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Military Families

Military Insurance

My hubby is in the AF, and just added me to his insurance. I have some questions about the insurance. and I'm 13 weeks and 3 days pregnant and I really dont want to have my doctors appointment on base or delivery my baby on base, since we live about 30 mins away from it. Can I have my doctors appoinment at a regular doctors office or do I have to go on base?

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Re: Military Insurance

  • Do you have TriCare Standard or Prime? It also depends if there is OB services at your base. There is no OB services at our base so I have to go off base for OB services, but my PCM is on base. I believe if you have standard you can choose where you go and you pay a copay.
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  • its worth requesting!

    I'll tell ya though.. we are AF and our closest AF hospital is an hour away and our Army hospital is 30/40 minutes away and I go to the AF hospital for my first OB appt on the 12th and have had some u/s's done at the AF hospital and some at the army hospital. I have tricare prime and plan on asking for a OB here in my town after my inital appt.

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  • If you are Tricare Standard than you can go off base to anywhere that takes tricare standard.  (I always just ask before I make the appointment).

    If you are Tricare Prime you must first be seen on base and request to go off base or be assigned off base.  Either way you must first contact base.

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  • I thought if you lived within a certain distance of the base you needed to use base services if you are on Prime. Last year when my Hubby signed me up they said I had to have my PCM on base because of where we lived. I live 25 min from base and I'm over an hour from the OB's office and the hospital I will deliver at. It sucks driving that far for appts. I'd ask, the worst they can say is no.

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  • I think TriCare Standard is well-worth it here where we are. We don't have OB/GYN on base so I'd be referred out anyway but maternity care is covered almost 100% regardless. We paid $50 after delivery...that's it. I know it differs at every base but the one here is hard to get appointments at and the doctors, from what I've heard, are not very good. One friend said when her kids were sick she used to wait until after hours so that she could just take them to the ER because she knew they'd get better care. DH once had a virus so bad that he was blacking out in between vomiting/diarrhea/etc, and was told he was fine to work. So for me it was worth the little bit extra cost for Standard...but like I said, it all depends on how the care is at your base. :)
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  • I suggest going in to your local Tricare Service Center and discussing your options with them.  You will not need your husband to accompany you to do this and generally you do not need an appointment. 
  • image Chels1222:

    If you are Tricare Standard than you can go off base to anywhere that takes tricare standard.  (I always just ask before I make the appointment).

    If you are Tricare Prime you must first be seen on base and request to go off base or be assigned off base.  Either way you must first contact base.

     

    About TriCare Prime that is not true about contacting base first...I live about 30-45 min from Camp Pendleton and still (for 2 years) have not stepped foot on base to be seen by the Dr neither has my DD since we live that far away I contacted TriCare and requested my PCM to be off base and was accepted.  I just have to use someone in network.  And there are a TON of in network people.   

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  • This year when I got pregnant I requested an off base OB/GYN and was told NO. The closest military hosptial for birthing with OB Care is 1 hour away and I was told as long as I was prime I had to deliver there but I could however have a PCM off base. So I switched to Tricare Standard and have paid NOTHING for my OB care. I will pay for my copay for delivery which around here is normally less than 150.00 depending on how many days you stay etc. It is important that you ask if the OB you wish to see bills globally. This means they will accept what tricare pays them for their services and you pay nothing additionally so long as what they bill you for is part of normal medical necessity services. (For instance they aren't going to cover additional ultrasounds just because or 3-D unless they are medically necessary)

    I am so happy I decided to go off base for my care. I know I have had a better experiance because of it, and now that I am high risk they would have sent me off base anyway to exactly where I'm going now.

    Your best bet is to go talk to your base's Tricare reps and see what your options are. They can explain it to you in detail, as well as give you packets and the necessary paperwork can be filed the same day if you decide to switch.

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  • I have standard and have a civilian doctor and pay no co pays... im switching to prime as soon as i deliver to avoid copays inthe future. you do not have to pay copays for maternity care however your hospital stay will cost about $16 a day :)
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