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Military Families
hoping4sticky
member
Tricare Standard vs. Prime?
hoping4sticky
member
Hopefully you ladies can help me out. I currently have Prime, but have not heard wonderful things about the base hospital that I would deliver at. Because of this, I thought that I would transfer over to Standard for my pregnancy/one year. Well, I finally narrowed down a hospital and a handful of doctors and most don't take Tricare, and the one that does requires that I pay up front $1800 for vaginal delivery and $2800 c-section and then get reimbursed through Tricare.
Any experiences with Prime/Standard? I'm trying to figure out if I should continue researching doctors and switch to Standard or just suck it up. Also, if you did use standard did you just pay the nominal hospital charge or did you have additional charges? I appreciate any help/insight.
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Re: Tricare Standard vs. Prime?
I have Standard. My OB charged me 300.00 for the vaginal delivery. I payed the hospital a total of about 200.00. I payed my high risk doctor 200.00 also.
These charges were all based on meeting a deductible and, in addition, paying a percentage of the services.
I would keep looking if you want more choice. Check out the Tricare website for a complete listing of costs for Standard as I am sure it varies by area.
Interesting. I have been told by a couple military moms that all they paid on standard was $16 for each day they were in the hospital, but that was not really what I was seeing on the website. I did see that the max for the year is $1k, so I guess in a worst case scenario it is not that bad. i can definitely understand paying out of pocket if I were high risk.
I am jealous of them.
I do remember reading the $16/day thing while I was pregnant. The additional charges may have been for services provided by the anesthesia provider for my epidural. I honestly can't remember. I had an uncomplicated delivery and was only there for two days. Good luck in your decision.
i would see what other options you have with tricare prime...i think that out here in VA they will pay for a mid-wife...i am currrently prime (only because dis-enrolling from prime and enrolling in standard was a huge hassle)...but i also have my own insurance so that is paying 100% of everything right now and Tricare is just my back up insurance (hubby gets out of the mil the first of August)...
also, make an appointment and talk to the doctors in the OB office...they may have really great doctors and the 'stories' that you heard may be individual cases...the bad stories also occur at civilian hospitals too, so take that into account before you make a permanant decision.
you could also end up being high risk (hopefully not) and be referred to a MFM clinic for a lot of different reasons, so that could also be a way to get seen under tricare prime without a lot of out of pocket expense.
also check out the c-section and induction rates at the hospitals in the local area...that could be a strong indication of what types of births the doctors are used to performing for each hospital.
just remember that it is your birth and having a birth plan that you and your providers agree on is important...whether you go tricare standard or prime for your care...birth plans can change, but ultimately you have to feel comfortable with your provider.
GL...HTH:)
I have Standard which is accepted by my OB's office and the hospital where I will deliver. I will pay nothing out of pocket except $16/day for the hospital stay.
You could always contact Tricare and ask to see a civilian provider, even while still on Prime. I asked to have all my regular gynecological care switched to the practice that provides my OB care and they said "sure, just fill out these forms." But we don't have the option to deliver at a MTF here so maybe it was a special case. Plus I can be pretty persuasive.
I have Standard just for my son so we can see a civilian and the costs have been very minimal. Definitely worth it to our family.
I'm very new to all this, but I was under impression (based on a lot of research and talking to tricare reps) that Standard has universal maternity so it will cover everything related to maternity care, and the only costs are $16 something per day in the hospital. But obviously this doesn't seem to be true in all cases.
Yep, that what I thought too, but obviously some people have been having different experiences. Very interesting.
You were likely paying your deductible. I am on standard and never got one bill for any of my visits, bloodwork or ultrasounds. The only thing I was billed for was my hospital stay, but we've got 2 other kids and had lots of trips to the doctor/emergency room before LO#3 was born so our deductible was taken care of!
hmm I have Prime, i go to all civilian docs and never paid a penny. This includes my pregnancy, high risk, multiple hospital stays and delivery.
ETA: My lo has prime obviously, she sees a civilian ped, again never paid a penny. Same for myself and my regular civilian primary and endocrinologist
I was a brat before I became a spouse so I think the biggest difference to note is Prime costs a little more but you don't have anyupfront out of pocket costs. After Tricare pays it's part, which is usually100% from my experience, you get a bill for the difference. But as I said, I've never been billed with Prime.
HTH.
It usually depends on how far you live from base/the nearest MTF. If I lived a few miles further North I could see all civilians for no cost with my Prime coverage but because my zip code is technically in the 20 mile "zone" I have to use the base clinic for the kinds of care they offer.