Tricare and Infertility

dragontears507 · September 2011

Hey all. I'm just about to wrap up my first cycle on Clomid...and it looks like an unsuccessful one. I tried to get a straight answer out of the doctor's billing department and Tricare but nobody seemed to want to tell me what will be and won't be covered.
I was told that they should cover the medications, meaning the Provera, Clomid, and even the HCG trigger shot, but probably not the ultrasound I had to have. I couldn't get a straight answer. My husband told me to go ahead and do it anyway, but I want to be prepared in case we get a whopping bill.
Anyone gone through IF treatment with Tricare?

lisa&andy · September 2011

I saw an RE and all my medication, ultrasounds, and blood draws were all covered under my referral for infertility. Tricare won't cover IUI or IVF and anything that goes along with it (ultrasounds, etc.)

lauren2_00@yahoo.com · September 2011

All my meds, ultrasounds, appointments, and blood draws have been covered through Tricare. I'm currently on my 5th IUI cycle and the only thing I've paid for OOP has been the sperm washing, which is done through the local IVF clinic.

MyHusbandMyHero · September 2011

I did IVF through our military clinic. There are several posts farther back on this board that you should read with lots of info. I did IVF and that's not covered under tricare but IUIs are through them. All my meds, scans, and appts were covered but the actually procedure is not typically covered (ours was but it was under very special circumstances). If you're not close to one of the military REs and fertility clinics then your OB will be able to refer you and once you get the referral you'll be able to ask your REs office what is and is not covered by tricare.

jb2rn · September 2011

Are you seeing an RE? You didn't say. If not, please get a referral, don't waste time with an OB. Tricare covered my RE appts - bloodwork, and early pregnancy u/s. Also my HSG and the SA my husband had. I would have not qualified for IVF at a MTF due to my high FSH, so we would have had to be OOP for IVF.

ufsandra85 · September 2011

same thing as everyone else. all of my appointments, us, bloodwork, and other tests have been covered. I have also had 2 surgeries and a SHG.

dragontears507 · September 2011

Thanks everyone for the advice. I had a referral to an OB and he did an HSG and SA right away to make sure we didn't have any basic issues. Then, he started me on clomid. He seems to have it under control, but of course we had to move. Now, I'm trying to get a new referral to a doc out here, so I'll be sure to take all your advice and request a referral to an RE instead. Thanks!

drcolleen · September 2011

Depends where you are, each MTF Commander decides so rules have been different different places I have been, e.g. at the post I work at now they do not pay for anything infertility related off post-- and note we do not have RE on post, but our pocket books are not deep enough to cover anything elective. Ask locally if you don't want surprises.

ufsandra85 · September 2011

drcolleen:
Depends where you are, each MTF Commander decides so rules have been different different places I have been, e.g. at the post I work at now they do not pay for anything infertility related off post-- and note we do not have RE on post, but our pocket books are not deep enough to cover anything elective. Ask locally if you don't want surprises.

what if you have to have reproductive surgery? they still dont let you see an RE?

jb2rn · September 2011

drcolleen:
Depends where you are, each MTF Commander decides so rules have been different different places I have been, e.g. at the post I work at now they do not pay for anything infertility related off post-- and note we do not have RE on post, but our pocket books are not deep enough to cover anything elective. Ask locally if you don't want surprises.

We didn't have an RE on post, either, but I had no problem getting a referral to one. There was no OOP cost to me for that.

hunt2005 · September 2011

drcolleen:
Depends where you are, each MTF Commander decides so rules have been different different places I have been, e.g. at the post I work at now they do not pay for anything infertility related off post-- and note we do not have RE on post, but our pocket books are not deep enough to cover anything elective. Ask locally if you don't want surprises.

It is NOT up to the MTF Commander. Call Tricare - it is up to them. They have patient care reps just for this purpose if the base MTF refuses to give you a referral.

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