Military Healthcare????
kimmiekp
member
I posted this on my month board, for July, but I wanted to post over here too, because I know you ladies will feel my pain over this! I have lived in Fayetteville, NC (home of the airborne hooah) for quite a few years and have experienced military healthcare. Let me tell you, while I appreciate free healthcare, I can tell you that my experiences, while few, have all been bad. So can you blame me, when I moved away and then moved back, that I looked for off-base PCP and OB and managed to get them approved (I guess Fort Bragg is that over-run). I knew I did NOT want to give birth at Womack, based on my previous experiences. I realized in doing this that I might have to jump through certain hoops but that it would be worth it. I am experiencing some of those hoops right now *sigh*
After two weeks of antici..PATION, I finally made it to the
day of my first ultrasound where I hoped and prayed I would see a
little heartbeat. I was so stressed out yesterday, worried something
wouldn't be right. I went to the appointment, sat there for a half an
hour, only to be told my "referral had expired". What? I thought once I
received a positive pregnancy test I wasn't going to need referrals
from my PCP. So my option is 1) pay the $250 for the ultrasound (which I
really don't have) or 2) go back to my PCP and get a new referral -
(My PCP is at an urgent care, you can't make an appointment. You have to sit there for up to 4 hours with potentially infectious people. Nice...). So I called and left a message with my PCP office asking them
to fax an extension of my referral, I mean this would make sense right? If an OB is saying I'm pregnant, they can't really expect me to come in there and pee on a stick for them to confirm it. An EXPERT has already done that! I didn't hear back from my PCP last night.
This morning I called Tricare and told them the situation. I fibbed and told them I have another appointment today (it's actually tomorrow-- wanted to make sure I had some wiggle room), I explained that I am a high risk pregnancy, that my doc is monitoring blood levels and that they need to do an ultrasound. They were really nice at Tricare and I thought "awesome... they're going to fix this". They said I just needed to have my PCP call in the referral, do it verbally and put it in as an emergency referral. (Neat!) So, still not hearing from my PCP, I call them again - They were "very glad I called back because they couldn't understand my phone number." (Gee, since I'm a patient, and you have my first and last name, you couldn't look it up???? - but that is besides the point.) She said she would do the verbal referral right away. Yippie????
So I called my PCP back a bit later: "I have some good news and bad news". Great... (all I hear is the bad news part of this). It seems, because I am close to Womack, and I am not being treated by the base, the referral first has to be denied by Womack before it can go to my OB and this could take up to 72 hours. I am surprised at this, but I shouldn't be, because we went through this the first time I had a referral over a year ago. The army hospital grabbed my referral (even though it wasn't made out to them) and decided they would treat me. I had to call patient services and explain that I had already been treating with my OB and they have all my information. Womack then released me to my OB. I would THINK you would ONLY have to go through this ONCE!!! Not every time! *sigh* -- My PCP office said the good news is that Tricare put an emergency on it and all the right language and hopefully it will be done in 24 hours. Well that's all fine and great, but remember I told them that my appointment is TODAY? (Good thing I did that right?) - And she said it could take up to 48 hours (which means I will miss my appointment anyway!)
So I just left a message with patient services at
Womack to see if I can't light a fire, and I will be on
the ass of Tricare to get them to continue to follow through to ensure I
get to go to my appointment tomorrow at 1pm.--Seriously, my doc said - avoid stress as much as possible. So why is it the majority of stress is my life is coming from the people that are handling my medical care?!?!
Re: Military Healthcare????
You know, I am strongly considering it. I if I do run into any more red tape I may just go that route. I have been pretty fortunate to not get sick very often, and all the times I have it has been a nightmare dealing with it all. But since I have been pregnant and having much less patience than I normally would (especially being a high risk pregnancy, making me that much more hyper). You definitely have to weigh the good with the bad.
This. And honestly, if your ticker is correct a lot of civilian OBs wouldn't even have you seen yet. I had my first kids before my husband was in the Army and I called my OB but they didn't want to even see me that early. My first ultrasounds with both pre Army babies were at 20 weeks.
This is not quite as dire as you are making it out to be. Yes, any care OTHER than the OB care will have a 15% - 20% cost share.
However, the yearly Cat Cap is only $1000 for the entire family (so any drugs, and your ob care are included).
I disenrolled from Prime for my pregnancy (i dont have a problem with Prime or Military Care, but I did have a problem driving 20 miles past the civilian hospital to get TO the Military Hospital - BAD traffic).
The only concern I had was having an accident and having to pay that $1000 up front. But I was healthy and safe.
Just for the record, I delivered at Womack and had a good experience there. Everyone in L&D was wonderful. I can't think of anything that could've been better as far as L&D goes. Just wanted to put a good word in there for Womack.
Good luck!
I would switch to standard. I had DS on standard and I paid under $130 after my deductible. I got pregnant soon after DH came home from Iraq in 09 and I ended up having a miscarriage. Hours later I went to the ER here on pendleton and they told me it wasn't an emergency and I had to wait. Needless to say H had some words and I got in soon after. Days later I switched to standard and I'll never go back. $1k a year is a small price in my mind to be happy with my healthcare.
And to the OP who said most civilian OBs won't see you at 7 weeks I think that depends on the area. My first pregnancy I was seen at the same time but there was no HB so two weeks later i went back and there was still no HB. This pregnancy with DS they offered me an appt around the same time 7ish weeks and I wanted to wait longer to the point where there should definatley be a HB.
The reason I've been seen so early is I have experienced four miscarriages in the past year and a half - this is why i was seen early and why I'm hyper about being seen, because they are closely watching my blood work and want to do the ultrasound to see how I'm progressing or if there might be some sort of complication that would require immediate attention.
Really, you know, I have heard such bad things that I've been afraid to even investigate the possibilities. Especially with how busy they are all the time. Then again all of Fayetteville is getting that way everywhere. I'm glad to hear you had a good experience. Everyone I talked to when I came here steered me away from Womack. Maybe they were all just paranoid, causing me to be paranoid.
I'm also on Standard for this pregnancy. I also had several miscarriages before I conceived DD and was treated horribly by MTF's.
Here's a tip, though if you decide to switch. Most OB's will require a pregnancy confirmation appointment before they fill out the Global Maternity paperwork for Tricare. Make sure your OB only does the urine and/or blood work at this appointment. Tricare will not pay for ANYTHING that takes place on the same calendar day as the confirmation appointment. I was unaware of this and my OB went ahead and did a vaginal ultrasound for dating, pap smear and other blood work and I ended up with a whopper of a bill. I would have paid less than five bucks had it just been the confirmation lab work.
Also, while maternity is 100% covered (no co-pays or deductibles), if you have any service that is not directly related to your prenatal care you will have a copay (15-20% depending on provider). I had my OB give me the flu shot and whooping cough vaccine. It was only $14 and well worth not having to deal with the vaccine cattle call at the Naval hospital.
On the other hand, I saw a civilian OB with DD while on Prime status. I never had any problem with my referral expiring. It sounds like your PCM made a mistake with the dates. If you get a new referral, make sure the dates go about 2 months past your due date.
Not the case for me. hmm. My first appointment with DS I was about 8ish weeks along and they did a vaginal U/S, pap smear, and blood work and I never got a bill for anything.
REALLY? Had your pregnancy been confirmed at an MTF or somewhere else? I've been round and round with Tricare. It is stated in Tricare's policy that pregnancy confirmation appointments are not covered under Global Maternity and that deductible and co-pays apply, but it's not in the handbook or on their website. Even the patient advocate had to dig for it. After umpteen phone calls and visits to the Tricare office, I just paid the dang bill. They weren't budging since my doctor had coded one part of the appointment - the urine test - as "pregnancy confirmation". I even had to pay a co-pay for the next visit because it was still unclear if the pregnancy was viable, therefore Tricare said it was still a "confirmation" appointment. Nice.
All very excellent advice. I think what happened is, I was being treated for pregnancy first, which is what the first referral was for. Then after the pregnancy the OB wanted to treat me for recurrent miscarriages, so I actually had to go BACK to my PCP and get a referral that specifically stated "recurrent miscarriages". So I think, once I became pregnant again and have been staying that way they started using the original pregnancy referral which was dated back in August of last year??? I dunno... Either way I'm guessing both of them ran out. Thankfully I was able to get every thing done over the phone and I can get my blood work and ultrasound today at 1pm (I have to call and verify that tricare actually sent it over to the ob's office, but according to Womack last night it was approved).
So are you saying, if I switch to Standard I then have to have my pregnancy confirmed again??? Or am I considered confirmed already since I did this on Prime?
By the way, I found out that you have a lot of help in dealing with referral nightmares and what not if you contact the patient representative at the hospital. They were VERY helpful with my situation so Womack does get super star points for that!!!
So you're saying the ***-up was at my OB? All I can say is I'm going to pay close attention to it this time. I was under the false belief that once I had the "recurrent miscarriage" referral that I was good to go. I mean the point was, I am attempting to get pregnant and something keeps going wrong and I need to be treated to ensure a proper pregnancy and delivery. And silly me didn't realize referrals expire during treatment. I thought so long as I was referred my care was then in the hands of the OB (which makes sense that they should stay on top of the referrals when you think about it). But yeah I'm going to ask them when it expires and put it on my calendar two months ahead to make sure this doesn't happen. I've quickly realized, ultimately, it is up to the patient to stay on top of it if they want to ensure the best care possible.
Seeing civilians on Tricare Prime can be tough with the referral process. Our base is quite small and the clinic doesn't have specialty care like OB or derm and getting referrals into town can really be annoying because Tricare Prime is stingy about how many visits (eg: if you go to a derm and need a consult, then surgery, then post-op you need to make sure you have THREE visits in your referral).
I personally think that Tricare Standard is the best kept secret in the military. They try to scare you with wording but it is VERY cheap as insurance goes.
You pay $150 annual deductible up front. Then you pay 20% of allowable charges up to $1000. That's it!!! And OB care is FREE. I just went through an entire pregnancy with two doctors - one high risk and one OB - all civilian with ultrasounds every 2 weeks and paid $0 with Tricare Standard. I also see any doctor I want (who takes Tricare) whenever I want without referrals or any issues. It is great!
I am willing to pay up to $1000 per year for less stress with my healthcare. With two kids under 2 I don't have time to see m PCP every.single.time I need a referral for something. I also like the freedom to pick and choose my doctors and not feel pressure to see whoever is at the base clinic because that is who Tricare Prime says I have to see.
oh wow. thats crazy! to answer your question no. it was my first appointment ever with ds. i was standard so i called my ob to make an appt and the day of the appt they did everything.
my final bill for a failed induction and an emergency c section was $114.10 after my deductible.