Military Families
Tricare Standard Question
We just got a BFP 2 days ago on a home test and my first appointment is on Feb 3rd to confirm.
My question is to anyone with Tricare Standard.
How much is covered by Tricare for the visits and for the delivery itself? Is there anything I should know? With Tricare standard can we not go to the hospitals on base? I called Womack to find out if I could get an appointment there and they said No. Is that normal?
Thanks in advance!
MC: Feb 24th, 2011
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Re: Tricare Standard Question
I believe that everything beyond the original appointment to confirm is covered under Global Maternity care. Since the original appointment (your appointment on the 3rd) is not technically "maternity" since they don't know that you're pregnant until the get the lab work back at the end of the appointment. You'll have to pay the regular co-pay/cost-share as if it were any other GYN appointment.
You can be seen on base if they have room, but ADSMs and family members on Prime get first priority for appointments. They probably told you no because they don't have room in the schedule. That's totally normal.
For delivery, you will pay $16.50 for each day you are hospitalized, and no less than $25. Your total cost for the pregnancy should be your cost-share for this first appointment, plus the hospital surcharge of $25-35. HTH and congrats!
PP covered pretty much everything unless you are high risk. Then some of your extra's and your perinatologist or maternal fetal medicine appoints do have co-pay's also. I was high risk and had 3-4 appointments a week with specialists and lots of extra tests. I also had a nicu baby. With all that said my total payment was still probably under $250 for everything.
Congratulations and hope everything goes well for you!!!!!
As PP stated, your first appointment will be for confirmation and will have either a 15 or 20% co-pay depending on the doctor you have chosen. If they are a preferred provider, the co-pay is 15%. If they simply accept Tricare, it is 20%. You can search for preferred providers on the Tricare web page.
I made the mistake of allowing my doctor to do a pap smear, dating ultrasound, etc. at the confirmation appointment because I was unaware that it would not be covered under "global maternity". If I had just gone in for a blood test, my bill would have only been 3 bucks (vs. $240). Once they have the pregnancy confirmed, your OB should submit the global maternity paperwork. After that, everything should be covered 100%, unless it is not directly related to the pregnancy then the co-pay applies (examples: flu shot, bladder infections).
I am also seeing a high risk doctor in addition to my regular OB. I have had several tests with them and it is all fully covered under the global maternity provision. No co-pays or deductibles.