Now, Maybe this was so easy for me because I really Planned ahead. But today I want to share with you how I got Tricare Prime to cover an our of network birthing center, no questions asked.
We are stationed at Scott Air Force Base, in Illinois. Its a pretty huge base when it comes to manpower, and the two different headquarters here. Also we are right outside St. Louis Missouri, and if you look closely at the Tricare east boundaries you can see they are strategically drawn to include those of us stationed here. Everyone is constantly getting referrals to one of the two major children's hospitals here, or the many specialist. But when it comes to prenatal care, many of us seem stuck with base providers. And if the spouses page counts for anything, most expecting mothers are not too happy about that.
Now I don't think anything is wrong with the military doctors. I work with them often and they always seem nice enough, and many of the residents are eager to learn what a doula has to offer. But they all work in a hospital that is rather small (5 birthing suites) and a lot of the nurses are not that great at supporting their unmedicated births. They all seem to be really big on major interventions, and its just not a place for me personally. Really anywhere on base isn't really for me. I haven't had the greatest experience anywhere we've been stationed. And really don't think I should have to bring my husband with me to all my appointments, just to be treated kindly.
So without further delay....
Everything I did to get Tricare Prime to cover an out of network birthing center.
For starters, I had to call Tricare-Humana to learn that I did not have to stay on base for my PCM. The base clinic is already in the process of becoming active duty only. So when I wanted to see a primary care doctor at a local clinic they were more than happy to simply switch me, and my daughter. Now I'm grateful my daughter and I have the same doctor and I can schedule our appointments together. When meeting my new doctor it was brought up that I am actively trying to get pregnant, she told me that when I did get a positive test all I had to do was call and she would write a referral to anywhere I wanted. SWEET
When I did get a positive test I called Tricare-Humana back, the lady was nice enough to pretty much walk me through everything I had to do to get the birthing center covered. First they were out of network, but not really. The Tax ID was accepted by Tricare but they were so far away that they were considered out of network. The woman on the phone told me that they would cover the birth center, completely, if I had a really good reason for wanting to go there. And my reason was simple, they are the only place that allows water births.
So I called up that new PCM office of mine and asked for the referral, I let them know that I had to have my good reason written on the referral if I wanted Tricare to accept it. They happily obliged and sent the referral to Tricare the same day.
And guess what, Tricare approved it that very same day, it didn't take weeks.
So that's it, that is literally all I had to do. Fly my little pretties, and never let your insurance control your birth wishes again!