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Tricare question

beccabride2bebeccabride2be member
in Military Families
I am trying to get an appt on base at womens health but they have no appointments and told me to keep calling until they have an opening. They wont refer me off base, so my question is if i schedule my own off base appt will i have to pay out of pocket or will they bill Tricare? 
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Re: Tricare question

  • LemonLover33LemonLover33
    They are required to see you within a certain amount of days. If not they need to refer you off base. Call your patient advocacy person and talk with them about this behavior.
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  • IlumineIlumine member
    Access to Care standards. For specialty, it's 30 days.

     

    That's not to say that they can keep having you call back for 30 days, but that if they do not have an appt within 30 days of the initial call / PCM appt, they MUST refer you to to the NETWORK.

    I am working off my IPad, so no access or clickies. Just google TRICARE access standards and print out the info. Then go into the TRICARE Service Center and get your referral.

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  • preppymamapreppymama

    Have you considered switching to Standard? I just wrote this in another post but I switched out of Prime & onto Standard when I got pregnant because of this exact issue at our base here. It was impossible to get any appointment at our base here, even for "emergencies". I didn't want to go through 9 months of that, so I switched. I'm actually going through a birth center now, and they told me that I more than likely won't have to pay anything to them even though I'm on Standard.

    Obviously each situation is different and once you switch to Standard, you can't re-enroll in Prime for a full year, but it was worth it to us...just wanted to bring it up to you, too!

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  • blue_angeleyes06blue_angeleyes06 member
    As far as I know, the only way that Tricare Prime will pay for you to go offpost is if it's an emergency and you aren't able to make it to the military hospital.  I know it's a pain, but I would just keep calling or do as a PP said and try switching to Standard.  GL 
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  • IlumineIlumine member

    imageblue_angeleyes06:
    As far as I know, the only way that Tricare Prime will pay for you to go offpost is if it's an emergency and you aren't able to make it to the military hospital.  I know it's a pain, but I would just keep calling or do as a PP said and try switching to Standard.  GL 

    That is incorrect.  TRICARE has a host of civilian providers, mostly specialists, within a specific radius of the Military Treatment Facility to augment the Military Providers. 

    You DO have to have a referral to use the network, but if you have it - and by the laws/regulations you have to be seen within a specific time period. 

    Here are the various links (baby is finally in bed for the night). https://www.tricare.mil/mybenefit/home/Medical/GettingCare/Appointment

    https://www.tricare.mil/mybenefit/Glossary.do?F=a (look up Access Standards - they are listed right there)

     

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  • amandalupamandalup
    I agree I would switch to standard for pregnancy. On the website it says that 100% of maternity costs are covered. The only thing it won't pay for is anything non pregnancy related so if you have any other children you may have to pay the deductible if something happens to them ie colds and doctor visits.
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