Military Families
khowell16
member
TriCare Prime pissing me off
khowell16
member
Okay - so I have Tricare Prime. I was given the wrong number for my PCM, and I couldn't find any OB services on Fort Myer or Bolling. I made an appointment with a doctor who takes Tricare Prime. I asked them if I needed a referral and they said NO. I looked online and found otherwise. I called and spoke with Tricare and they said I just needed to request my PCM create a referral. My appointment was July 13th and this call took place that morning. I called my PCM with the correct number they gave me and asked for a referral. They said that it wouldn't be a problem...go to my appointment. But I got a call today from my PCM's office saying that I would have to cover my appointment out of pocket since I didn't see them first. WTF? My PCM is NOT an OB, nor is there an OB on site. The closest medical facility is 45 minutes away. I was told I would have to have an appointment with my PCM, THEN I would have to go to a military facility, THEN I could MAYBE get a referral for a civilian doctor. This whole situation is pissing me off because it's my *** vagina and my *** baby....why can't I choose my own doctor? Has anyone else dealt with this? Would tricare standard be better - and if so how long does it take to switch?
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Re: TriCare Prime pissing me off
the trade off of not having to pay any copays (regular care) is that you dont get to chose most of the time. You must ALWAYS go to your PCM first BEFORE you see any other type of provider (unless it is mental health). Sometimes when you go to your pcm they let you pick and sometimes they just tell you who to go to.
With standard you just pick anyone who takes standard and go. the process is pretty quick to switch over but if you/your husband is over a certain rank then you cant switch back to prime for a year (if you wanted to).
If you want to pick where you go I would go to standard
Married 11/27/09 and TTC right away
Dx: Complete septate uterus with cervical duplication, endometrial polyps, PCOS, endometriosis, hypo thyroid, luteal phase defect
4 uterus surgeries to correct my complete septum and to remove polyps and 2 years of seeing the RE, medicated cycles and IUIs
Baby 1 and 2: BFP 3/3/11 with 2 babies EDD 11/1/11, M/C 4/6/11
Baby #3: 8/11 pregnant EDD 4/27/11 and m/c:(
Baby #4: 10/12/11 BFP! EDD 6/16/12m/c 10/26/11
Baby #5: 3/13/12 BFP! EDD 11/25/12 ANOTHER m/c
Baby #6: 2/14/13- BFP! EDD 10/24/13, CP 2/19/13
Baby #7: 3/15/13- BFP! EDD 11/27/13, another CP
Baby #8. BFP 5/19/13 EDD 1/22/14. 8 was not our lucky number
4th septum resection on 5/31/13.
Baby #9: 6/29/13 BFP. C section scheduled for March 5th!
My miracle baby was born March 5 at 9:33am. He was 8 lbs 12.5 oz and 21.25 inches long!
Yes, you do have the right to choose to see any doctor you like, but as your insurance provider Tricare reserves the right to refuse to pay for out of network providers or for a provider you see without going through the authorization/referral process.
Since you did call your PCM to discuss the preauthorization prior to the appointment, I'd call that office back and see if they will speak to Tricare about getting the preauthorization entered into the system. And like the PP, I would recommend switching to Standard if you want to choose your doctors in the future.
PCM for confirmation of pregnancy.
PCM submits referral.
Tricare notifies you as to who will provide OB care.
You make appointment.
Tricare is who you need to contact for information regarding Tricare, not a provider. With Prime, 100% of the time, you will need to schedule an appointment with your PCM in order to get a referral for anything. You can always switch to Standard. Your pregnancy is covered 100%. You will pay nominal fees for delivery, and you can choose your provider. No more referrals. Below E-5, you can switch ack and forth between Standard and Prime. Above, you have to stick with Standard for 1 year. Even with deductibles and cost shares, Standard is 100% worth it.
Educate yourself on how Tricare works. All insurances have rules and stipulations, not just Tricare.
Tricare Prime is basically a HMO. What that means is that you are required to go through your PCM for ALL doctors/specialities that they do not take care of. Always.
If you don't want to have to see your PCM for every referral, then go Tricare Standard (basically a PPO). With Standard (not sure about pregnancy type care) you will have co-pays (you don't with Prime).
Okay thanks for all of the advice.
Thats not exactly true. Pregnancy is covered 100%, even with Standard. You might have to pay cost shares with your first appointment because it is about confirmation vs. pregnancy care. I paid $34 for my entire pregnancy, delivery, and postpartum care. The $34 was for my 2 day stayin the hospital. I had Prime for 7 years, and I only regret not switching to Standard 8 years ago.