Last month I posted a discussion about my struggle with my military health insurance, TRICARE, to pay for a home birth with a Certified Professional Midwife (CPM). TRICARE currently partially pays for planned home births, but only with Certified Nurse Midwives (CNMs). My original letter to them included 13 pages of research and data backing up the safety and rigorous certifications of CPMs, and I got a one-line response saying they wouldn't look at my grievance unless I had already requested coverage through the CPM. This made no sense to me because I could clearly see from their regulations they would deny my coverage. I wasn't asking for coverage under their current rules, I was asking for a change in policy.

So I wrote them again, and this time copied my congressional representatives. And they responded! Rep. Susan Davis of San Diego, where I used to live, has forwarded my letter to the Congressional subcommittee that writes TRICARE policy. She can't do more for me because I'm no longer her constituent, but at least it's something. Rep. Kevin McCarthy of California's 22nd district has taken my case on personally and will see if TRICARE can make an exception while legislation is pending. This is great progress! Although I don't want to get too excited that something will actually happen, at least someone is listening, and the more the message is out there, the more likely it is that something will be done.

I've attached the original letter I wrote to TRICARE, their response, and the letter I wrote to Rep.McCarthy. If you print them out, forward them to your representative, and say that you support changes to policy, then maybe we can make a difference in insurance for everyone. It's a hot issue right now with all the healthcare debates, and it's a clear way to save money while providing a better standard of care. Let's keep our fingers crossed!

~Suchada, www.mamaeve.com

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Thank you so much for sharing this!
I'm curious, what is the difference between a CPM and a CNM (other than definition - I imagine its having an RN degree as well?) I am in Canada, not sure if we have one or both designations here...
Hi Karen --

I don't know if Canada has the same designations as the US or not, but I'd imagine they're similar, since I believe Europe has CPMs and CNMs. A CNM is an RN that has undergone additional training to become a midwife. In the US, they more commonly work in medical settings such as a hospital or birthing center, but they can also do home births. A CPM is a direct-entry midwife who has undergone specialized midwifery training including classroom education, hands-on training (an apprenticeship), and passes certification tests and licensing (usually based on NARM guidelines, which most states that license midwives have adopted as their standard). CPMs tend to work more in home settings, and their training actually makes them ideal for it. The reason my military insurance, TRICARE, doesn't recognize CPMs as authorized providers is because it's a national insurance system, and right now CPMs aren't recognized in all states, although I believe at this point their is at least legislation pending in every state to allow them to practice legally.
ok, I think we have the same thing here. I am in Alberta which has midwives (I think both designations) covered through our provincial healthcare, so hospital, birthing center or homebirth are all covered. I don't know if that is just our province or if its is Canada wide.

A couple of the doulas we talked to were student midwives but said nothing about being nurses which makes me think that we would have CPM's as well.

Hopefully all the legislation passes in all states, and hopefully you can get an exemption!
im proud to see another military wife stand up to tricare!
You are amazing! You really are an activist. We all complain so much about the system . . . but sometimes I wonder, what are we doing to change it? You did something! And it could make a difference not just for your family, but for so many families in the military!
Way to go!!! That is awesome!
I am in search of a midwife and had NO idea if tricare would cover me or not. Now i see that i need to take these extra steps to change something!!...just a question if tricares denies your homebirth will you just have to pay out of pocket?
Hi Amanda --

TRICARE actually does cover midwifery care in many cases, including for home birth. They allow CNMs to be authorized providers, and will almost always cover 100% of maternity care with midwives at a hospital-based or freestanding birth centers, which are normally staffed by CNMs (and some CPMs). When I lived in San Diego, I had TRICARE Standard and was getting full coverage for my maternity care at a freestanding birth center. I also had a friend who had her care fully covered at a hospital-based birthing center (also in San Diego). And the military hospitals there actually had midwives on staff (but those midwives were still required to follow the restrictive hospital protocols).

If you want a home birth, TRICARE will partially reimburse you for a planned home birth with a CNM. The reason you won't get full reimbursement has to do with billing codes, which is confusing and frustrating. Basically, TRICARE allows birth centers to bill at an all-inclusive rate up to a certain amount, but doesn't allow midwives to do this for a planned home birth. The result is that midwives have to try to fit their services into restrictive billing codes like "10 minute routine visit" or "30 minute urgent visit" -- and they have to justify the "urgent" status in order to be paid for a longer visit.

So if you have TRICARE, you do have options for them to cover midwifery care, but it's restrictive. The reason I'm in the situation I'm in is because we moved from San Diego to a town that has only one midwife (she not actually based out of my town, she's 80 miles away, but she's the closest one), and she happens to be a CPM. And I have decided to pay out-of-pocket to see her. After speaking with the local hospital staff, I just knew I wouldn't be comfortable with giving birth there, and I didn't want a stressful labor, birth, or recovery.

This is probably WAY more info than you need, but I hope it's helpful. I would love it if you printed out my letter though and forwarded them to your TRICARE branch grievance department. I think it will make a difference if they see what a demand there is for solid midwifery coverage. I have a lot of resources for finding a midwife on my website, www.mamaeve.com if you want to check it out. And best of luck with your search and your pregnancy!

Cheers,
Suchada
Suchada, Thanks so much. I am located in Las Vegas Nevada and it seems that only CPMs attend homebirth as the CNMs here only attend births at the hospitals. ( We also have no Birth Centers) The CPM that i am actually trying to see was a CNM and gave her certs up because she wanted to attend homebirths. So i am guessing when i do try and call tricare i will have an issue. Horrible to hear especially being prego and hormonal and having no options :(
Hey, well, the good news is that you're the same region that I'm in -- TRIWEST, and you're in a state that licenses CPMs. I totally understand about being preggers and hormonal -- my DH has been a SAINT the last few months putting up with all of this and agreeing with me that out-of-pocket is ok if it comes down to that. He was able to catch our son and lift him up out of the water and into my arms when he was born, and I think after that he understands the importance of having a birth free of unnecessary medical interventions.

Anyhow, feel free to use everything I have done to send to TRIWEST, and forward the packet on to your representative (you can find the address here). Let them know that Rep. McCarthy of California is supporting me in my efforts, and see if they'll do the same for you. I think it will be an eye-opener if there is more than one person at the same time asking for a change.

If there is ANYTHING I can do to help, please email me (suchada@mamaeve.com) -- I think CPMs provide such an important service, and there's no reason TRICARE shouldn't cover their care. Hang in there with the hormones -- I am sending good vibes and strength your way!

S.

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