Thought that might get you in here!
DD's birth was at an MTF (Womack at Bragg - very nice facility!), and we saw the midwife clinic there all through. We had the 20w ultrasound and that's it. Totally fine with that policy.
I'm 12w along with #2 and stationed >50 miles away from the nearest MTF, so we're on Tricare Prime Remote (basically same as Prime w/ no copays, and don't have to use an MTF). I went to my first appt with an OB yesterday and they wanted to do an ultrasound. I told them my ins. does not cover 1st tri and they kinda freaked out and said "how can we confirm the pregnancy without an u/s?" "Uhh, with a blood test and external exam?" (helloooo, 2nd time around, I'm clearly showing uterine swell!)
So DH and I, separately, call Tricare to inquire and are both told that they cover zero ultrasounds. Without medical necessity. Said that if we got one with #1, it was because the MTF gave them, not because of Tricare.
And so it is:
https://www.hnfs.net/common/benefits/ultrasound_policy_040106.htm
I haven't told my friends IRL who had kids with private providers, and I'd like to ask them, but I guess they all got their providers to submit medical codes of "poor fundal height growth" and other fake diagnoses to get their u/s? Sheesh.
Re: Tricare doesn't cover any ultrasounds
Tricare doesn't cover anything without medical necessity. It may be for dating purposes, but that is considered a medical necessity by many providers when an EDD cannot be exactly determined with other means.
Tricare will cover the u/s, the office has to code it correctly so that it is covered.
I'm on Standard and I've never had to get an ultrasound approved. Standard does not require prior authorization. Is your doctor a Tricare Network provider? If so, I would definitely dispute this. The doctor should have filed the "global maternity" paperwork.
TRICARE follows the Standard of Practice that most Civilian HMOs follow. They will cover the initial dating U/S and then one at the 20 week mark to check on the overall health of the baby.
Depending on how YOU and YOUR DH asked your questions, the TRICARE person would tell you no U/S if they were not medically necessary. Which is true. The two mentioned ARE medically necessary.