Tricare West... driving me crazy

AlliBalleza

I swear I feel like I have gone through a million hoops. When we first moved here, almost a year ago, I was ran in so many circles that I felt like I couldn't breathe.

Apparently the insurance that covered Tricare West was changed, and it caused some major upset. I live in San Diego, so I went to Balboa to start my check ups and whatever else I needed. They told me just to go to whatever doctor and it would automatically enroll me. $600.00 bill later and the fact that I was working your typical business hours, I just had the mindset that I'll wait until they get their stuff straightened out.

Now I'm pregnant and while it's better, I'm still getting run around like crazy. I had to go to an external general doctor because they didn't have room for me (which didn't bother me at all). I went to the general doctor, she confirmed I was pregnant, now she needs to refer me out to an OBGYN. I was told the navy will accept or decline it, and if they decline it, you will be admitted to the base's OBGYN (which doesn't bother me much either).

Now they have denied my claim, but they haven't allowed me into the navy hospital. So I'm just in limbo. I'm going to be in my freaking second trimester before I can even schedule an appointment. Really?! /end rant

Has anyone experienced something similiar? And is there something I can do to help?

Kredsing

The minute I found out I was pregnant I switched to Tricare Standard to avoid the naval hospital. I wanted the freedom to choose my doctor and it has been a very pleasant experience! I would suggest switching to standard.

AlliBalleza

I'm actually on standard now and have been having this trouble. Gr!

JENandJEH

If you're on Standard, you shouldn't have to worry about what Tricare is allowing aside from making sure you are choosing providers that are in network.  You don't have to wait for a referral from Tricare, you just call the provider you want to see, ask if they accept Tricare and are in network and then make your appointment.  

I would call Tricare to make sure that you are, in fact, enrolled in Standard and then if they confirm, I would start calling OB-GYNs and make an appointment.  Maternity care will be 100% covered (except for a certain set amount for hospital stay and possibly some lab tests) but you may end up paying a co-pay for other visits that aren't maternity related.  

If you have a Tricare rep on your base/post, go in to see them and get it all laid out for you as to how it works.  As of April 1, all of the Tricare service centers are going to be closed but until then, you should be able to walk in and ask any question you may have concerning your benefits.  

shyviolet101

As others suggested, Tricare Standard might prevent some of these problems.  If you are having more issues, you need to find out if Tricare or the hospital has a patient advocate program you can utilize for assistance - waiting until 2nd trimester to be seen is considered "late to care".

mdominguez621

I reiterate checking to see if you're on standard. I had to switch from PR because they wanted me to drive to another state to get a referral to see an OB in the town we live. I wouldn't have been able to get my first OB appt until almost 16 weeks pregnant! Once I switched to standard I could see anyone. However, Tricare won't authorize my script for Diclegis (I have HG) and its around $315 out of pocket. Hope everything gets straightened out for you...it can be extremely frustrating!

chloebeth930

Ditto on the Standard.  You shouldn't have to wait for any kind of referral.  Call an OB, make sure they are a Tricare provider, and then make yourself an appointment.

Jennicillin

You're not on Standard, you're on Prime

You don't need a referral for anything when you're on Standard.  The whole process you're talking about with the Naval Hospital.  That's all TriCare Prime stuff.   If you were on Standard you wouldn't even have the Naval Hospital as an option, you'd be seeing all civilian practitioners.  Time to get on the phone with TriCare and switch to Standard...

sweetpea2003

Call Tricare and find out exactly what is going on with you.

When you PCS to a new region, you must call to make sure you are enrolled in that region. Make sure they have you in their system correctly, make sure you are in fact enrolled in Standard as you claim.

I have been a Navy wife for over a decade and while I've definitely had to advocate for myself with Tricare, nothing has been really that confusing or insurmountable. If you are on Tricare Standard, as long as you are seeing doctors within the network you do NOT need a referral. You will have to pay a deductible ($150 for you), but with maternity coverage it is Global and will not incur cost sharing or co-pays. 

Don't just sit around waiting for them to straighten it out. Either call Tricare (United Healthcare Military West), or find a Tricare Service Center (if they are still open in your area). If you are in DEERs properly and are enrolled in your region properly and officially on Standard then you should not be having these issues.

sweetpea2003

Also, billing isn't always Tricare's fault. I had to go to Urgent Care once when we first moved to CA and was billed something astronomical. When I called the office, they had "oops" just completely forgotten to submit the visit to Tricare. They re-submitted and I ended up paying the correct percentage for my care.

You can also keep track of all things Tricare online. You can see your claims, co-pays, and how much you have paid toward your deductible and cat cap here: www.mytricare.com OR www.uhcmilitarywest.com (mytricare.com is more comprehensive IMO but requires that they mail you a PIN).