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Military Families
lilpumpkin10
member
a tricare question
lilpumpkin10
member
I'll start off by saying I know some people can go through life without any problems with the army hospital. I unfortunatly am not one of them. I have prime and I know if I switch to standard I can go anywhere I want. But is there anyway to stay prime and get maternity care elsewhere. Honestly after today I don't think I can go back into the ob office without wanting to freak out.
And if I do switch to standard do you know how much maternity care usually cost?
Thank you
This discussion has been closed.
Re: a tricare question
I haven't gone through a pregnancy on Standard, but BFF just did and I think she paid a few hundred bucks, not including delivery costs (which supposedly aren't going to be very much at all). She says it was totally worth it, after her experience at the military hospital here with her first daughter 7 years ago.
If you've had a bad experience, you can take it to the OIC of the clinic and try to get referred to a civilian that way and stay on Prime. If it's bad enough, and they won't do anything for you, take it up to the person in charge at the hospital. Let them know how you were treated, and that you want to be seen by someone else. It may or may not work, but it's worth a shot.
Just remember that if you switch to Standard, you have to wait a year before you can apply to be on Prime again. You can enroll baby in Prime as soon as they're born, but you have to wait the full 12 months from the date you switch. It probably won't be a big deal, but you will have the co-pays and stuff (assuming you don't meet the OOP max) even after you're not pregnant anymore.
Good luck!
i havent had my own bad experience at the MTF here... but my husband and i didnt want to risk it...
i was on prime and tried to go off post and they wouldnt let me. i got like 9 calls from the women's clinic to set up an appt (i went to my primary doctor who was offpost and got a prego confirmation) and i was like ummm id rather let a blind rabid monkey deliver my child... so i went to the tricare office and switched to standard.
the MTF's L&D and OB was pretty dead with 3 huge brigades deployed so they werent letting any one with prime go off post.
if your husband is i think its e4 or e5 or below then you are not locked into tricare standard for a year. you can just switch back. but really the co pays regardless are not that bad.
My husband is and E4 so I wouldn't be locked into standard for a year? And he wouldn't have to switch to standard would he? What are your co payments like, and are the deductibles bad?
Service members can't switch to Standard. It's not an option for them.
And I forgot about it before, but yes I believe it's E4 and below that are not locked out for a year.
your husband doesnt have the prime or standard option. he goes on post and that is that. your tricare doesnt affect his.
i dont have any co-pays with m y materni ty care. maternity care is FREE! regardless of if you have standard or prime. i think you have to pay 16.36 or something a night when you are in the hospital after having the baby. but thats nothing.
and if your husband is E4 (mine is too) you arent locked into standard because of the paygrade. like they dont make enough to do the co-pays or whatever. i think thats the reasoning behind it.
It is definitely possible to stay on Prime and see a civilian doctor, but you have to be adamant about it and not back down. I was successful with DD #1 while stationed at Fort Knox. With this pregnancy we are back on a Marine base and they were sticking to their guns. I'm sure if I had kept at them (and visited the hospital commander), I could have made it happen, but I was so fed up with the entire MTF system and hated my PCM so I switched to Standard.
As others have said, maternity care under Standard is 100% covered. You will only pay $16.30 for each night you stay in the hospital and I know several people who haven't even paid that because of the way the hospital coded the bill. There are also no deductibles or co-pays. Just make sure the doctor's office codes the first appointment/claim as a "pregnancy diagnosis" and everything from that point on (that is medically necessary) will be covered under the global maternity provision.
When my DH was in USMC, I was the same as above... Prime and my Dr was civilian out in town... We also lived off base, which I have heard is part of the reason?? They shouldn't be able to make you only see a military dr since you are not military....
DD #2: BFP: 8-19-18 EDD: 4-30-19
They can if you choose to stay on Prime. If you don't want to see a doctor at a MTF you must petition for a special referral or switch to Standard. If you lived in San Clemente at the time, they probably allowed you to see a civilian doctor because of the distance to the naval hospital. The rules have changed recently and you either have to sign a waiver or switch to Standard if you don't want to make the drive.
You do have one other option. You CAN stay with your PCM through your pregnancy - ie for your check-ups and then only use the Women's Health Clinic / OB clinic for the birthing.
However, if you have any problem with your pregnancy, they will insist you go back to the WHC.
As for Standard - you should not have any out-of-pocket costs for the basic prenatal coverage (your first appointment where the civilian ob verifies that you are pregnant is usually not covered), is free. I did not pay for a single thing (other than my initial visit) thing.
You WILL only get 2 ultrasounds unless there is a medical necessity determination - but that is the standard of practice for the civilian world as well.
This is right. I switched from prime to standard while pregnant. My husband was an E-4 at the time so I switched right back after the baby was born. I had to pay a portion of bloodwork costs and 50.00 total after my c-section. SO WORTH IT in my opinion!
New here with a question.
If I switch to Standard can I see any ob/mw or do they have to specifically accept Tricare? When I called and asked I was told they have to be Tricare certified (whatever that means). I know I don't need a referral for maternity care while on Standard. I have Prime and they refer us off base for maternity, but most of the ob/mw are exclusive with the "baby factory" hospital here. I'm planning on a vbac and I want the hospital that is known for vbac friendly nurses, midwives and doctors. Also, when I called to try and make a drs appointment the woman on the phone told me to stay away from the "baby factory."