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Changing OB-GYNs with Tricare Prime

laurenlomsdalelaurenlomsdale
in Military Families

Hi all! Congrats on your respective pregnancies! I am a first-time bumpie so I'm just getting all the details about how Tricare works in terms of prenatal care. If you can help with any suggestions I'd greatly appreciate it!

 

My hubby and I live on Camp Pendleton in Southern California and we have a Naval Hospital here on base that we are assigned to go through during the pregnancy. However, Camp Pendleton is HUGE and the hospital is small (they're in the process of building a second one) so they really don't have the means to take care of each mommy-to-be in the best way. Appointments are few and far between and you rarely see the same doctors or twice, much less build a relationship with them. 

So my question is this: has anyone had experience in trying to get Tricare to allow you to go to an outside OB-GYN that accepts the insurance? What did you do to go through the process?

Thanks so  much for your help! I appreciate it!

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Re: Changing OB-GYNs with Tricare Prime

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    GreenFlamingo7GreenFlamingo7 member
    imagelaurenlomsdale:

     don't have the means to take care of each mommy-to-be in the best way. Appointments are few and far between and you rarely see the same doctors or twice, much less build a relationship with them.

    If they are unable to meet access to care standards, then you will be referred to a civilian provider.

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    runnergirl2008runnergirl2008 member
    I had the same issue at the NNMC in Maryland and was not referred out because they could get me appointments and care in a timely (I believe their definition of this is 30 days or less) manner. My overall experience ended up being great though. With electronic records I had a great continuity of care.
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    Lissa832Lissa832 member
    All I have to says good luck with that. I highly doubt they will let you switch. MTF have changed their standards for OB care in the last couple of years. It used to be that you would be seen every four weeks until 28 weeks; every two weeks until 36 weeks, and every week until delivery. That is the general standard. NOW, however, most MTF will see you every six weeks until 28 weeks, every four weeks until 36 weeks, two weeks until 38, and weekly until delivery. You are not going to be able to use your reasoning to switch because the policy has changed. It is irresponsible, IMO, but that is military healthcare for you.
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    babymamaT77babymamaT77 member
    I am in the exact same situation- also at Pendleton, and I am switching to Standard instead of Prime so that I can be seen off base because they will not let me switch. I even go to a civilian primary doctor who sent in a referral for a civilian obgyn and they denied it and  re-routed me to the naval hospital. Switching to Standard means I can choose to go wherever I want. There are co-pays and deductibles involved but the cap that you can pay out of pocket per year is $1000, and I personally think that even if I did end up having to pay all of that, it would be worth it to have the type of care I am looking for. Plus, pregnancy related visits are covered and most women don't end up paying anything out of pocket, even in Standard. Good luck!

     

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