Tricare and ultra sounds

LetsHikeToday · February 2012

Hi everyone!

I'm new here and have a question! My husband is in the Navy and I'm enrolled in tricare standard. My doctor told me tricare only covers one ultrasound and I found that on the website too.

For those of you who got an ultrasound to find out the babies sex, did you pay out of pocket? Or we're you able to have a second because yours was medically necessary? If you did pay out of pocket, do you remember how much it cost?

Any help would be great! Thanks.

ufsandra85 · February 2012

if your doctor's office codes correctly you can have many ultrasounds for medically necessary purposes. they are allowed to do us to check growth, placement, etc just not solely for the purpose of determining sex.

LetsHikeToday · February 2012

Thanks :-)

LemonLover33 · February 2012

Ultrasounds: Doctors often perform ultrasounds at different times during pregnancy for different reasons.TRICARE will cover ultrasounds used to:Estimate gestational ageEvaluate fetal growthConduct a biophysical evaluation for fetal well-beingEvaluate a suspected ectopic pregnancyDefine the cause of vaginal bleedingDiagnose or evaluate multiple gestationsConfirm cardiac activityEvaluate maternal pelvic masses or uterine abnormalitiesEvaluate suspected hydatidiform moleEvaluate the fetus's condition in late registrants for prenatal care
TRICARE does not cover maternity ultrasounds for routine screening or to determine the sex of the baby.If you have ANY questions about coverage, please contact your regional contractor.https://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Maternity+Care&topic=WomenNo, I have never read or heard that TRICARE will only cover one ultrasound. Nor does the website list that it only covers one ultrasound.

pesci12 · February 2012

When I was pregnant, a nurse initially told me Tricare would only cover one ultrasound as well. I ended up having six. They did a pelvic u/s at my first appointment with the OB, and then around 20 weeks they did the anatomy u/s. I found out LO's sex at that time.

From working in MTFs for several years, I know if during that u/s they see that your baby is healthy but can't see the goods, they will not do another just to find out the sex. Tricare will only cover it if it is a medical necessity, so you would have to pay out of pocket if you really wanted to know.

In my case, there was medical concerns so I had several ultrasounds.

StarJay · February 2012

pesci12:

and then around 20 weeks they did the anatomy u/s..... if during that u/s they see that your baby is healthy but can't see the goods, they will not do another just to find out the sex. Tricare will only cover it if it is a medical necessity, so you would have to pay out of pocket if you really wanted to know.

This was my experience as well. Most drs will at least try to determine gender for you, if you request, during your 20 week anatomy u/s which is covered under TriCare. However, TriCare will not cover any additional u/s that are not deemed medically necessary. That being said, it all comes down to how your drs. office codes their u/s

Gismo123 · February 2012

Not sure about Standard but on Prime I've had 4 U/S so far and will have at least 2 more. My first one was for dating and was done at the Navy hospital on base but the other 3 were done out in town. 1 NT Scan, 1-A/S Scan, 1-Growth scan....I have a low Pap A protein so I'll have at least 2 more Growth scan's. The place I went to in town billed tricare every time and it was covered as long as I had a referral from base.

BabyCampbell312 · February 2012

I have been fighting with tricare and the billing b**ch at my doctors office for months now about my 20 wk anatomical ultrasound. Tricare paid for most of it, but I still have to pay like $80. I'm pissed cause I was told it is medically necessary to have the 20 wk ultrasound and that tricare would cover 1 U/S. I've spoken to everyone about it and am getting no where. Now I just feel like I need to give up and pay for it.

Lissa832 · February 2012

With DD, I had three ultrasounds in the first trimester, 2 in the second, and 1 in the last. With DS, I had 3 in the first, and 1 in the second. Each one was covered.

WeWearCombatBoots · February 2012

Everyone is correct, Tricare will cover as many as your provider will code correctly. I had probably 15-20 ultrasounds during my pregnancy. I had high blood pressure and they were monitoring me for pre-eclampsia so I had one at least once a month and then once a week the last couple months.

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