Question for active duty ladies, pregnant with civilian insurance...

meganroselee · November 2011

Hi! I am a current AD AF member who recently confirmed pregnancy through a blood test at my mtf. When I got back on active duty back in July 2010, I specifically maintained my husband's private insurance so I could go to the ob of my choice. I just rcvd a phone call from public health telling me I need to come in to do ob intake. I have the type of job where taking time off is an incredible pain... It causes more work for me and inconveniences multiple ppl. I plan on calling the guy back on a day that I could potentially come in but my question if for you ladies who have done this or know someone who has... Does the AF force me as and ad member to participate in their healthcare? I have a midwife picked out and don't want to be forced to seek care with an ob not of my choosing... Thanks!

sweetpea2003 · November 2011

Hmmmmmmmmmmm... That is a really interesting question. I have used civilian insurance in the past as the wife of an active duty member. But I never thought about putting DH on my civilian insurance.

I know for my DH he has to be seen by specific doctors because he flies and needs specialized flight physicals. His doctors are flight surgeons and familiar with what his body goes through and what it needs to be capable of to fly safely. So civi doctors wouldn't cut it in his case (and a civilian physical wouldn't cover what he needs).

But for OB care, unless you will need a spcial clearances for work that require military training (for the doctor), I wouldn't see the big deal. Of course, I am not AD and this is just a guess.

Good luck with your pregnancy!

BLT20051 · November 2011

I'm active National Guard so take this as you will. But, I have been told that I have to use Tricare Prime. When I was pregnant(I later miscarried) I was to drive the hour to Great Lakes Naval to see their Women's Health Clinic. They would have referred me out before delivery only because they didn't deliver there but all my care had to go through them and I had to receive a referral. Does your MW not take Tricare? Is it an option you could discuss with her?

hilwithonelary · November 2011

Well, you will most definitely have to process through public health. That's necessary to get you on your pregnancy profile and update their computers to show that you're not world-wide qualified.

As far as seeing a civilian provider, I'm not sure. If your base has OB services, you might be required to see them. If OB services are not available, you will be referred out anyway. I was AD when I had DS, but since they didn't have OBs on base, I pretty much got to pick my provider. When I went to the referral office with my paperwork, I told them who I wanted, and they had no problem sending me to her. If your base refers you out and your midwife takes Tricare, this might be an option.

My only experience with AD member seeking care outside of Tricare has been with plastic surgery. Several members of my squadron did this a few years ago. I know that they had to have paperwork filled out and approved with the SGH (Chief of the Medical Staff) and signed by the Gp commander. I advise that you inquire with the Tricare office how this works.

meganroselee · November 2011

s. To clarify, I am looking to use hubby's humana (i am a listed benificiary, we pay for my coverage monthly) not tricare at a civilian clinic. But I wil definitely stop by public health... I didnt think about the profile issue. Thanks for thevreplies ladies!

Ilumine · November 2011

You may want to double check this, but when I worked for TRICARE, the regulations were VERY CLEAR. If you are Active Duty, you MUST USE TRICARE. And I just asked my SMSgt DH if this was still true and HIS understanding is that this regulation has not changed.

So unless you are TRICARE Prime Remote (which sort of negates the whole wanting to choose my own doc debate), you could very well get yourself into a whole mess of trouble.

Now again, it's been 6 years since I worked as a lobbyist for one of the military assn. and 10 since I worked in Skyline, but I doubt that the DoDs need to control their assets has lessened.

The_Spanish_Inquisition · November 2011

What Illumine said is correct. If you are active duty, you must use Tricare. There are no other options for healthcare for you.

People do work the system by "forgetting" to mention that they are mandatorily covered by Tricare, but obviously, it's fraud. And if you become sick or disabled, the $hit would certainly hit the fan.

I would just take the time to find a Prime doc that I'm comfortable with. If you're not comfortable with the docs at the MTF, you can appeal to the Patient Advocate at the facility to be seen off-base by a civilian doc who accepts Tricare, but it's within their rights to deny your request.

LuluP82 · November 2011

My H is on my employer-provided insurance and he uses it all the time for little things (chiropractor, eye doctor, dermatologist) because he doesn't need a referral. It saves a TON of time. His command knows this and no one ever has said anything to him. I really don't see why it would matter, so long as he's still getting physicals and such and is being taken care of. Technically, we're saving the DoD oodles of money.

However, none of those things are like a pregnancy, though. Usually a visit once in awhile for something discrete. Nothing that affects his job performance or causes him to miss work.

I do know with OB it's different though. Just like AD can't select Tricare Standard and go off base for OB care, I'd imagine it's the same for opting out of Tricare totally. I will say though, I have awesome civilian insurance and I still chose to go with Tricare (I have prime) and am delivering at the MFT. I have had a wonderful experience thus far.

BLT20051 · November 2011

LuluP82:

My H is on my employer-provided insurance and he uses it all the time for little things (chiropractor, eye doctor, dermatologist) because he doesn't need a referral. It saves a TON of time. His command knows this and no one ever has said anything to him. I really don't see why it would matter, so long as he's still getting physicals and such and is being taken care of. Technically, we're saving the DoD oodles of money.

However, none of those things are like a pregnancy, though. Usually a visit once in awhile for something discrete. Nothing that affects his job performance or causes him to miss work.

I do know with OB it's different though. Just like AD can't select Tricare Standard and go off base for OB care, I'd imagine it's the same for opting out of Tricare totally. I will say though, I have awesome civilian insurance and I still chose to go with Tricare (I have prime) and am delivering at the MFT. I have had a wonderful experience thus far.

The_Spanish_Inquisition:

What Illumine said is correct. If you are active duty, you must use Tricare. There are no other options for healthcare for you.

People do work the system by "forgetting" to mention that they are mandatorily covered by Tricare, but obviously, it's fraud. And if you become sick or disabled, the $hit would certainly hit the fan.

And, you can get Tricare standard to be seen off post. It happens often times if a) your MTF doesn't deliver b) you're high risk c) the OB services at your MTF are too full d) if you go through your patient advocate and they approve you seeing someone else.

elfitche · November 2011

I have the opposite issue (my DH is AD and I am on Tricare Prime through him, but my Private Ins through work is my PRIMARY ins, and Tricare is secondary), I called Tricare to ask what the protocol is on this. And I was told, that basically whatever your PRIMARY insurance is, is what determines the rules. Since you are AD I would assume that Tricare would be your Primary insurance and your DH's private insurance would be secondary. That being said, you have to follow the rules of Tricare, meaning you would have to see their doctors, get any referrals etc, that would be necessary if you were wanting to see an outside physician. The secondary insurance would follow any rules set by Tricare, as well.

Gismo123 · November 2011

As previous posts have said you HAVE to use tricare if you are AD. Don't take this the wrong way but you're government property and they can do what they want with you.

When I was AD the only time they would allow me to see a non military doctor was if there wasn't that specific specialist in the area....for example when I was stationed in Iceland I had a breast reduction and had to see a civilian Icelandic doctor since the base couldn't provide a military one that specialized in that field.

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