Tricare and TTCing

Mickeyjazz · December 2011

Hello ladies! I don't know why I have not frequented this particular message board (I usually post under the Trouble TTC board). Anyways, My husband has been Active Duty in the Army for 11 years now and is stationed at Ft. Lee, VA. We have been married for 10 years and decided a year ago that we were ready to TTC.

The problem is that I have irregularly long cycles (one being 119 before provera kicked in). So after about 6 months (while we were stationed at HAAF) I went to see the dr and got a referral for an RE because she suspected I had PCOS. Luck has it that we PCSd before I could get in with the RE I was referred to.

Once I got to Ft. Lee I set up an appointment to see if I could get the referral again, but was referred to an OB instead. There has been no testing to see if I have PCOS with the OB and I feel like I am getting the run around; Although I do have a HSG scheduled for next Tuesday. Saturday will hit the year mark for our TTC journey and I don't know what my next step will be.

Should I go back to my PCM and request an RE referral? I called the OBs office and expressed my concern and they said that after the HSG they can send me to an infertility clinic. My concern with that is I know Tricare does not cover infertility. They cover testing to see why you are not conceiving but they do not cover procedures such as IVF or IUI because they are not 100%.

Have any of you ladies gone through this? Do you have any advice on what my plan of action should be?

Any info would be GREATLY appreciated!!

Lissa832 · December 2011

An RE is an infertility specialist, so what's the difference between the original referral and what the OBis saying? You'll be sent to the RE for more testing in all likelihood. If it is deemed necessary that you should undergo IVF or IUI, then that is your decision to make personally and financially. I've been to an RE. The purpose of my visits were to attempt to find a diagnosis for my recurrent miscarriages, and also to have a game plan. If you are diagnosed with pcos, an RE will help you with treatment options. Tricare won't cover fertility procedures, but they will cover treatment.

Gismo123 · December 2011

Lissa832:
An RE is an infertility specialist, so what's the difference between the original referral and what the OBis saying? You'll be sent to the RE for more testing in all likelihood. If it is deemed necessary that you should undergo IVF or IUI, then that is your decision to make personally and financially. I've been to an RE. The purpose of my visits were to attempt to find a diagnosis for my recurrent miscarriages, and also to have a game plan. If you are diagnosed with pcos, an RE will help you with treatment options. Tricare won't cover fertility procedures, but they will cover treatment.

This is not true....I've talked to many women who underwent fertility treatment and they all said that Tricare covers the meds like Clomid, and also IUI's. Most said that they didn't cover IVF's but I think it depends where you are because I have run into a few cases where they did cover it. I would ask for a referral to an RE because of your long cycles, I find it odd they made you wait a year when there was clearly a problem from lack of periods.

NSL · December 2011

Gismo123:
Lissa832:
An RE is an infertility specialist, so what's the difference between the original referral and what the OBis saying? You'll be sent to the RE for more testing in all likelihood. If it is deemed necessary that you should undergo IVF or IUI, then that is your decision to make personally and financially. I've been to an RE. The purpose of my visits were to attempt to find a diagnosis for my recurrent miscarriages, and also to have a game plan. If you are diagnosed with pcos, an RE will help you with treatment options. Tricare won't cover fertility procedures, but they will cover treatment.
This is not true....I've talked to many women who underwent fertility treatment and they all said that Tricare covers the meds like Clomid, and also IUI's. Most said that they didn't cover IVF's but I think it depends where you are because I have run into a few cases where they did cover it. I would ask for a referral to an RE because of your long cycles, I find it odd they made you wait a year when there was clearly a problem from lack of periods.

This isn't exactly true in my experience. A handful of large MTFs have RE clinics and perform IUI and IVF st greatly reduced cost. You do still have to pay, and medication coverage is sketchy.

OP, I'd recommend sitting down with the RE's billing office and discussing how, in their experience, Tricare has been handling claims. It's been far too long since I've personally gone through diagnosis and treatment for me to feel comfortable giving you really specific advice.

Good luck!

Mickeyjazz · December 2011

Thank you ladies for responding! I guess the main question at the moment is Who should be the one to refer me? The OB I was referred to or my PCM?

I know that in any case of IF I may incur some type of financial responsibility. Since I am not teaching at the moment, I just want to make sure that we are prepared.

Thank you again. Hope yall have a wonderful weekend :-D

lauren2_00@yahoo.com · December 2011

NSL:
Gismo123:
Lissa832:
An RE is an infertility specialist, so what's the difference between the original referral and what the OBis saying? You'll be sent to the RE for more testing in all likelihood. If it is deemed necessary that you should undergo IVF or IUI, then that is your decision to make personally and financially. I've been to an RE. The purpose of my visits were to attempt to find a diagnosis for my recurrent miscarriages, and also to have a game plan. If you are diagnosed with pcos, an RE will help you with treatment options. Tricare won't cover fertility procedures, but they will cover treatment.
This is not true....I've talked to many women who underwent fertility treatment and they all said that Tricare covers the meds like Clomid, and also IUI's. Most said that they didn't cover IVF's but I think it depends where you are because I have run into a few cases where they did cover it. I would ask for a referral to an RE because of your long cycles, I find it odd they made you wait a year when there was clearly a problem from lack of periods.
This isn't exactly true in my experience. A handful of large MTFs have RE clinics and perform IUI and IVF st greatly reduced cost. You do still have to pay, and medication coverage is sketchy.
OP, I'd recommend sitting down with the RE's billing office and discussing how, in their experience, Tricare has been handling claims. It's been far too long since I've personally gone through diagnosis and treatment for me to feel comfortable giving you really specific advice.
Good luck!

I've been seeing the RE here at Ft. Bragg for a year now and have done 4 IUIs and will be doing IVF in April. As far as coverage goes, the only thing I paid for during my IUI cycles was the thawing of sperm and the sperm washing. All of my meds, blood draws, and ultrasounds were covered. While the cost for IVF is significantly higher, my meds, blood draws, and ultrasounds will still be covered by Tricare. The money I will pay out of pocket will go to the off-post IVF lab.

To answer your question about who to get the referral from, OP, I got mine from my PCM. It's good that your OB has scheduled you for the HSG. That's a start. Good luck!

Gismo123 · December 2011

NSL:
Gismo123:
Lissa832:
An RE is an infertility specialist, so what's the difference between the original referral and what the OBis saying? You'll be sent to the RE for more testing in all likelihood. If it is deemed necessary that you should undergo IVF or IUI, then that is your decision to make personally and financially. I've been to an RE. The purpose of my visits were to attempt to find a diagnosis for my recurrent miscarriages, and also to have a game plan. If you are diagnosed with pcos, an RE will help you with treatment options. Tricare won't cover fertility procedures, but they will cover treatment.
This is not true....I've talked to many women who underwent fertility treatment and they all said that Tricare covers the meds like Clomid, and also IUI's. Most said that they didn't cover IVF's but I think it depends where you are because I have run into a few cases where they did cover it. I would ask for a referral to an RE because of your long cycles, I find it odd they made you wait a year when there was clearly a problem from lack of periods.
This isn't exactly true in my experience. A handful of large MTFs have RE clinics and perform IUI and IVF st greatly reduced cost. You do still have to pay, and medication coverage is sketchy.
OP, I'd recommend sitting down with the RE's billing office and discussing how, in their experience, Tricare has been handling claims. It's been far too long since I've personally gone through diagnosis and treatment for me to feel comfortable giving you really specific advice.
Good luck!

I guess it's different at every duty station because I know where I am everything is covered except for IVF's.

Smudges*Mom · December 2011

Would you consider driving up to Bethesda, MD, to be seen at the Infertility Clinic at Bethesda Naval Medical Center (or whatever it's called these days)? I ask because three years ago, we PCSed to Fort Lee just as we'd reached the point in our IF journey that we needed to do IVF to get pregnant. Before we moved, I drove from Fort Irwin to San Diego to be see at the Infertility Cinic at one of the MTFs there. Until we did IVF, I did not have to pay a penny for meds or procedures because they were done at a military infertility clinic.

Granted, it was three years ago, but we paid $6k for IVF with ICSI. The clinic is not posh like a private clinic, but they get good results. Let me know if you have any questions! Good luck!

Mickeyjazz · December 2011

Smudges*Mom:
Would you consider driving up to Bethesda, MD, to be seen at the Infertility Clinic at Bethesda Naval Medical Center (or whatever it's called these days)?

I believe that is or was Walter Reed which closed its doors recently. I would have been more than willing to drive there especially since I have a cousin who lived near it.

ufsandra85 · December 2011

I have had 7 months of infertility treatment all paid for. They pay for everything up to iui and ivf and that is hit or miss. There is a lot they can do fertility wise before iui and ivf. I would go to your pcm for an re refferal

Smudges*Mom · December 2011

Mickeyjazz:
Smudges*Mom:
Would you consider driving up to Bethesda, MD, to be seen at the Infertility Clinic at Bethesda Naval Medical Center (or whatever it's called these days)?

I believe that is or was Walter Reed which closed its doors recently. I would have been more than willing to drive there especially since I have a cousin who lived near it.

Yes, Walter Reed Army Medical Center closed this summer. Most everything is being transitioned over to the new Walter Reed Military Medical Center (what used to be called Bethesda Naval Medical Center). I found this link: https://bestivf.org/. They also have a Facebook page.

To be seen at WRAMC, I had to get a referral from my PCM. I found getting into IVF program a little frustrating, BUT, I was coming from another MTF IF clinic and I was under a time crunch (we were at Fort Lee for only six months). But once into the program, it got much easier. I share this to let you know that even if it seems frustrating, it will be worth it!!!! Let me know if you have any questions, I'm happy to share about my experiences.

summerof69 · December 2011

lauren2_00@yahoo.com:
NSL:
Gismo123:
Lissa832:
An RE is an infertility specialist, so what's the difference between the original referral and what the OBis saying? You'll be sent to the RE for more testing in all likelihood. If it is deemed necessary that you should undergo IVF or IUI, then that is your decision to make personally and financially. I've been to an RE. The purpose of my visits were to attempt to find a diagnosis for my recurrent miscarriages, and also to have a game plan. If you are diagnosed with pcos, an RE will help you with treatment options. Tricare won't cover fertility procedures, but they will cover treatment.
This is not true....I've talked to many women who underwent fertility treatment and they all said that Tricare covers the meds like Clomid, and also IUI's. Most said that they didn't cover IVF's but I think it depends where you are because I have run into a few cases where they did cover it. I would ask for a referral to an RE because of your long cycles, I find it odd they made you wait a year when there was clearly a problem from lack of periods.
This isn't exactly true in my experience. A handful of large MTFs have RE clinics and perform IUI and IVF st greatly reduced cost. You do still have to pay, and medication coverage is sketchy.
OP, I'd recommend sitting down with the RE's billing office and discussing how, in their experience, Tricare has been handling claims. It's been far too long since I've personally gone through diagnosis and treatment for me to feel comfortable giving you really specific advice.
Good luck!
I've been seeing the RE here at Ft. Bragg for a year now and have done 4 IUIs and will be doing IVF in April. As far as coverage goes, the only thing I paid for during my IUI cycles was the thawing of sperm and the sperm washing. All of my meds, blood draws, and ultrasounds were covered. While the cost for IVF is significantly higher, my meds, blood draws, and ultrasounds will still be covered by Tricare. The money I will pay out of pocket will go to the off-post IVF lab.
To answer your question about who to get the referral from, OP, I got mine from my PCM. It's good that your OB has scheduled you for the HSG. That's a start. Good luck!

I will have Tricare Reserve Select in Jan. So Lauren Tricare covered IUI and meds? I might have to make a trip to Fay. I have relatives in NC.

RealMomma · December 2011

I am active duty and the duty station I am at I see a OB. To see a RE would be an out of pocket expense we can't afford right now. She has done all the proper workups for me and I trust her fully. Tricare has covered the clomid and will cover the other meds if I need them. She does the IUI's also without charge, but I do have to pay for the washing off post. She did say if I need IVF, then we will have to pay out of pocket. When I looked into it, it is less expensive than the civilian world. The 5 MTF's they do it at, they do it because they need the "experience". So if it comes to that you could weigh your options of seeing and being treated at a MTF or by a civilian.

GOOD LUCK!

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