Military Mom

Deansmommie

I am currently pregnant with my second, 5 weeks 3 days. I am high risk, with a strong family history of blood clotting disorder, and I developed polyhydramnios (extra amniotic fluid) and gd very late in my previous pregnancy(34 weeks). Just with my family history alone I was referred out to a civilian doctor with out being check when we were stationed in North Carolina. 

I was saw by my PCM at Mayport and he automatically told me I he was going to send me out into town. I was then called by the Tricare office the next morning and was told that I was denied because they had room in the OB department for me at Nas Jax. The lady was extremely rude to me when I explained that I had to be seen by a Maternal Fetal doctor that specialized in APS. Later on that day the OB nurse called me and was just as rude when I tried to tell her that my PCM had my previous pregnancy medical records and that he said I needed to be seen by a specialist. She told me "well you don't have those conditions now, so you will be seen here until you develop them and then you will be referred".... completely dumbfounded that some one had the audacity to tell me this, I proceeded to tell her "your right we DONT know if I have the clotting disorder with this pregnancy because you won't let me get my blood drawn until after this class". I have never been so disrespected by any one in the medical field. I have never been a fan of the Mayport clinic, as they just heard patients around and do not care about them. I have sent this nurse my medical records from my son (with all the 100 ultrasounds I received). 

Now my question is...Does anyone know if Nas Jax has a high risk department, as I can not find anything online about it, just the lawsuits against them. Also if anyone knows what this class is about, and if I can go around this nurse/ob and get a referral to a civilian doctor. My husband and I have discussed going standard, but we don't want to pay out of pocket with each visit, because I had ultrasounds done 2 times a month until i developed polyhydramnios, then 3 times a week, and this can get pretty expensive. I appreciate any advice in advance.

josie12367

Check on this military families forum too....

https://forums.thebump.com/categories/military-families

I would try and check with your PCM about getting the blood work drawn. Just explain that the OB unit will not order the test till after the first appointment, but due to your condition you're worried about the delay. If that doesn't work, then I would try putting in an official telephone consult with the OB unit. A doctor has to respond to them, and it might be a way to talk directly to a doctor, and get their actual opinion. Many times nurses are the "gate keepers" and think that they are giving the correct advice, but the doctor would disagree if they had been consulted about it.

If you really want to go standard, I would call your regional TRICARE and figure out if a referral is necessary from your PCM or not. I don't think they are required with standard...but I could be wrong, especially since you need a specialist. You could also ask about potential payments/costs while you have them on the phone. (Also, they don't really care about us either....both times I've call the regional office the people were very unfriendly but still knew the answers to my questions. So just a heads up to be prepared that you will get no sympathy, but you will get answers!)

These are the few things i would try. TRICARE can be very frustrating. I'm not even getting seen till my second trimester due to TRICARE issues and moving, so I feel your pain (sort of). I do hope you get this all straightened away!

missnc77

I have Tricare Standard, and it's really not anything crazy out of pocket. I think my deductible is $300 a year, and I don't have to deal with the PCM stress, which is worth it in my opinion. Also, Tricare Standard covers most ultrasounds. The only ultrasounds they don't cover are those not medically necessary such as seeing the baby's sex.

Ultrasounds

Doctors often perform ultrasounds at different times during pregnancy for different reasons. TRICARE will cover ultrasounds used to:

• Estimate gestational age
• Evaluate fetal growth
• Conduct a biophysical evaluation for fetal well-being
• Evaluate a suspected ectopic pregnancy
• Define the cause of vaginal bleeding
• Diagnose or evaluate multiple gestations
• Confirm cardiac activity
• Evaluate maternal pelvic masses or uterine abnormalities
• Evaluate suspected hydatidiform mole
• Evaluate the fetus's condition in late registrants for prenatal care

TRICARE does not cover maternity ultrasounds for routine screening or to determine the sex of the baby. If you have ANY questions about coverage, please contact your regional contractor.

JessicaB0627

Do y'all know what TRICARE for reservists is like? DH is trying to switch us to that instead of the insurance through his employer because he heard it's so much better, but this conversation makes me nervous! Obviously I couldn't be seen on post since he isn't active duty but I'm not sure what to expect.

missnc77

Tricare's website is really informative in comparing plans. You can also google plan comparisons.

Reservists -
https://www.tricare.mil/Costs/HealthPlanCosts/TRS.aspx
https://www.tricare.mil/Costs/HealthPlanCosts/TRS/CostShares_US.aspx

JessicaB0627

@missnc77 Thank you! I have such a hard time figuring out insurance.

Deansmommie

Thank you ladies! I am going to go to the Tricare office tomorrow after the class I have to attend, before I have my actual first appointment.

I have one last question, would it be possible for my PCM to override the rejection of the referral? Since he has my medical records from my previous pregnancy, I had them faxed directly to him.

josie12367

They probably can not override the rejection of the referral, because a referral to a high risk OB has to come from a normal OB office...but they might be able to provide you the blood test that you need to prove that you are going to need a specialist.

EDIT: Also, make sure that you call your TRICARE regional office as well. Most of the time the small in-hospital TRICARE offices will give incorrect information.

Deansmommie

Thank you!!

mightylady

If you're still not satisfied you should became to look up providers on your regional tricare website to determine if there's a high risk OB you could self refer to if you switched to standard. Standard was the best decision I ever made. Where I live it have to drive over an hour for ob appointments/to deliver. F that noise. Not doing that again.

amelia004

I have had Tricare Reserve select for years and LOVE it. I dont need referrals and can see whom ever I want. The only down side is the $1000 catastrophic cap. The deductible is $250 until I reach $1000, then all is covered. This works for me because it is very much hassle free. Also, you can get same day coverage if you e-mail the application.

karmana

Personally, I hate Tricare. My husband has been active duty for 17 years and we have seen it go from bad to good and back again. Unfortunately, they are forever changing with what they cover especially if you're not seen on base. I will say I am happy that they are now covering breast pumps!