Infertility....and Tricare.

marikoono · July 2011

Hi all!

I have a few questions about TRICARE and infertility, but I don't want to waste your time (and mine) asking if no one on this board has gone through all this, so before I layout my whole story...anyone dealt with infertility at all?

Meanwhile....
Hi! I'm a military wife...that's in the ANG. I was active guard for 6+ years, but now I'm back to being a traditionalist. Been married for 3+ years, hubbers is a military brat (as am I); my FIL is also in my guard unit. Hope you don't mind if I post here and poke around a bit.

JENandJEH · July 2011

I have a tiny bit of experience (Tricare Prime and doc prescribed Clomid to hopefully jumpstart my cycles). They have covered everything I've needed (doc visits with referral from PCM, ultrasounds to monitor and bloodwork) and I haven't had any issues up until recently. Once I got a positive test and needed to be seen for lab results asap to check progesterone levels, they wouldn't let me see the doc til I had a referral go through (minimum of 72 hours). Aside from that, no issues but it's only limited experience. I spoke to a very nice rep at Tricare yesterday who took the time to explain all maternity coverage on Prime and Standard so you may be able to call and have them explain what is covered.

Good luck!

lauren2_00@yahoo.com · July 2011

Currently going through 3+ years of infertility and dealing with Tricare Prime. I'd be happy to answer any questions you might have.

mandapie · July 2011

I'm not personally but I know a couple of women who are/have. My one GF is still going through all her testing. They've decided to stop actively trying and just see what happens for now. Her hubs is getting out of the MC and going into the ANG in the next 12 mo so they are trying to get all their testing done before he get's out and while they know they have Tricare Prime still. I also know another woman who had the full gamet of testing done and they found the issue and she has 2 children. From what I gather they cover it all (Prime anyway).

ufsandra85 · July 2011

I see a re and have a messed up reproductive system. I did get pregnant and lost the baby. My doctor said it was literally a miracle that I got pregnant. I also have PCOS. I am in the beginning stages. I have had 2 surgeries and then we are going to work on the next problem, my lack of/weird ovulation.

lisa&andy · July 2011

We tried for 3 years to get pregnant, the last year was on Tricare Prime with a new RE and we ended up with our twins. We saw an RE prior to DH joining the Army so I had a pre-diagnosis already which cut out alot of red tape for us. Tricare covered all the ultrasounds, bloodwork, meds (except the copays). For us it was a breeze to work with Tricare.

oasis16 · July 2011

Tricare only covers testing and Clomid scripts. I had all my IF testing and Clomid cycles done while on Tricare Prime. Once we had to move on to IUI, I switched to my employer's insurance (Maryland is a fabulous state for RE insurance coverage).

The_Spanish_Inquisition · July 2011

We did IVF while on Tricare and are gearing up to do it again in a few months. DH is Active Duty and I'm Reserve, both Air Force.

Tricare will pay for certain medications and procedures, but not everything. The way I've always understood it is that they will pay for most diagnostic tests to indicate infertility, and for medication that's intended to improve your system/health. They will NOT pay for anything that's intended to "get you pregnant".

For example, in most cases Clomid and Metformin are covered for PCOS because it's used to regulate cycles. They will not pay for injectible drugs. They will pay for your husbands sperm analysis because that's diagnostic, but they will not pay for IUI or IVF.

It can be confusing, but I've had no problem getting what I needed paid for. The rest was out of pocket for us.

Also, be careful with Clomid - I never had any issues, but a few acquaintances did. If your doc codes it incorrectly, Tricare can (and will) reject it. They need to be sure it's coded as regular medical treatment, NOT infertility treatment.

lauren2_00@yahoo.com · July 2011

I've been on injectibles for the past 4 cycles and have never had to pay out of pocket for those. The only part of the IUI procedure that we have paid for is the sperm washing. Tricare also pays for my progesterone supplements that I take after my IUIs.

The_Spanish_Inquisition · July 2011

I stand corrected about the injectibles; apparently they will pay for those so long as they are coded as ovulation induction and not IUI/IVF prep. They didn't pay for my progesterone, which sucks because that crap is pricey!

OP - this is a good article about Tricare and infertility. It's very informative and accurate (from my experience) but not provided by Tricare themselves, so keep that in mind.

https://www.associatedcontent.com/article/2826576/tricare_coverage_of_infertility.html?cat=52

GL!

Smudges*Mom · July 2011

I'm sorry that you are to the point where you are having to consider your options because of infertility.

I was seen at military infertility clinics for all of my treatment. I did two Clomid/IUI cycles and three Gonal-F (injectibles)/IUI cycles at the Infertility Clinic in San Diego. We did not pay a penny for any of those five cycles, and the testing leading up to them. We then PCSed and we were close enough to Washington, DC, to go to WRAMC for IVF. Almost 3 years ago, we paid about $6k for IVF with ICSI--which, I think was reasonable. The Army, at the time, paid for all the meds since it was part of a teaching program. While the paperwork to get accepted into the IVF program was a PITA, once we were in, the process was straight forward. It was bare bones/minimal hand holding, but, for us, it worked.

It seems that each person has a different experience. It is important to educate yourself (like why it it so important to be monitored if/when taking Clomid) and to advocate for yourself, too. Good luck!

MyHusbandMyHero · July 2011

Im still going through the fertility program through Wilford Hall on Lackland AFB / BAMC on Fort Sam. I did IVF with ICSI and got my BFP on Memorial day! If you have an specific questions that you need help with, feel free to PM me

MyHusbandMyHero · July 2011

oasis16:
Tricare only covers testing and Clomid scripts. I had all my IF testing and Clomid cycles done while on Tricare Prime. Once we had to move on to IUI, I switched to my employer's insurance (Maryland is a fabulous state for RE insurance coverage).

For us, we got our IVF covered by Tricare because our infertility was directly related to DHs injuries, and our urologist speciliast was able to prove it. Luckily, our local bases have an infertility program but still charge for IVF. It was $4500, but Tricare covered ours.

Not the norm, but it does happen.

marikoono · July 2011

OMG. You girls are A.MAZ.ING! I definitley didn't expect to check back with all these responses and help. Smile

So here's a bit more about my situation...

I was on BCP for 10 years, but have been BC free for the last 2.5+ years.
Hubbers and I actively tried to get preggers for about a year and a half (we've had SA and HSG done, all good/clear)
We decided to take [lack of pregnancy] as a hint and pursue adoption. Our adoption agency eff'd up, for lack of a better explanation, so we've decided to put adoption on hold for now (definitely something we want to pursue again in the future, regardless if I ever get preggers or not).
We've been talking about "trying" again, but I think this time we want to be a bit pro-active and get more testing and such done.

I'm overwhelmed at the thought of finding a doctor. At the time we had the SA and HSG done, I was AD and had TRICARE Prime, so I went to the military clinic first, got a refferal, then went to a civilian gyno for the procedures.

Now, I have TRICARE Reserve Select as my insurance. I'm not sure if I should try to go back to the military clinic first, go to the gyno I went to before (who had performed the SA and HSG),

I'm thinking I may need go to the "big dawgs" and try to get in at Walter Reed, or try to find a infertility specialist in my area, but who do I get the refferal from? My gyno? Military clinic gyno (if they'll let me in, I think TRICARE Reserve Select lets me go to military docs. only if space available). ::sigh::

I am just sooo overwhelmed. Off to go call TRICARE...

oasis16 · July 2011

MyHusbandMyHero:
oasis16:
Tricare only covers testing and Clomid scripts. I had all my IF testing and Clomid cycles done while on Tricare Prime. Once we had to move on to IUI, I switched to my employer's insurance (Maryland is a fabulous state for RE insurance coverage).

For us, we got our IVF covered by Tricare because our infertility was directly related to DHs injuries, and our urologist speciliast was able to prove it. Luckily, our local bases have an infertility program but still charge for IVF. It was $4500, but Tricare covered ours.

Not the norm, but it does happen.

So sorry to hear that, but very good to know.

jerseygirll · July 2011

my husbandmyhero-

I'd appreciate it if you can actually email me some info on your experience with IVF through Wilford Hall. I am stationed in LA currently and was considering the IVF treatment there if my current treatment here in LA doesnt work.

MyHusbandMyHero · July 2011

marikoono:

OMG. You girls are A.MAZ.ING! I definitley didn't expect to check back with all these responses and help.

So here's a bit more about my situation...

I was on BCP for 10 years, but have been BC free for the last 2.5+ years.

Hubbers and I actively tried to get preggers for about a year and a half (we've had SA and HSG done, all good/clear)

We decided to take [lack of pregnancy] as a hint and pursue adoption. Our adoption agency eff'd up, for lack of a better explanation, so we've decided to put adoption on hold for now (definitely something we want to pursue again in the future, regardless if I ever get preggers or not).

We've been talking about "trying" again, but I think this time we want to be a bit pro-active and get more testing and such done.
I'm overwhelmed at the thought of finding a doctor. At the time we had the SA and HSG done, I was AD and had TRICARE Prime, so I went to the military clinic first, got a refferal, then went to a civilian gyno for the procedures.

Now, I have TRICARE Reserve Select as my insurance. I'm not sure if I should try to go back to the military clinic first, go to the gyno I went to before (who had performed the SA and HSG),

I'm thinking I may need go to the "big dawgs" and try to get in at Walter Reed, or try to find a infertility specialist in my area, but who do I get the refferal from? My gyno? Military clinic gyno (if they'll let me in, I think TRICARE Reserve Select lets me go to military docs. only if space available). ::sigh::

I am just sooo overwhelmed. Off to go call TRICARE...

If you CAN, go through your local military clinic for IVF -- its a LOT less expensive then outside care. Your military OB should be able to get your the referral, and tricare processes the claim. If there is room and availability at your closest military IVF clinic they will put you there first. If there is no room, they might refer you off base, but like PP said, you most likely wont get your IVF expenses covered for an off base clinic by Tricare.

I had a wonderful experience with the Wilford Hall / BAMC fertility clinic. I did my first IVF cycle in May, got my BFP May 30th, and am now about to move on to the OBs at Wilford Hall.

sweetface83 · July 2011

Lurker here. TRS only allows you to be seen at an MTF on a space-available basis, so you might be a lot better off going through a civilian provider. Your regular OB will be a good place to start with a recommendation.

They have an infertility clinic @ Hershey Medical Center. I've heard mixed reviews from people about them tho, but worth checking out since you're close.

Infertility....and Tricare.

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