Pregnant with Tricare Prime — The Bump
Military Families

Pregnant with Tricare Prime

This may be putting the cart before the horse but I just want to know what to expect when the time comes! None of my military wife friends know that we are TTC or else I would ask them what their experience was like. I am on Tricare prime and have a civilian PCM (I have never been to or seen by a military doctor). After my DH and I hit our one year mark TTC and no baby she put a referral in for me to see an RE. I have my appointment with them November 10th after a two month wait which I have been told is completely normal. Fingers crossed that we get pregnant in the coming months...what is the procedure of me getting a referral to an actual OB? I had a military friend that got a BFP on a HPT and went to her doctor the same day to confirm with a blood test. After that her first appointment with her doctor and ultrasound was at 10 weeks. Just wondering how does Tricare determine which doctor I will be seeing from that point on and how do I know if I will have a military doctor or civilian? I guess I've always wondered whether or not I would be delivering at a military hospital or one out in town. Again, way cart before horse question just wondering what to expect...again, when the time comes! Thanks in advance!

TTC our first Navy baby! Me:27 DH:30, together since 8/2003, Married on 7/2006
9/26/10 stopped BCP and started TTC.
9/2011 referred to RE. All blood work normal and DH's SA=normal results
11/2011 HSG=both tubes clear
One natural (monitored) cycle of Clomid, 50mg 2/2012= BFN
Getting ready for first IUI, 3/2012 received orders to Japan! (postponed IUI)
5/2012 Moved to Japan, fought Tricare for months over referral (no fertility treatment on our military base) for Japanese RE out in town!
8/2012 Started seeing new RE
9/2012, post coital test= hostile cervical fluid, (finally) moving on with first IUI!
9/29/2012 IUI #1+trigger= BFN
10/27/2012 IUI #2+100mg Clomid CD5-9+trigger= BFN
11/28/2012 IUI #3+100mg Clomid CD5-9+trigger= BFN
12/28/2012 IUI#4+100mg Clomid CD5-9+trigger=BFN
2/1/2013 IUI#5+injectables+trigger=BFN
3/2013 IUI#6+injectables+trigger=???

Re: Pregnant with Tricare Prime

  • I would call your on post Dr. to make an appt. They will set you up with an OB unless they are full and cannot accept any more patients. Same with the military hospital. If you are being seen on post for care, you will deliver on post.
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  • I believe they just pick a doctor for you.  I am on standard and because of Global Maternity, won't have to pay any type of cost shares (that is what Tricare rep told me on the phone yesterday).  The civilian doctor you see just has to be participating in Tricare. If you want to see a civilian and pick yourself, then maybe you should switch to Standard.
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  • Once you get a BFP you will call your PCM, who will confirm with an in-office urine test and possibly a blood test. Then s/he will refer you to an OB. If there in an OB on post with room for new patients you will be referred there. If not, you will be referred to a civilian. If you have a civilian doctor in mind that you want to see I suggest switching to Tricare Standard as soon as you get your BFP so you can choose that doctor. GL!
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  • If you are at a base that has OB's and the facilities at the base hospital to deliver babies and have a nursery then you'll be seen on base.

    If your base does not have the facilities they will refer you off base.

    Our base does NOT have the facilities and there are 2 OB clinics in this town and I got to choose which one I wanted and then they referred me for my maternity care. I will deliver at the local hospital.

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  • imagemeltoine:
    Once you get a BFP you will call your PCM, who will confirm with an in-office urine test and possibly a blood test. Then s/he will refer you to an OB. If there in an OB on post with room for new patients you will be referred there. If not, you will be referred to a civilian. If you have a civilian doctor in mind that you want to see I suggest switching to Tricare Standard as soon as you get your BFP so you can choose that doctor. GL!
    This.  My PCM is also an OB.  She had to put in a referral to Tricare for herself.  They denied it and made me go to the Naval hospital.  We had to switch me from Prime to Standard to go to her again.

    BFP#2 2.5.11 (EDD 10.15.11) DS born 9.28.11

    BFP#4 8.27.13 (EDD 5.6.14) DD born 4.23.14


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  • Since you're going to be seeing an RE, you won't have to deal with anyone on post until you get your BFP. DH and I are in the same boat right now. We've heard some horror stories about OB care and delivery at an on post hospital. It's usually a given that you'll have to deliver on post if you live within the 30 minute required radius. As soon as we get our BFP, we're switching to Standard. I don't feel comfortable, especially after struggling with IF, having just anyone handle my and my future baby's care. From what I understand, pregnancy and delivery is pretty much entirely covered under Standard anyway. Good luck!
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    PCOS--TTC since 11/2010:   
    5 cycles of Clomid: all BFN, 1 cycle of Follistim:CP
    1 year break thanks to deployment.
    1 cycle Follistim: BFN, Lap to remove peritubal cyst May 2013
    2 cycles Follistim + trigger: BFN, Gonal F +IUI April 2014: BFP!!!!!! 

    Boy/Girl Twins due Jan 5, 2015!!! 

  • You go to your PCM for a referral. If you live near an MTF that offers OB care and space is available, Tricare will send you to them. If you don't live near one, or they are full, they will assign you to a civilian. However, if you are going to be assigned to a civilian, you can choose your own doctor as long as they are in the network. You just have to call Tricare, OR, your PCM can put in the referral for that doctor at the time of referring you to OB. If the MTF is closed, then Tricare should approve the referral to the doctor that was listed.
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  • When you get the positive test result, you will have to make an appointment with your primary doctor, who will then do a blood test. When that comes out positive, s/he will put in a referral with Tricare for you to see an OB. Just like everyone said, if they can treat and deliver your baby on base, they will refer you there. If they can't, they will attempt to assign you to a civilian OB. If you have Tricare standard, you can pretty much pick whoever you want to deliver your baby and I believe you and your husband would be responsible for about 20% of costs (?) and some co-pays. If you stick with Tricare Prime, you can chose a civilian doctor that is approved by Tricare (you should be able to get a list of approved doctors by contacting them or visiting their website) and you guys won't be responsible for any pregnancy related costs. We have Prime right now, but the base doesn't have facilities for prenatal care/delivery, so we are seeing a civilian. I have heard both good and bad about on base delivery. I have been seen by military doctors (was active duty AF) and haven't had any problems with my PCMs. My advice to you would be to do your research and already have the name of a Tricare approved OB, so that you don't automatically get assigned. They won't wait around for you to pick one. Also, I would call Tricare directly as they should be better at answering your questions (I have already done this a few times). Good luck.
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  • I didnt read all the responses all the way through but I just wanted to tell you my experience. I got pg with DD with the help of an RE. During the cycle I got pg I went in for a blood test with the RE at 9 DPO. They called me and told me it was positive. I then stayed with the REs office untill I was 10 weeks pg. I got an ultrasound every week with them. Then I just called the OB on post and I went to them after my RE released me. Tricare covered everything. Hope that helps!
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  • I was told the other day it depends on if your base (military facilty) that you are stationed at has a Gyn, womens center, or a hospital for you to give birth. If not you will have to go to a non military off base provider. This is my situation since my husband hasnt been stationed yet and the hospital is under construction. Good luck.
  • most RE will see you until 10-12 weeks and you get weekly ultrasounds which is always nice :) If you are high risk they will probably suggest a high risk OB. that is what my RE did

    Married 11/27/09 and TTC right away
    Dx: Complete septate uterus with cervical duplication, endometrial polyps, PCOS, endometriosis, hypo thyroid, luteal phase defect
    4 uterus surgeries to correct my complete septum and to remove polyps and 2 years of seeing the RE, medicated cycles and IUIs
    Baby 1 and 2: BFP 3/3/11 with 2 babies EDD 11/1/11, M/C 4/6/11
    Baby #3: 8/11 pregnant EDD 4/27/11 and m/c:(
    Baby #4: 10/12/11 BFP! EDD 6/16/12m/c 10/26/11
    Baby #5: 3/13/12 BFP! EDD 11/25/12 ANOTHER m/c :(

    Baby #6: 2/14/13- BFP! EDD 10/24/13, CP 2/19/13
    Baby #7: 3/15/13- BFP! EDD 11/27/13, another CP
    Baby #8.  BFP 5/19/13 EDD 1/22/14. 8 was not our lucky number

    4th septum resection on 5/31/13.
    Baby #9: 6/29/13 BFP. C section scheduled for March 5th!

    My miracle baby was born March 5 at 9:33am. He was 8 lbs 12.5 oz and 21.25 inches long!


  • I have prime and I'm pregnant. It took 7 yrs for this to happen, so we were caught off guard to say the least. I called a few OBs in the area to be sure they accepted prime and that they were accepting new patients, then I found out which one could see me soonest. Got the info and called my PCM to get a referral. Simple as that ;)
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  • I'm on Prime remote, seeing a civilian doctor, but this is still how it works either way:

     You go to your regular PCM to confirm your pregnancy as early as you know it.  They will refer you to an OB- could be military or civilian; it really does depend on a lot of factors.  Some posts allow you to see civilian OBs.  Some posts will make you see the military OBs.  It's up to the post to allow Tricare to offer civilian OBs.  Sometimes they will give you options to choose from, sometimes not.

    Once your OB is chosen, they are your de facto PCM for the term of your pregnancy and post partum.  You're original refferral will cover all your appointments up through your 6 week post partum appt.

    Married August 23, 2008!

    My little angel RIP August 12, 2010 - September 5, 2010

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  • imagemeltoine:
    If you have a civilian doctor in mind that you want to see I suggest switching to Tricare Standard as soon as you get your BFP so you can choose that doctor. GL!

    This is what I've done with my pregnancies.  Prenatal & Postpartum care is 100% covered on Standard, there's a small charge while at the hospital (I think I paid a total of 30-something dollars last time for 3 days).  I, personally, didn't want to be seen by a military doctor during my pregnancy.  Good Luck!!

  • You have Tricare Prime or Prime remote? Are you near a base? I haven't really heard of this. When I had DD we were stationed at a base, but I switched to standard so I could be seen by a civ. doctor. Now my husband is recruiting so we're no where near a base and have Tricare Prime Remote. I chose my own OB and called to notify Tricare. I didn't know you could have Prime and get a civ. doctor without a referral from a mil. doctor first.
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