Tricare isn't covering my anatomical ultrasound...!?!? — The Bump
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Tricare isn't covering my anatomical ultrasound...!?!?

Long story short... I've had to switch from 3 different doctors, because, this seems to be the year everyone wants to retire. Jeez!

Up until I came to this new doctor, around 16 weeks pregnant, I have not paid for a single thing, seen a bill, nothing. With this new doc, I am now being billed for the anatomical ultrasound that I had at 20 wks. 

I was under the impression that this ultrasound was routine for pregnancies. I'm confused as to why it is not covered under the whole global maternity care. When I talked to tricare, they told me that under GMC, only one U/S is covered. This is strange to me as I've actually had a few... I had 2 vaginal when I first got pregnant with the first doc, then a regular one when I went to see the next doctor, and then when I finally found a doc that wasn't planning on leaving during this pregnancy, he did an U/S at 16 weeks and then did the 20 wk anatomical u/s. 

The anatomical is the first one I have been billed for and tricare says its not medically necessary.

Anyone else have this problem? I feel like if it's not medically necessary, why is my doc having me to this when I am going to have to pay for it out of pocket.

Any thoughts or anyone who has experienced this or more experience with Tricare, I would really appreciate your help!

Thanks ladies!

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Re: Tricare isn't covering my anatomical ultrasound...!?!?

  • Tricare covers only medically necessary ultrasounds. The problem lies in how your doctor's office billed Tricare. They used the wrong billing code. Call the office and ask to speak to the person in charge of billing. 
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  • I'm glad I read this........I have my first appointment on Thursday and have Tricare as well. You would think they would cover all of the U/S b/c they have to do them to know the baby is developing properly. 

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  • This may just be a mis communication error. I just went through the same problem a few weeks ago. I was sent a bill for some genetic blood work from my NT scan and it turned out the company wasn't told to bill tri care. All you have to do is call the company who billed you and explain you have tri care. You will need to supply them with yout DH's ssn also.
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    Call the doctor's office Mmday and speak with the billing department.  The problem is in the code they used to bill Tricare.
  • Yes, it is a coding error.  Tricare will cover all medically necessary ultrasounds - your doctor needs to code them properly if he feels that there is a reason to be doing multiple ultrasounds. TECHNICALLY, for a routine, low risk pregnancy, Tricare only covers one ultrasound at 20ish weeks for anatomy.  If your doctor is billing tricare under "routine ultrasound" because his routine is to do one at every appointment then Tricare will deny them.

    I have had two babies where I had ultrasounds about every 2 weeks.  I have cervical competance issues and need to be monitored carefully.  Both of my pregnancies were with civilian doctors and perinatologists.  Both pregnancies were covered 100% with no issues.

    All about the coding and billing.

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  • I agree that it is about coding.

    I had several u/s during my last pregnancy because of a low-lying placenta.  During this pregnancy, I have had 2-- one to date the pregnancy and the anatomy ultrasound.  They have all been covered and I haven't seen a bill.

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  • image meltoine:
    Tricare covers only medically necessary ultrasounds. The problem lies in how your doctor's office billed Tricare. They used the wrong billing code. Call the office and ask to speak to the person in charge of billing. 

     

     

    def this ^^^^ 

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  • Just as everyone else suggested, the code is probably wrong. If the U/S is coded as being a "gender scan" then TriCare won't cover it...but an anatomy scan is not just for gender; its medically neccessary, therefore they're inclined to pay.

    Just give them a call in the a.m. Hope they work it out in a timely manner! 

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