Tricare and ultrasounds — The Bump
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Tricare and ultrasounds

So I just found out this week I am pregnant...I know its early for any of the u/s but I was doing some reading from other spouses in the area about how they were only getting one u/s approved without having to pay out of pocket.  I checked on the tricare site and it does say that they will not cover the u/s for determining the sex of the baby.  How do you find out if you want to know.  Do most doctors just say oh we are checking for this but tell you or do you really have to pay for that part of the u/s?

Re: Tricare and ultrasounds

  • They tell you as part of your anatomy scan

    Married 11/27/09 and TTC right away
    Dx: Complete septate uterus with cervical duplication, endometrial polyps, PCOS, endometriosis, hypo thyroid, luteal phase defect
    4 uterus surgeries to correct my complete septum and to remove polyps and 2 years of seeing the RE, medicated cycles and IUIs
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    Baby #5: 3/13/12 BFP! EDD 11/25/12 ANOTHER m/c :(

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    ArmyWife114[Deleted User][Deleted User][Deleted User]
  • I was told at my anatomy scan, but I was warned that if the baby wasn't in a good position to identify the sex, that there would be no repeat.
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  • As PPs have said, unless you have a history of losses or other issues, they'll do one ultrasound at 20 weeks. They will cover that, but they would not cover an ultrasound just to determine sex.

    From what I've heard it's hit or miss on whether they'll try even a little bit to determine the sex or not. Some doctors/ultrasound techs seem to be okay with trying a few simple things to get the baby to turn around and be able to determine it. With others, as long as they're getting all of the other measurements, will not try anything to see the sex. If they see the sex at the anatomy scan at 20 weeks, and you want to know, they will tell you. That ultrasound is covered whether they tell you or not.

    Other than that, your best option if you want to know and can't find out then is to find one of those ultrasound boutiques that just does sex scans. I don't know how much they are, $200 is the price I've seen quoted most.



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  • edited February 2014
    Like others have stated, they will tell you at your anatomy scan if baby cooperates.  Tricare will cover any u/s that the doc deems and codes medically necessary.  My doctor for both my last pregnancy and this one did a dating u/s at my first appointment (around 8 weeks), one at 13 weeks as part of my NT scan, the anatomy scan at 20 weeks and last time they did one at the very end of my pregnancy to check the baby's position before they induced me.  All of them were covered because they were things my doctor coded as necessary.  I know some women only get one at 20 weeks, and some have far more than I did, it really just depends on your doctor.
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    Jennicillin[Deleted User]amscharfChadAlana
  • Thanks, I am so new at this since its my first kid.  I have yet to even go to the first appointment yet I just remember reading things over forums.  
  • I had multiple ultrasounds done when I was pregnant in '08, including the gender determination, and Tricare covered them all.  I'm not sure if they're stricter now, though my referral approval letter stated several ultrasounds on it.  Even still, I'm also going to a local boutique that does the "first heartbeat" ultrasound for $50, then that is credited towards the gender determination ultrasound as early as 14 weeks, so that's only $30.  They repeat the ultrasound if they can't determine the sex.  My gender determination will be at the end of March, woohoo!  It's called My First Peekaboo.  I recommend it if you have Tricare issues.
    Baby Zoey arrives Sep 14 2014!

  • I'm being seen at at MTF and have had several ultasounds.  I had one for dating, one at my 12-week appointment, another one for the NT test, and then one at 21 weeks for the anatomy scan.

    The warming about not finding out the sex is kind of alarmist I think.  They just want to make sure you know that the purpose of the anatomy scan is NOT to determine the sex, it's to check out the function of lots of parts of baby's body to make sure there aren't any abnormalities.  There's a lot that the techs need to look at and measure in a short period of time.  Sometimes the baby just isn't positioned right to determine the sex, and if not then they won't redo that part of the scan at a different time.   


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    Erin1510
  • They will cover necessary ones. For me I had one at 9w for dating and then my anatomy scan was at 17w. They will not cover an u/s just to find out the sex, nor would your Dr give you one probably. Like Avion said the anatomy scan is so much more than finding out the sex, that's just a perk of it. They do important measurements, checks the brain, spinal cord and heart, check development, etc. Most of the time they can tell the sex, but that's not the main purpose.
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  • They want to know the baby's sex as well so they check at your anatomy ultrasound. They just won't host an ultra sound for the purpose only being the sex
  • I think getting the bloodwork done for maternit21 (to let you know if there are any issues genetically) will let you know if you're having a boy or girl, and you can get it at 10 weeks.

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  • The tech will tell you during the anatomy scan if you want to know. I've already had 3 ultrasounds during this pregnancy- a dating, follow-up, and a surprise one day I went in for a scheduled appointment. 
  • I have had 4 ultrasounds so far and we haven't had to pay for anything. First was in the ER around 6 weeks when I had cramping and bleeding. Second was at my first OB appt at 8 weeks, doctor wanted to follow up from the ER visit. Third was NT scan at 13 weeks and my fourth was earlier this week (20 weeks) for the anatomy scan. The tech was able to identify the baby's sex at the anatomy scan.
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    Cyndy73
  • I've had about 30 all for medically necessary reasons. They will pay for as many that are needed

    Married 11/27/09 and TTC right away
    Dx: Complete septate uterus with cervical duplication, endometrial polyps, PCOS, endometriosis, hypo thyroid, luteal phase defect
    4 uterus surgeries to correct my complete septum and to remove polyps and 2 years of seeing the RE, medicated cycles and IUIs
    Baby 1 and 2: BFP 3/3/11 with 2 babies EDD 11/1/11, M/C 4/6/11
    Baby #3: 8/11 pregnant EDD 4/27/11 and m/c:(
    Baby #4: 10/12/11 BFP! EDD 6/16/12m/c 10/26/11
    Baby #5: 3/13/12 BFP! EDD 11/25/12 ANOTHER m/c :(

    Baby #6: 2/14/13- BFP! EDD 10/24/13, CP 2/19/13
    Baby #7: 3/15/13- BFP! EDD 11/27/13, another CP
    Baby #8.  BFP 5/19/13 EDD 1/22/14. 8 was not our lucky number

    4th septum resection on 5/31/13.
    Baby #9: 6/29/13 BFP. C section scheduled for March 5th!

    My miracle baby was born March 5 at 9:33am. He was 8 lbs 12.5 oz and 21.25 inches long!

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  • shutaffshutaff
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    edited March 2014
    So far I have had four: one for spotting in the ER around 7 weeks, one that my doctor requested for dating at my first appointment around 10 weeks (his standard practice), one at the high risk doctor at 13 weeks, and another one in the ER this week for spotting again. You can choose to have an ultrasound around 12 weeks to determine your baby's risk for chromosomal abnormalities (NT scan) if you'd like. Instead (because I'm high risk), we did the Harmony Test which also reveals the sex. If you choose not to do either of those, you should be able to find out the baby's sex at the anatomy scan which is the one you are guaranteed to have around 20 weeks.
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  • Just adding this late and it doesn't really have anything to do with the initial post

    As an u/s tech, the gender is actually pretty important. There are certain things we look for if it's a boy or a girl. Certain syndromes that only apply to a certain sex. All of our worksheets at the hospital (not an OB office) ask for the sex. So even if they don't say, they do look. But it's not the most important thing obviously. If we don't see it, we don't see it.
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  • At my tricare pregnancy briefing they said generally 2 ultrasounds are covered... or any and all prescribed by your obgyn. If you request one just because you wanna see the baby, they may have you sign something saying you know you're responsible for the bill.

    But, a lot of docs do them and don't even bill them to tricare. The hospital on Ft. Jackson doesn't do maternity anymore so I'm seeing a civilian obgyn. I'm 7wks 6days and had my first appt this past week. They did an u/s to confirm pregnancy, instead of blood work (pcm confirmed via urine 2 weeks prior). I'm going back for another in 2 weeks to check everything out bc it seems I ovulated late. I'll have another at 12 weeks for the NT test. So that's already 3 u/s within the 1st trimester. Just depends on what YOU need :)

    We are so blessed to have tricare, IMO! Because they cover practically all pregnancy costs. :)
    IrishcurlsBeachy730
  • I had 3 u/s during my pregnancy. One at my first appointment to determine a due date. One at around 10 weeks bc I had heavy bleeding so they had to check for a mc. And the 20 week anatomy scan, which is when I was told the sex. All 3 were covered with no problems. You just can't get a u/s strictly for the purpose of finding out the sex. But if it's medically necessary, you're fine.
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  • If you are wanting to see the sex of the baby and baby doesn't cooperate during the anatomy scan you can opt to have an elective one done. I see pp have mentioned the fees associated with doing an elective u/s and I thought I would mention another route. Are there any medical schools in your area? I know that in my area there is and they asked pregnant women to come in for free u/s so their students could practice reading u/s. I would recommend doing this AFTER you've done your anatomy scan and know that LO is OK. The last thing I would want is to go to a medical school and have a training tech guess or say they see a problem with LO and cause panic.

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  • As PP have said, it's all how the doc codes it. They have to be deemed medically necessary--dating the pregnancy, checking for movement, positioning, etc. If they code it as a "normal pregnancy" Tricare may bump it back. We were told to call Tricare directly to get that fixed because the doc should know better.
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  • kelslyniekelslynie
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    edited May 2014
    Depends on who your doctor is. If you're going to a military hospital, the 20 week ultrasound will probably be done free without question. If you're going to a civilian doctor, it won't be (unless the doctor writes your pregnancy off as high-risk).

    Baby #1 -- Husband was deployed and I went to a civilian doctor back home. Tricare would not pay for the 20 week ultrasound because I was not high-risk. If I wanted it, I had to pay for it out of pocket, between $500 - $600. I chose to do it anyway.

    Baby #2 - Attended the military hospital throughout most of the pregnancy, all ultrasounds done at no charge.
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  • Honestly, I think it depends on whether or not your base has a maternity ward. Mine doesn't, so I have to do all my prenatal care off base, and I'm going to the same obgyn as my friend, and he told her the gender of her baby and she didn't have to pay out of pocket for that.
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