Tricare Standard and pregnancy? — The Bump
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Tricare Standard and pregnancy?

I switched to Standard after a horrible experience last year at our MTF. I have had one ob visit, and I just got a bill for over $100. I was thinking pg was 100% covered, even on Standard?? Am I wrong? If I owe it, I will gladly pay it (seeing a civilian was worth it to me with my history of loss) but I was thinking I wouldn't have to?

 

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Re: Tricare Standard and pregnancy?

  • As long as the civilian doctor you are seeing is a Tricare provider it should be 100% covered.  I don't believe they pay for that initial pregnancy confirmation appointment thought.
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  • Your first appointment to confirm pregnancy is not technically a "pregnancy" appointment according to Tricare, so it's not covered under Global Maternity. Anything deemed medically necessary from here on out will be though. 
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  • This was my appointment where I had an u/s too, so would that be covered? I don't remember any of this from when I was pg with my son 8 years ago. 
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  • The only ultrasound Tricare  will cover unless the doctor billed it as "medically necessary" is the standard ultrasound around 20 weeks. An Ultrasound to confirm pregnancy is not considered medically necessary since it can be done with a blood test, however that 100 dollars I would check on unless they were confirming your pregnancy at the time of the appointment. You should call your tricare region line to make sure they got your global authorization so that you will be 100% covered or the dr will try to charge you for you deductible and 20% cost share.

     

    I am on standard so i could see a midwife off mtf and i called 4 times to make sure i had my global authorization because they were originally trying to charge the 20% cost share for my total prenatal care, 1700$. This was wrong for me on two accounts, 1, i already had my pregnancy confirmed while on prime at an mtf, and 2, I was 21 weeks when i saw the midwife and already had global auth, i just needed to make sure it transferred when i switched regions. now i pay nothing until admitted to the hospital for delivery, then its 17ish dollars per day.


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  • Did you have a urine or blood test at this appointment to confirm pregnancy, or was that done before? If your doctor had already confirmed that you were pregnant previously and this was a follow-up appointment with an ultrasound, than it should be covered. If part of this appointment was to confirm the pregnancy with a urine or blood test, than none of the appointment will be covered. 
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  • I hadn't had any other pregnancy tests done before the appointment, but technically didn't have one done AT the appointment either. They had me go a few days before the appointment to the lab at the hospital so they would already have the results when I came in to the appointment. I've never had it done that way. I think I am going to call Monday and just double check to make sure it's right. 
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  • Any doctor experienced with Tricare knows how to code ultrasounds. I had 3 in the first trimester, 2 in the second, and 1 in the third. I didn't get billed for any of them. Your bill is likely from any lab work you had done, as well as the office visit itself. After this, you shouldn't receive any more bills unless you are seen for anything other than prenatal care.
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  • imageLissa832:
    Any doctor experienced with Tricare knows how to code ultrasounds. I had 3 in the first trimester, 2 in the second, and 1 in the third. I didn't get billed for any of them. Your bill is likely from any lab work you had done, as well as the office visit itself. After this, you shouldn't receive any more bills unless you are seen for anything other than prenatal care.
    This. I had Prime the first half of my pregnancy, and had four u/s done, at no cost. The second half of my pregnancy, I was on Standard and had four or five more u/s and did not have to pay for any of them, either. They were all deemed medically necessary and coded as such by the billing office.

    As Lissa mentioned, though, if you have to see a doctor for anything not pregnancy related, you will get billed. But, it shouldn't be too much.
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  • imageNeverLostHope:

    I switched to Standard after a horrible experience last year at our MTF. I have had one ob visit, and I just got a bill for over $100. I was thinking pg was 100% covered, even on Standard?? Am I wrong? If I owe it, I will gladly pay it (seeing a civilian was worth it to me with my history of loss) but I was thinking I wouldn't have to?

     

    You should call the billing department and make sure things were coded correctly and then call Tricare claims and make sure that it's something that wasn't covered.

     

    I went to the ER at 9 wks for spotting, and the ER coded it as something not pregnancy related at all {even though it was} and I recieved a bill for 300 bucks.  After a few phone calls I paid nothing.

    I've also had 3 u/s so far this pregnancy, including a "dating" u/s at my first appointment, and haven't paid for any of them. 

  • I was on standard my entire pregnancy and I only had to pay for specialty diagnostic procedures, and never had a bill over 20 dollars.  I had to see cardiologists several times during a high risk pregnancy.  My normal OB/GYN fees I never paid a dime.
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