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Tricare Co-Pay ?

JPed*JPed*
in Military Families

I am on Tricare Standard, seeing an off base in-network OB. I was seeing another OB on private (through work) insurance until we PCSed. I just got the bill from my first appt here and they are charginging me a co-pay. I thought maternity care was 100% covered.

Do I have to pay this one time because it was technically my first appt, or was it just coded wrong? If I'm not supposed to pay this I will call, but I wanted to check and see if any of you had to pay for the first appt or not.

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Re: Tricare Co-Pay ?

  • bootsie08bootsie08

    What did they do at your first appointment with the new OB?  Tricare won't cover "pregnancy confirmation" or any other procedures that take place on the same date as confirmation under Global Maternity.   I learned that the expensive way myself.  So if your new OB coded a urine, ultrasound, or blood test as "confirmation" or something similar, Tricare will bill you the co-pay.  But I would be livid if my doctor's office coded it this way given how far along you are.  Then again, doctor's offices know that Tricare won't pay for it and that they can bill you for the difference.  Some doctor offices also charge new patients an administrative fee for filing insurance (usually a one time charge) or "special reports".  Tricare will not pay for that either.  I just had to pay it at my appointment today. 

    On the other hand, it's possible your OB did not complete the Global Maternity paperwork yet.   I would definitely call the billing department at your OB's office and Tricare. 

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  • Killer CupcakeKiller Cupcake member

    I was under the impression that Standard had a co-pay, but, I'm not sure, so don't quote me. 

    Anywho...

    Tricare was having some issues with their system a few months ago. I went to my annual pap and I got an EOB from Tricare telling me I had to pay a deductible. I called them and it turns out that the system was coding incorrectly.

    That could be it. They can fix that really quickly if that's what is up. 

    Did you get a referral? Call Tricare and ask, you may need one and they MAY be able to do something called a retroactive referral if you do. Ask them about it. Good luck!

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  • IlumineIlumine member

    What Bootsie said - the Standard covers the pregnancy at 100% except for a few things:

     

    1. Your initial appointment with your provider (so if you switch midstream, you get to pay for that visit if the office codes it as a new patient visit - which it is).
    2. any tests that are considered/coded confirmation
    3. anything more than 2 ultrasounds (does not matter if this is a new doctor) unless there is a medical necessity for it. (the doc can read the old U/S or needs to recode)
    4. any issues not directly related to the baby (so my GERD was not paid covered, even though it was caused by the pregnancy).

    While you will have a cost-share (in standard its a cost share, since you are to pay a %, not a set co-pay), your overall costs (that means ANY medical costs including your Rx co-pays) will CAP at $1000 a year. 

    ALSO - the TRICARE Annual Deductible runs the FISCAL YEAR.  So if this was your first visit after October 1st, you may be seeing your deductible.

     

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  • ladybug8510ladybug8510
    I was on standard and didn't pay anything.  I would make a call to check why you are being billed a co-pay. 
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