Tricare clomid, ovidrel, with TI

ElynWise

Hi I was wondering if anyone knows if Tricare will cover doctor's appt, u/s, clomid, and ovidrel if you doing it with TI, if you are going to a civilian RE.  I know once you start IUI they won't cover anything but I heard that they will cover everything if it's TI.  The billing office at the RE i'm going to won't even put in another referal (my first referal was for consult and 3 visits) because they said that I wasn't covered under Tricare for that.  I'm doing the same thing this month as I was doing last month, they paid for it last month but now all of a sudden they won't pay for it anymore?  Has anybody had this happen?  Does anybody know how to fix it?  Does anybody know the billing code they need to use to have it covered.  I think they are billing it wrong which is why they think it won't be covered.

lisa&andy

My kids are the product of Follistim, Ovidrel and TI with a civilian RE.  I got my referral for him and just added visits as needed, it covered all of my bloodwork and ultrasounds. I paid my copay for meds, nothing to the RE. I would make sure that they are billing it as TI and not IUI, other than that I would contact Tricare and determine why it wasn't/wouldn't be paid. Is this the Insurance person at the RE or the front desk person? I would also start questioning them why it was paid last month, but not this month, what changed for the RE's office? As long as you have visits with Tricare and they are still a Tricare provider, I don't see why there would a be problem. Hope you get everything worked out!

SunshineDanie

I was just talking with another woman this morning and she said that the TriCare support here on base actually said "they cover anything and everything going in, but not coming out and going back in" meaning they won't cover Invitro, but medications, tests, ect.  You'll most likely have to be referred to a civilian specialist, but at least you'll only have a few copays!

ElynWise

Well I did call Tricare and they told me that it should be covered as long as I'm not doing IUI or IVF and all they would have to do is request more visits.  I talked to the lady at the RE's billing office and she told me that what she is reading under my benefits that when i started clomid that is considered treatment and Tricare will not treat it anymore.  So I called the RE's office and all he did was call the billing office and the lady told him that Tricare would not cover it anymore so they aren't really doing anything.  I'm trying to find out what the billing codes they are using so I can call Tricare and they can tell why "they are not going to cover it" even though they should.  I think it has something to the way they are coding it.  I have to wait until monday to call they back.  We are stationed in Port Hueneme and I think I might just drive down to San Diego to go to the MTF there because I don't know how I feel about a RE that won't take the time to try to figure out how to fix the problem.  

Ashley858

Everything for us was covered as far as the meds, visits and u/s. The only two issues I had were getting away from the RE on base to a civilian RE and getting the meds covered.

Everytime that I tried to put in a referral to an off post RE it had to go through the AMC for approval and when they saw what it was for they tried to send it over to their office to have me go there so I had to have the referral done 3 times and on the 3rd time I had to call Tricare and let them know it had been put in so they could watch for it so it wouldn't be kicked out of the system at the Hospital on post.

As far as the meds the RE had to call and get pre-approval for the medications before Tricare's third-party Rx coverage provider would pay out. It was a headache at first trying to get everything set up but after the first few weeks it was straightened out and worked fine.

Good Luck!