on the Tricare website, I hadn't expected to get reimbursement but I figured if I'm just one more person submitting a request and showing the benefits AND cost savings maybe they'd realize "this makes sense".
- First, I completed the DD 2642 in it's entirety. You can download it from the website (on desktop it's in the right sidebar).
- Next, I requested either an itemized bill or a HCA Form 1500 from my midwife. She completed the HCA Form 1500 and emailed it to me.
- And finally, I wrote a letter which I included with the claims forms. My letter I expressed how much money I saved Tricare by going to the midwife of my choice.
Colorado Springs, CO XXXXX
TRICARE West Region
PO Box 7064
Camden, SC 29021-7064
To whom it may concern:
I am writing to request reimbursement for covered services I received through Demetra Sereki, CPM, RM and A Mother’s Choice, LLC, which operates as a cash-only practice.
The services of A Mother’s Choice are very cost effective. In Colorado Springs, CO, a hospital birth with no interventions costs approximately $10,000. The cost of my homebirth was much less, and the care I received was much more time intensive and thorough.
Our 3rd baby was born at 2:52 AM on Friday March 4, 2016. Due to the evidence based care and careful management of A Mother’s Choice, I was able to remain at home and safely deliver our baby, complication free. The alternate option from Martin Army Community Hospital included a recommended induction to avoid precipitous labor. That was not an evidence-based recommendation which could have escalated to other unnecessary interventions and avoidable cesarean section, which in turn would have increased costs significantly. I have no history of complications during any pregnancy and have always remained low-risk, therefore, homebirth was a safe, reasonable birthing choice for me.
I am seeking reimbursement for my out of pocket maternity expenses totaling $XXXX.00. I am enclosing the HCA 1500 from A Mother’s Choice Birth Service, as well as claim form DD 2642.
Thank you in advance for your cooperation. I’d be happy to answer any further questions and can be reached at: (719) XXX-XXXX.
Crystal A Swanson
DOD ID# XXXXXXXXXX
enclosures: HCA 1500, Claim form DD 2642
* Your claims must be submitted within ONE YEAR of the time of service. Tiny was born in March, so I was still within the one year timeframe.
The Tricare website also mentioned most claims are responded to within 30 days. I mailed my claims form via certified mail with signature confirmation Oct 28th (signature receipt confirmed Oct 31st). My reimbursement check is dated Nov 22nd, so that was LESS than 30 days!!
And here I just filed a claim because I thought "Why not? No harm, no foul. The money was already spent anyway." I'm so glad I did. Like it mentioned, it wasn't a full reimbursement. They gave me nearly 40% of my out of pocket cost, which is amazing considering I was expecting ZERO!
Have you tried getting reimbursed for your CPM attended birth? Have you had success? Let me know!!
**UPDATE: I've been informed that Tricare has on ocassion requested moneys be returned after they've performed an audit. This is in no way advice on how to "cheat" the system. I still feel if enough moms are showing they value freedom of choice in birth AND that we are saving the insurance companies money, eventually they will come around and cover the care we want and deserve.**