Tricare Standard Question — The Bump
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Tricare Standard Question

I've read some posts that Tricare only covers one US unless the doctor's office codes it right and not just routine.  This is my first preganancy and I have my first OBGYN appointment tomorrow morning.  Is Tricare Standard the same? I don't have to get referrals and can go to any doctor that I want.  I would like as many US as they normally do and I think Tricare should cover these so I guess I will mention to my doctor to code them whatever they need to so they will be picked up.  I thought Tricare was pretty good insurance.  I have a deductible which I've already met so I hope everything else will be covered.  Any info would be great ladies :)

Re: Tricare Standard Question

  • You shouldn't have to even say anything to the DR about coding it right, if they take standard they know what to do :) I have been standard since being married and have paid zero out of pocket.  They do a pretty good job of knowing whats coverend and what's not. 
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  • Thanks! I was worried they weren't going to cover it and I would receive all of the bill for the US........that makes me feel better :) It makes no sense just to have 1...it's my first pregnancy so I'm a bit paranoid and don't just want one at 20 weeks! That would drive me crazy not hearing a heart beat for that long......it makes it real :)
  • I had 6 with DD and 4 with DS. I had so many due to my history. I want to forewarn you though. Some doctors only do one ultrasound at 20 weeks as a matter of procedure.
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  • image jworkman1980:
    I've read some posts that Tricare only covers one US unless the doctor's office codes it right and not just routine.  This is my first preganancy and I have my first OBGYN appointment tomorrow morning.  Is Tricare Standard the same? I don't have to get referrals and can go to any doctor that I want.  I would like as many US as they normally do and I think Tricare should cover these so I guess I will mention to my doctor to code them whatever they need to so they will be picked up.  I thought Tricare was pretty good insurance.  I have a deductible which I've already met so I hope everything else will be covered.  Any info would be great ladies :)

     Tricare says they only cover one, but most doctors I've heard of code two for medical necessity:  1 for initial dating purposes at your first appt. and one for the anatomy scan at 20 weeks.   Now, of course, it varies from doctor to doctor, but I think this is the most standard practice.

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  • Also, you know that you can hear the heartbeat on a doppler, you don't need an U/S, right? I had more U/S than normal because of some test results, but even on the appointments where I didn't have an U/S, I still heard the heartbeat with the doppler.
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  • I was on standard and had 3 ultrasounds. The first was at 13 weeks they couldn't find the heartbeat on the doppler so they did an internal US, second was at 20 weeks, and last was at 34 weeks because I was measuring way ahead. All were covered because they were all deemed "medically needed". Most doctor's know the tricare system and know what will and won't be covered. A lot of first time mom's go in wanting an US every apt to see the baby, etc. but trust the doctors know what they are doing and won't be giving you US for no reason, so in turn not creating extra bills for you.
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  • I had 3 with tricare standard, so its really up to your doctor, Tricare will cover one for sure but if the doctor thinks its necesary it will be cover by tricare, they say they wont cover the US for you to know the sex (which is with most insurances) thats why most doctors wait until you are about 20-22 weeks so they can make sure everything is ok with the baby and you can see what you are having.
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  • I've had three so far (I'm 38 weeks) and they've all been covered, and that's on Prime.

    Ultrasounds are medical tests. Unless your doctor is dumb, she/he won't do ultrasounds for no reason. If they're medically necessary, TriCare will cover them.

    You don't need more than a couple. The 20 week ultrasound is the one that they use the most. They wait until 20 weeks because that's when they can get the most accurate measurements, and figure out if everything is okay with the baby. If at that ultrasound you can't see the sex and you want to know, that's what TriCare (and most other insurances) won't cover, because knowing the sex is not a medical necessity. In this case, I'd recommend going to one of those mall places since it's likely cheaper than whatever the diagnostic ultrasounds at the doctor's would cost you.

    The other two that I got which are pretty common are: an early dating ultrasound (usually at your first appointment, and the first time you see/hear the heartbeat); and a late 3rd tri one to check on the position of the baby if they can't tell externally (couldn't in my case because my abs were in the way).

    I've heard the heartbeat at every other appointment through a Doppler, like PP mentioned. The reason TriCare and most insurances don't cover an u/s at every single appointment is because it's not necessary to have so many in most cases, the Dr can tell everything is okay with a Doppler and his/her hands and a measuring tape.

    You should ask your Dr what is standard practice at his office, but TriCare isn't much different than most other insurances. It's just nice that it's free/very low cost.

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  • I'm on Tricare Standard, and they cover everything prenatal, including ultrasounds. I've had two ultrasounds thus far and haven't received a bill. You just need to be careful when it comes to things like whether or not your OBGYN is in or out of network, because there are some things that TS will make you cover a certain percentage of. Example, for our 1st Tri Screening we had to call Tricare and make sure that they would cover the labs and stuff. If a blood draw is sent to an outside lab, you will most likely have to pay for part of it. I say, if you have any questions about coverage you should just call your Tricare branch. They were pretty helpful with us.
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  • Pretty much what PPs said. You'll be fine. I Had DS last April and recently looked at what me and DS paid in copays for 2011 and honestly, it would never be that cheap with any non-mil insurance! I loved having the choice of doctors. That was high on my list. I haven't had to duke it out with Tricare yet! Good luck! :)
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  • We pay for Tricare Reserve Select which from what I understand is similar to Tricare Standard. I have had some small out of pocket expenses but so far have had ultrasounds at 8, 12, 16, and will have the anatomy scan today at 19 weeks.

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