Military Families
Options
Another Tricare ?
I was told today by the Tricare office that I will have to be seen at Balboa Naval Hospital to receive maternity care since I am considered high risk. I'm not at all upset about not being seen at my local MTF (awful, awful, awful), but it will be an hour drive without SoCal traffic. Isn't there a Tricare policy stating that if the available MTF is over a certain distance they have to refer you to a civilian doctor?
I have already researched OB's figuring the MTF wouldn't be able to "handle" me. Most of the "good ones" are in the Northern San Diego area, but are still about 25 minutes closer to me than Balboa.
TIA.
This discussion has been closed.
Re: Another Tricare ?
I can't find anything via Google except info about a new policy that essentially forces people to sign a waiver or switch to Standard if they live more than 30 minutes away from their PCM. This makes me wonder if they have done away with referring beneficiaries to civilian drs. now?
I've considered going Standard, but I've heard some horror stories about medical bills from other moms. Mostly from women who had complicated pregnancies and had to go to the ER and/or see a specialist. My last pregnancy was very much like that. On the other hand, I've heard women with uncomplicated pregnancies say they haven't paid a dime.
Thanks for the reply. Your story is definitely reassuring. Do you, or anyone else, know if Standard will fully cover things like L&D triage (kind of like an ER on the L&D floor)? I had to go there for monitoring twice during my first pregnancy and those are the types of things I'm concerned about. I find a lot of ambiguous info regarding things outside of "routine maternity care". Some say it's covered, others say it's "specialist care" and subject to co-pays and cost-sharing.
Can't we just trade? Haha... they are having me go to the miramar branch clinic, I figured that balboa's prenatal clinic must have been pretty much full. Its actually not bad, I just always get lost on that base because other than that I have no business there (I usually go to north island). I would gladly just switch you... haha. Yeah right, like THAT would ever be possible!!
If you are worried about getting all the way down there in an actual emergency you can always go into your closest hospital and tricare should cover it as long as its an actual emergency... I would scope them out and find out which one you prefer,
I'm really leaning towards Standard - just printed out the disenrollment form. I just want to make sure I understand the fine print. The catastrophic cap is $1,000, correct? If for some reason I reach that (unrelated to maternity), there are no further co-pays, cost-sharing, etc. for the fiscal year. Is that right?
ETA: If I switch to Standard, can my daughter stay Prime? She's able to see a civilian provider while on Prime and I'd like to keep it that way.
Thanks for everyone's insight. It's really helpful and appreciated.
I ended up in L&D once for monitoring (the weekend that my DH deployed). They covered it completely.
IMO, switching to Standard is a viable option for you, providing you are healthy otherwise, or can afford the cost sharing for treatment that is not pregnancy related.
Your daughter can remain on Prime. I was on Standard and my son was on Prime, with a civilian provider. Just make sure that if she needs to see specialists that the referrals are done correctly. I didn't follow-through with one for my son and I had to pay for the appointment. Not a big deal, but I learned my lesson!
It's definitely worth it! I had a complicated pregnancy and was seen every 2 weeks starting at 26 weeks and had ultrasounds done and NST's every 2 weeks and then every week and then twice/week. I was also put on a very expensive blood thinner, and had a c/s. I paid absolutely nothing during my pregnancy. Afterwards I had a complication with my incision and needed some extra OB visits. I had to pay a co-pay of like $20 for those, but that's all I paid and it was 100% worth it. I don't feel like I would have gotten the care I needed being high risk if I'd stayed at our MTF.
Even though you've already disenrolled, just as an FYI to all reading this thread...
'Tricare' policies are dependent on the company supplying the benefits for that region.
This is our second time being stationed at Pax River. When we were here in 2006, I had my daughter, and I had to switch my type of Tricare so I could self-refer to the OB I wanted...there are no OB services on base here, but they were trying to send me to a base about 1.5 hrs away, since our zip codes were 'within 50 miles' of each other. I tried to argue and lost, so I just switched Tricare types...OB services were no cost to me either way. This time around, I'm pregnant again and was ready to go through the same process, but a new company is providing Tricare services and they automatically give you a civilian referral since they have no OB services (there are no 'base within X miles' rules with them), so I didn't have to change anything this time.