Thursday, 1 February 2018

Home Births and Tricare Overseas (Examples from South Korea)

Updated 11 September 2018

Tricare Overseas is not like Tricare stateside. A few women recently had home births in Korea and filed claims with Tricare Standard (now Select). After a year of going back and forth, with Tricare asking for more and more documentation and these women being reassured that Tricare would reimburse them, Tricare finally issued their response: they wouldn't cover it. None of it was covered. These women were about $8,000 out of pocket. The home births took place with staff from MediFlower.

Switching to Tricare Select for Pregnancy
Starting January 1, 2019 you will no longer be allowed to switch to Select due to pregnancy. What this means is that if you have Prime, you would need to do one of the following
  • Get a referral to get the birth you want.
  • Pay completely out of pocket (OOP).*
  • Switch during a QLE (qualifying life event, not pregnancy, but for example, a move).
  • Switch during the the annual late fall 90 day open enrollment period.
However, while being pregnant isn't a reason to switch, having a baby is a QLE. So you can switch back after the baby is born.

* Costs vary greatly if you decide to pay out of pocket. A midwife for a homebirth can be 3.5-8mil. A birthing center can be 3-15mil.

What Kind of Labor and Delivery is Covered?
On Tricare's website it states that labor and delivery are covered. On that page, they also say . . .

Usually, your TRICARE plan determines the type of birthing facility you will use (military or civilian, office-based or freestanding, etc.). You also have different options for the type of provider who delivers your baby (obstetrician, Family practice provider and or Certified nurse midwife, etc.). These types of decisions will be made by you and your provider during your prenatal visits. 

However, there is no mention of home births, just certified nurse midwives. All midwives in Korea are CNMs.

What about Home Births?
Tricare Standard (now Select) actually does mention home births. The December 2015 Tricare Maternity Care Fact Sheet talks about choosing to deliver at home and what the cost shares are. 
Contacting Tricare on Facebook and the Tricare Overseas Hotline
That sounds promising, doesn't it? Don't get your hopes up. I contacted them on Facebook since the Tricare Overseas hotline kept saying home births should be fine when I talked to a representation after pressing 3 (for claims).


Calling Tricare Overseas, Again
About a week later, I called the Tricare Overseas hotline, again. This time instead of calling about claims, I pressed 2 (for referrals and authorizations). I said it looks like home births are covered but women in Korea are repeatedly getting denied. They put me on hold and came back and said home births are considered home health care and home health care is not covered overseas. I couldn't believe it, but sure enough, you can find the information on Tricare's site as well. How in the world they consider home birth to be the same as an illness or injury is beyond me, but that's Tricare for you!

The funny part is that they're wrong. (I know, you're shocked that Tricare is wrong). Home births are not home care. So why aren't home births being covered? It's because of the midwives.

Are Korean Midwives Covered?
The midwives they went through also work at a birthing center in Seoul. Tricare Overseas will cover births at that birthing center (MediFlower), but won't cover home births. Tricare says they cover midwife services if they're state licensed and certified by the American Midwifery Certification Board.

Korean midwife do not fulfill those requirements, so why is Tricare reimbursing patients who give birth at the birthing center but not those who give birth at home? When women give birth at the birthing center, a doctor is put down on the invoice since there is always a doctor on call. The midwife is then put down as a nurse. The same is not true for home births: the midwife is simply put down.


Bottom Line: Tricare is Not Covering Home Births in Korea
It's not fair to women to be told that home births are covered and then to find out they're stuck paying the full bill. Had these women known, they may have gone to birthing centers or chosen a less expensive midwife.

Tricare's Convoluted Stance on Home Birth Overseas
On Tricare's website it states that labor and delivery are covered. However, there is no mention of home births, just certified nurse midwives (CNM). All midwives in Korea are CNMs. Tricare claims that home births overseas fall under home health care and therefore don't cover them. Home birth really isn't home care. If Tricare doesn't want to cover home births overseas, that's up to them, however, they should update their maternity section and specifically list home births.

If You Still Want to Have a Home Birth, Read This:
If you're going to have a home birth in Korea, here's a list of providers. You might also want to consider reading The Essential Homebirth Guide as well as getting some birthing supplies together.

I personally believe that women should allow to choose where they give birth as long as they are able to do so safely. Hopefully Tricare will change. I just wouldn't hold my breath. Since Tricare isn't covering home births overseas, you have three options.
  1. Choose a cheaper midwife. MediFlower is great, don't get me wrong, but they're also more than double what other birthing centers charge for people with Tricare.
  2. Choose to give birth wherever you want and pay out of pocket. Don't bother filing a claim.
  3. Go to the USA and find a CNM who will do home births.  

Tips for Dealing with Tricare or any Medical Insurance Company
This medical hack below has lots of tips to help you out. Many times the people dealing with claims are paid minimum wage and have no medical background. They're simply checking boxes. If a claim is denied, it's usually because certain boxes aren't check. The last thing you want to do is have someone with no medical background making decisions about your health coverage! So follow these tips below if your claims are denied. (This will not work for home births in Korea since they don't fulfill Tricare Overseas requirements).

Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

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