Insurance ?, help! — The Bump
Military Families

Insurance ?, help!

Hi ladies! Im hoping someone will be able to help me, this is really starting to add stress that I do not need... So right now DH is in the reserves but he has a civilian position on base so we currently have bcbs federal. We are thinking about moving back to our homestate in a couple weeks though, so we would have to switch to tricare reserve select. He has spoken to tricare and Ive been on their website a million times and my pregnancy brain is not functioning and I dont get it. My question is that the tricare lady told DH that the delivery will only cost $16.17 (or something around that) a day and thats all. But on their website I see stuff about 15% cost shares and $1000 cap limits...sooo what is it?! Do I pay the $16 plus the $1000 cap??...do i pay the $16 plus 15% of the bill?? I need to know bcuz I am hesitant on switching insurance and dealing with all of this so close to my due date (in July) and I just need to know if it really is only the $16 bucks and thats all or are there going to be cap and cost share fees included in the delivery. Thanks to anyone who has experience and can help, I appreciate it!

Re: Insurance ?, help!

  • This is how it worked on tricare standard. Everything pregnancy related covered after we paid the initial deductible which was $150.00. Now if I would have fallen and broke my leg while pregnant I would have had to pay the cost share of 10% up to our family cap of I believe up to 1000.00. My cost per day in the hospital was 15.00 per day. I would ask the questions about pregnancy related vs. non pregnancy related expenses. 
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  • My husband is also in the reserves and we have tricare reserve select. honestly i have not paid a dime for any of my prenatal care and from what the other mothers in the area have told me, regardless of what it says online or elsewhere, they end up covering everything. My OB also said I shouldnt end up seeing a bill at all. I have even had a complicated pregnancy and needed to get surgery (on my cervix DURING pregnancy) it cost me $25 out of pocket and the total cost was over 3 grand. So dont sweat too much.  I completely understand your concern though. My best advice would be to talk to your OB and find out what the average labor and delivery costs are...then call tricare and tell whomever you speak with, when you deliver the cost would be estimated around (whatever total) and you need to know out of THAT total what you would be held responsible for....and that should give you a clearer picture.  If asking about costs without exact dollar amounts (even if they are just estimated) they will simply answer you with all the bull-hockey you see online, cost shares and cap amounts...and then you're swimming in jargon.

    As far as I have ever heard, the military covers damn near 100% of labor and delivery costs regardless of which tricare package you have.

    Good luck!

    Lilypie - Personal pictureLilypie First Birthday tickers
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  • Thank you both, I really appreciate it!!
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