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OB issues/ TriCare what to do
Hey everyone. Trying to figure out what to do. 1st pregnancy was easy and great. TriCare Prime and everything went great. No issues at all.
Just found out I'm pregnant with #2 and I called to make my first OBappt. Won't see me til 8-12 weeks and I MUST attend a first time parents class?? I'm not a first time parent, I just want to be seen by an OB doctor sooner than later??
A friend told me best option is to switch to Standard and go off post. What are the negatives of this and is it a big deal? I'm so confused and don't know what to do.
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Re: OB issues/ TriCare what to do
Great advice!! Thank you!! You're not at Ft Carson are you? This is their exact procedure too
All over a class and a later than you would like appointment?
Have you asked to see if you can opt out of the class? Have you asked what the ramifications are if you choose not to attend? Did you ask what the class entails? Do you have a high risk situation that necessitates an appointment before 8-12 weeks? What do you expect to get from an appointment sooner than 8 weeks?
Before I jumped ship over to Standard I would ask these questions. Then I would pay a visit to my local Tricare Service Office to ask them the differences between Prime and Standard if you can't make heads or tails of it from the Tricare website although I think they pretty plainly lay it out with regard to how it affects pregnancy related care.
Also, FWIW, many OB offices also require you to attend certain classes or collective appointments where they go over routine things like which medications you can/can't take etc so you may not avoid it at all.
I switched to Standard (for continuity of care reasons and our MTF will not refer anyone off) and have had no issues. All maternity related care is covered 100% under Global Maternity. If you end up with a sinus infection or something like that, then you'll pay a copay to your general practitioner for that visit but anything maternity related is covered. I think the hospital stay is $16/day.
When I had my first son, I was on Standard due to not being within 50 miles of a MTF and our total cost for the entire pregnancy/labor/C-section plus a 6 day hospital stay was $97. I've never been pregnant while on Prime so I have no clue how that side of things work but my experiences while on Standard have been great!
All of this, especially the bolded. I never understand why people are so desperate to be seen so early. You can't hear a heartbeat with a doppler until much later and there's not much to see on an ultrasound either. And in all honestly, if anything goes wrong, there isn't anything a doctor can do to stop it anyway. Your care off-base will probably not be much different.
The only other thing I can say about Standard that hasn't been said is that there is a 1-year lock-out before you can get back on Prime. If you switched to Standard today, you couldn't re-enroll in Prime until Dec. 12 next year. Anything non-pregnancy related between now and then will cost you a 20% co-payment.
We have Standard now because my children have to see specialists and getting a referal every few visits was a PITA.
That being said, stick with Prime. Most civilian OBs won't see you until 8-10 weeks anyway. The majority of them also have send you to some sort of class early on.
I am on PRIME and my first scheduled OB appt was at 10 weeks I believe. As was my first scheduled U/S ... thats pretty standard at all Naval Hospitals
The "class" I went to wasnt really even a class at all, it was them taking you through the paperwork piece by piece so it was completed correctly and then they also gave a bunch of paper resources it wasnt really a "class" ... if this is your first time at THIS hospital they may just call it a FTP class but really its just for all new patients. I mean this was literally a 15-20 minute thing with you and a nurse and maybe a few other mommies.
I think you're jumping the gun by abandoning ship and heading over to standard
Agreed. Even though I was a second-time mom and had been seen at the MTF's OB clinic before, I was still glad I went to the "class" when I realized that it was a chance to get a ton of pesky paperwork out of the way. There are WIC presenters and a lecture on why ou shouldn't smoke or drink while pregnant, but mostly it's just paperwork and setting up your first appointment. If your clinic offers a pregnancy centering program you'll hear about it then as well.
Yep, there sure is. Our Tricare rep asked us if we were sure and reminded us about the lock out period 3 or 4 times when we were switching.
YES there is a lock out if you are E5 or above.
YES, the STANDARD OF CARE FOR ALL MATERNITY CARE, civilian or military, is a first appt between 10-12 weeks - the military is not trying to screw you.
While the "class" is a pain, it's not a first time mother class as much as a first time class for this particular base with these particular rules/policies/procedures. While there are basic DOD MHS rules that the various services and bases follow, there are also particular policies and procedures the individual base follows, due to the type of clinic, the number of specialists, and overall number of providers at THAT particular time; which change due to TDYs, PCSs, Deployments and overall makeup of the base...not to mention the changes to the recognized STANDARD of CARE (like going the change inPAP Smear policies).
If you don't want to take the class that spells out exactly what you are going to go through with this particular labor, then opt out and go prime. Of course your civilian hospital / OB may do the very same thing (my civilian OB did at his office ANDI had to go into the hospital on a separate day to do all of my paperwork, so i actually had TWO "classes" vs the one I would have had to do had I stayed Prime - I went standard because I would have had to drive past the civilian hosp and go an additional 20 miles to the base).
While you won't pay for anything CHILD BEARING, you will pay for everything else out of pocket. As long as you have $1,000 for your CAT CAP, you should be ok.
I agree with what most are saying and wondering why you want to switch so bad. At my naval hospital, I have seen the same MW for every appt. They asked after my first MW appt if I wanted to see her again and have set me up with her everytime. They wouldn't make my first appt til 8 weeks, and that was just to do an ultrasound to confirm the heartbeat/pregnancy. It wasn't until I was 10 weeks I think that I saw my midwife.
I also had to take a class, but it was like an hour long, they talked about the ins and outs of pregnancy, and went over what pregnancy classes the base offered. They did this mainly to give us resources and make sure we knew what we could/couldn't do and what meds we could take, etc.
Apparently, I was wrong. I only know what the many people who work for TriCare have told my H and I several times. I'm pretty sure they told us that there isn't one. Maybe our case is different since I moved to an area that does not have prime providers. I had no choice but to switch to standard since the closest MTF is over 200 miles away and closest Dr that takes Prime is over 100miles. It will be interesting when we return to base in 6 months and try to enroll our LO and myself back in Prime. I personally would not switch unless you have to. We have almost maxed out our catastrophic cap in two months. You never know when you are going to get sick/hurt or if you LO will need testing and special care.
As far as the lockout thing goes, I had a tricare person tell me that I would not be locked out for switching to standard. I also just copied and pasted this off of the tricare website
"You may voluntarily disenroll from TRICARE Prime or TRICARE Prime Remote once per fiscal year (October 1-September 30) without a lockout. If you are disenrolling for the second time in the fiscal year, you will not be allowed to re-enroll with TRICARE Prime or TRICARE Prime Remote for 12 months. Family members with sponsors that are ranked E1- E4 will not be locked out."
From this link https://www.hnfs.com/content/hnfs/home/tn/bene/enroll/enroll/disenroll.html
With my 1st son I was seen at an Air Force Base in California. Then husband got orders to Jacksonville FL. We flew out there when I was 37.5 weeks pregnant. Went to the OB office to see about getting an appt, had my whole file from the AFB. They said I had to attend the "class" first also. I looked at them with the "are you kidding me?!" look. I had to wait until the next week, 38 weeks by then, to attend the class and fill out the paperwork again for crap I didnt need done. They set up appts during the class for peoples 1st appts. (usually 2-3 weeks out) I was seen the next day! ha.
Now with my twins we PCS'd back to California and Tri-Care started the whole "if you live within 90 miles of a base hospital you have to have OB done there" thing so I got screwed and didnt see a Dr until I was 12 weeks pregnant. I've been on Prime for almost 6 years now and wont ever look at doing Standard. My husband is a Corpsmen and works at the hospital in the OR so we know the "ins & outs" of what needs to be done. I really hope everything works out for you. Good Luck with everything!
I also think you're making a bigger deal out if than it needs to be. At our base, they generally see you at 10-12 weeks for the first appointment as well. I was due to be out of town on business during that time, and I'd had an early M/C previously, so I was just anxious to know everything looked okay before I left. I just called the clinic and spoke politely to a nurse, and she had me come in at 8 weeks for an ultrasound to see the heartbeat. At that same time, they had me attend the "class" which was literally just a nurse walking me through paperwork and telling me the resources available on base for me. Took 15 minutes. A few weeks later, they called me to take an "early pregnancy class" and I was out of town again. I explained I was going to be out of town on business pretty extensively until 3rd tri due to not wanting to travel during the 3rd tri and having to get things in good shape for my maternity leave. They waived that requirement with no problems at all.
As long as you're reasonable and have good, well-articulated reasons to want them to accomodate you, I don't see why they wouldn't. It generally helps to speak with an actual nurse or with your midwife directly-- a lot of time the poor receptionists are so tired of being yelled at because they won't make an appointment for a 4 weeks pregnant person that they're automatically tuning you out if you ask for special treatment.
I've had a wondeful experience at the Naval Hospital, and this is from someone who carries civilian health insurance just in case! Basically, before this pregnancy, I had 0 trust in TriCare and I found it was totally unfounded (just based on complaints I read online on message boards).
Im at 29 too!!! Anyways I had to do this same process (until I switched at 26 wks) at first I was on Prime but I wasn't comfortable with the Naval Hospital so I switched to Standard. Everything is covered like a PP mentioned. Although I only paid $34 and that was for everything..I also had a c-section! It was really worth it to me and if thats what you want to do go for it. I thought that class was pointless(& Im a first time mom) I didn't learn anything I didn't already know and I hated how I had to wait 6 weeks to just see a doctor. To me standard was so worth it and the cost isn't expensive so thats a plus =]