Infertility and Tricare — The Bump
Military Families

Infertility and Tricare

I know this question has been asked before, but I cant for the life of me find the posts.  I was wondering if any of you have had fertility treatments under Tricare and what they happened to cover.  I know that they don't cover IVF, but other then that the website seems pretty vague.  Also, how did you get the ball rolling on treatments?  I'm currently in the process of switching my PCM since the doctor I had insulted my intelligence and didn't seem to care much about my overall health.

If it makes a difference, my husband is AD Navy.

Thanks!

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Re: Infertility and Tricare

  • I don't have any personal experience but I know other people that have had treatments.  I really think it depends on where you are because tricare rules vary in different regions.  I think the "basic" stuff that is always covered is the meds....like if you end up taking clomid, which helps you ovulate, that's covered.

    I have known some women who got their IUI's covered as well but it's not too common.  I've only known 1 person who got their IVF covered but I honestly forget the circumstances with that.

    Edit: Also you need to be trying for at least a year before you can get a referral to an RE....unless that is you've already been diagnosed with something like PCOS.

  • Thanks for answering.  I was diagnosed with PCOS when I was 17 and had blood work and an ultrasound to reconfirm and put it on Tricares records December (2010) .  In November 2011 I was put on Metformin, which doesnt seem to have helped at all. We also have been trying for almost a year, which has been put on hold now since DH deployed.  Im just wondering what we need to be saving for and what they will be covering at this point.  Also, despite my PCOS my PCM has been a real pain to deal with since she seems to feel that Im too young to have kids.  Her words, not mine.  Confused
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  • imageSnoopyCubed:
    Thanks for answering.  I was diagnosed with PCOS when I was 17 and had blood work and an ultrasound to reconfirm and put it on Tricares records December (2010) .  In November 2011 I was put on Metformin, which doesnt seem to have helped at all. We also have been trying for almost a year, which has been put on hold now since DH deployed.  Im just wondering what we need to be saving for and what they will be covering at this point.  Also, despite my PCOS my PCM has been a real pain to deal with since she seems to feel that Im too young to have kids.  Her words, not mine.  Confused

    I would find a new doc too because that's really none of her business or concern, that's a decision between you and your DH. 

    I would anticipate having to pay for everything not med related.  Worse case scenario is that they cover more than you thought and you have extra $ in the bank!  I know you said you looked online but have you called the tricare office in your region?  If not start there.

  • Oh yea, it is definitely none of her business.  Im 24 also, not straight out of high school.  That aside, Im pretty sure doctors are supposed to give you the best medical care they can provide regardless of circumstance.  Hmm

    Thanks for the advice.  I think thats the road we are headed down now.  Save every penny and hope we wont need to use it all. 

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  • Snoopy: Hey! I just wanted to offer some info on your question. I did everything through the military up until IVF and we went civilian for that as we were no longer near Walter Reed in DC that does military IVF.

    My Hubby is AD Navy as well, and your age should not matter in the least. When you talk to your doc (NEW DOC) tell her you are trying to get pregnant and have been trying for over a YEAR, they won?t talk to you unless you have had 12 months of trying. And let her know you would like a referral to a GYN. That is your first step. Next your GYN will run some tests to confirm what you know (everyone runs their own tests!) Next they will go over options with you. And with hubby being deployed it will mean waiting longer for this to happen, unless you freeze his sperm NOW!

    If the GYN can?t get you pregnant with a combo of Clomid, Femora, IUI, TI, or steroids then the GYN will refer you to a RE, who is a specialist. The RE will do more tests and more blood work, more waiting, and try you on different injection meds, and different combos of that. If ALL that fails you will move on to IVF. You will again see your PCM and ask for a referral for IVF along with the recommendation from your RE. If you?re in VA or near DC ask to go to Walter reed, if you?re in CA ask to go civilian. The Medical Center here is not a good with bed side as the civilian is.

    The Navy covered EVERYTHING for us, up to IVF, and then the 3-8k on meds for IVF they covered 95% of. Don?t give up, it?s very expensive for IVF anywhere from 8k-25k for IVF not including the meds, but most places let you finance it so you are only making a payment every month...

    Good luck! I hope you get your baby soon! :o)

     


    Started TTC in 2006, LOTS of trying, and trying, and 7 rounds of IVF with 13 embryos, 2 perfect little boys and 5 loses....
    All finished with babies, started to make diet changes, Keto, to be MORE for my kids, lost 30 pounds, still going, and 3 months in, I had a natural cycle, and then ovulated... Hubs and I are going to see what happens now... Maybe a natural pregnancy? After everything we have been through? Or just a return to normal hormones? We shall see what the future holds!

    Baby Dust To All!!!

    LaciJaxx
  • Thanks for the response!  DH is already gone so we arent in a rush to get started.  I just wanted to know what to bring up to my new doctor when I go in for my annual exam this summer.  Thanks for letting me know how it goes.  Ill be sure to get a referral to GYN.

    Its nice to hear that they covered a lot of the cost. 

    We are currently stationed in VA so I will mention Walter Reed when the time comes.  Thanks again.

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  • KatyJ: Thanks!  I did know about Clomid and the risk of cysts and other complications and would definitely not take it unmonitored.  Im currently on Tricare Prime but plan to call Tricare to see if it would be more beneficial to be on Standard.  After speaking with the health services counslor on base they mentioned the possibility of my being able to switch to Tricare Prime Remote because of my complaints.  Im not too sure how that would even work since we live by a ton of MTFs.  Its great to hear that so much was covered, even under standard.
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  • Hi! I am active duty and have to tell you about my experience.

    Firstly, I had to see an OB here at the MTF that is also specialized in Reproductive Medicine. I was advised they will not give a referral to a RE if you have not been evaluated by a OB. With the OB we have done clomid and IUI with monitoring and she has done everything that a RE would do. I have been very fortunate and boards such as 3TC will help you know if you aren't being monitored properly or any tests they may have missed. I am lucky, as my OB has done everything and anything that other's RE's do. Do not count your OB out until you see him/her.

    Secondly,  PER TRICARE, Tricare will cover costs of diagnostics, and all testing/meds if related to timed intercourse (TI). They will not cover the U/S, meds, etc if they are leading up to IUI or IVF. --- Because I was seeing the doc here at the MTF, she did the IUI's as a covered service, which would not be covered with a civilian RE. The only out of pocket costs were the lab that washed the semen. I have heard that if you get your RE on board you can get most everything covered even when doing IUI or IVF, just pick a RE who is really familiar with working with Tricare. For the most part you can get the U/S's and Meds covered if you work it out.

    Thirdly, the will cover procedures to correct or diagnose a medical issue causing infertility. Such as laparoscopy, hysteroscopy, treating endo, blocked tubes, varicocele, etc.

    And lastly, I don't know where you are stationed, but there are MTF's that do IVF. The cost is significantly reduced as compared to the civilian sector and much more is covered. Plus, I was told my command can actually approve the time as TDY when doing it this way and thats a blessing. They might also for your DH. 

    Right now I am getting ready to go back to the OB and restart a couple months of IUI. If that is unsuccessful, I will be getting my civilian RE referral for consult for IVF. Because of the way the tricare system works many OB's have extensive experience in IF. As long as you are getting propper care and monitoring, do what is best for you and your DH.

     GL!!!!!!

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  • Katyj is correct Tricare will cover everything associated with an IUI if coded correctly even with a civilian.  I have had all 4 of my IUI's completely covered at a civilian doctor and a MTF.  

    The first things when your DH gets back is to ask for a referral to and RE and some testing.  You will need CD3 bw, an HSG, and DH will need an SA. 

    Personally I would not see the GYN for fertility treatment I would go to a RE.  Some MTF's have real RE not just GYNs that specialize.  They are not the same.  I spent 6 months with a GYN who said they could do the same thing as an RE and completely wasted my time.  Also there are 4 MTF's that will do IVF if you come to that in D.C, San Diego, Hawaii, and San Antonio.  We just did IVF at Walter Reed in DC and couldn't be happier with our experience.  GL I also recommend checking out 3T.

    Trying To Conceive since November 2009
    Dx: PCOS and MFI
    IUI#1-4 all BFN
    IVF#1 January (4R, 4M, 1F) BFP
    Colt was born on 10/27 at 11:50pm. 6lbs and 19 1/4"
    Surpise! Baby #2 is on it's way.  EDD 9.18.14

    Baby Birthday Ticker Ticker



    BabyFruit Ticker
  • Thanks for all of the responses!  I lurk on 3T but dont feel like I actually belong there to post there since everything is in limbo with DH gone.  I might suck it up and start posting one of these days..  Smile
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  • I think the discrepancies with Tricare coverage related to infertility isn't because of regional differences, it is because of coding differences.  Some people have doctors that know how to squeeze everything they can out of Tricare (rightly or wrongly) and some doctors don't or don't know how to do that.

    I think the basics of coverage is that they will cover all work-ups and medication (clomid, femara, injectibles) that are related to TI cycles.  It is when you start treading into IUI and IVF that they may start denying coverage.  As far as I know, they are pretty black and white about not covering IVF, but offer the low-cost IVF programs at WRAMC, Wilford Hall, Tripler, and San Diego. 

    I never used Tricare for my IF coverage (I used my civi insurance through the school district I worked for) but I did start my IF workup and testing through Tricare with no issues.

    Best wishes!

    Married 6/28/03

    Kate ~ 7/3/09 *** Connor ~ 11/11/10

    4 miscarriages: 2007, 2009, 2013, 2014

    *~*~*~*~*

    No more TTC for us. We are done, and at peace, as a family of 4.

    "Suffering has been stronger than all other teaching, and has taught me to understand what your heart used to be. I have been bent and broken, but – I hope – into a better shape.” — Charles Dickens

     

  • imagesweetpea2003:

    I think the discrepancies with Tricare coverage related to infertility isn't because of regional differences, it is because of coding differences.  Some people have doctors that know how to squeeze everything they can out of Tricare (rightly or wrongly) and some doctors don't or don't know how to do that.

    I think the basics of coverage is that they will cover all work-ups and medication (clomid, femara, injectibles) that are related to TI cycles.  It is when you start treading into IUI and IVF that they may start denying coverage.  As far as I know, they are pretty black and white about not covering IVF, but offer the low-cost IVF programs at WRAMC, Wilford Hall, Tripler, and San Diego. 

    I never used Tricare for my IF coverage (I used my civi insurance through the school district I worked for) but I did start my IF workup and testing through Tricare with no issues.

    Best wishes!


    This.   There is an infertility clinic at the MTF here so I was able to get my meds for timed intercourse cycles, ultrasounds, blood work, etc. covered. My diagnostics and laparoscopy were also covered through the MTF.   My IVF and all my meds were OOP at a civilian clinic because I did not want to wait a year on the waiting list for the MTF program. Anything associated with IUI or IVF is technically not covered through Tricare (unless you go through a MTF program) but I know there are loopholes. Prepare to pay 100% and then be happily surprised  if you are able to get some things covered. 

    I gave you life, then you gave me mine.

    TTC February 2008 to October 2008 One year forced break due to OIF deployment #2
    Resumed TTC in October 2009 HSG, Hysteroscopy, S/A all clear
    Five total medicated cycles and IUI #1-3 = BFN and all while we were still "unexplained IF"
    25 August Lap revealed Endo, adhesions and blocked left tube
    September 2011: Femara + IUI #4 (IUI #1 post endo removal) =BFFN
    November: IVF #1: Stims started 11/16 ER 11/25 (7R, 5F) ET 11/30 Transferred 2 beautiful expanding blastocysts +HPT 12/6/11
    Beta #1 at 9dp5dt=153! Beta #2 at 16dp5dt= 4009!
    Ultrasound 12/30 showed one beautiful heartbeat! EDD 17 August, 2012

    Hazel Evelyn arrived 10 August, 2012!

    Surprise natural BFP March 2015. M/C at 5 weeks
    Another surprise natural BFP April 2015


  • I have PCOS and did IVF twice and a lot of it was covered like blood work and meds, but some like a doctor fee wasn't. I did it Wright Patterson in Ohio. It cost me around 6k.
  • imagekatyj25:
    imageMrsT007:

    Hi! I am active duty and have to tell you about my experience.

    Firstly, I had to see an OB here at the MTF that is also specialized in Reproductive Medicine. I was advised they will not give a referral to a RE if you have not been evaluated by a OB. With the OB we have done clomid and IUI with monitoring and she has done everything that a RE would do. I have been very fortunate and boards such as 3TC will help you know if you aren't being monitored properly or any tests they may have missed. I am lucky, as my OB has done everything and anything that other's RE's do. Do not count your OB out until you see him/her.

    Secondly,  PER TRICARE, Tricare will cover costs of diagnostics, and all testing/meds if related to timed intercourse (TI). They will not cover the U/S, meds, etc if they are leading up to IUI or IVF. --- Because I was seeing the doc here at the MTF, she did the IUI's as a covered service, which would not be covered with a civilian RE. The only out of pocket costs were the lab that washed the semen. I have heard that if you get your RE on board you can get most everything covered even when doing IUI or IVF, just pick a RE who is really familiar with working with Tricare. For the most part you can get the U/S's and Meds covered if you work it out.

    Thirdly, the will cover procedures to correct or diagnose a medical issue causing infertility. Such as laparoscopy, hysteroscopy, treating endo, blocked tubes, varicocele, etc.

    And lastly, I don't know where you are stationed, but there are MTF's that do IVF. The cost is significantly reduced as compared to the civilian sector and much more is covered. Plus, I was told my command can actually approve the time as TDY when doing it this way and thats a blessing. They might also for your DH. 

    Right now I am getting ready to go back to the OB and restart a couple months of IUI. If that is unsuccessful, I will be getting my civilian RE referral for consult for IVF. Because of the way the tricare system works many OB's have extensive experience in IF. As long as you are getting propper care and monitoring, do what is best for you and your DH.

     GL!!!!!!

    This is not true. All of ours was covered. It is a matter of how the RE codes it.

    I was telling you all what Tricare's official stance on it is and what they told me, but if you read the entire thing I said about them paying for things as well!!! I highlighted that part. Thanks!

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  • Woot Woot, Sweatpea and Fraggle, you both said it beautifully!!! Thank you for your wise words! 

    Also I still say if you have a competent OB-Gyn and do NOT have access to a RE, then that is a personal choice. I work as a nurse in our facility and one of my best friends is a RE back in Nebraska and has completely supported everything my OB has done.

    I know we probably made this all even more confusing!!! Good luck with your choices and with your IF treatments! I hope you get your BFP real soon!

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  • jb2rnjb2rn member
    imagekatyj25:

    OP, please DO NOT take fertility meds under anyone elses care other than an RE. Clomid should NEVER be given by an OB/GYN. If you have been trying for over a year, go see an RE. They will run appropriate tests (bloodwork, HSG, SA, u/s). While taking meds such as Clomid, you will need to be properly monitored such as CD3 and 7 DPO bloodwork as well as an u/s around CD12. Clomid can cause cysts and thin your lining, which if not properly monitored, would not be known.

    We are Tricare standard and I did not need a referral to my RE. So far, everything has been covered besides our IUI. All bloodwork, meds, HSG, u/s(s) and appointments have been covered.

    GL!

    THIS! You need to see the RE, especially since you have a diagnosis. I had an HSG, my husband had a semen analysis, and I had bloodwork, all covered by tricare (prime). My RE referral covered the initial consult visit and u/s.

    good luck.

    b/w=FSH 15.6, AMH 0.4 surprise natural BFP on 3/12/11
    DS born via unplanned C-section at 40w6d

    image

  • I agree with what sweetpea and fraggle shared. I wanted to add that I believe there is a fifth MTF doing IVF now--Womack Army Medical Center at Fort Bragg.

    I did my IUI cycles at the IF clinic in San Diego and our IVF cycle at Walter Reed (which is now part of the combined Bethesda/Walter Reed medical center). We paid about $6k for IVF with ICSI in 2008. I know that the Besthesda/Walter Reed program has a FB page if you are looking for information.

    What infertility procedures that are covered/paid for for military members and dependents varies from location to location, patient to patient, diagnosis to diagnosis. The TRICARE line is that they will cover for diagnostic work, and for treatments that are timed intercourse based. MTFs operate separately and what is covered depends upon funding sources. When I was going through treatments, friends being treated at WRAMC had to pay lab fees for IUIs. In San Diego, we did not. So, take the information you have read here and talk to your medical care providers. My personal stance, on most things military related, is to prepare for the worst, hope for the best.
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    LushC
  • Thank you everyone!   I will prepare to pay everything out of pocket and be excited when things get covered then.  The Tricare provider list says there is an RE at the MTF here, so Ill see what thats all about.  Im terrified yet excited to get the ball rolling.
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  • I'll just throw in my two cents here...

    My DH is AD Navy and we're stationed at NS Norfolk. We've been trying for over two years to get pregnant. I also had a very difficult time with one of my PCMs but after changing to someone who actually listened to me, I got my ball rolling as it were. After getting my referral to an OB/GYN who specializes in Infertility, she set me up with all kinds of tests (bloodwork, sonogram, HSG, SIS, etc) and all of that was covered. DH's SA was the only thing that we had to pay for out of pocket because the naval hospital doesn't have an andrology lab. It was only $110. After all of my test results it came clear that I have PCOS and that medicated IUI cycles were the way to go. All of my meds (Prenatal vitamins, Provera, Metformin, Clomid, Femara, HGH injection, urinalysis) were covered by Tricare Prime and so were the following ultrasounds and IUI procedures. Again, the only thing we paid for were to have DH samples "washed" as that's required for all IUIs.

    We have done one IUI and had to take a break when DH went underway for a few months. Now that he's re-enlisted and gotten shore duty orders, we've just started a new cycle last week and we hope to have our second IUI later this month.

    Hope this helps you in some way... let me know if you wanna chat further!  Good Luck to you!

     

    image
    Dx Hypothyroid 2009 - Dx PCOS 3/2011- TTC since March 2010
    DH: Perfect
    April 2011 - HSG - Normal/Clear but tilted uterus
    May 2011 - Start Metformin
    June 2011 - SIS - Arcuate but normal uterus
    July 2011 - 100mg Clomid Cycle cancelled - No response
    August-September 2011 - Break for oral & eye surgery
    Oct 2011 - Femara 7.5mg + Metformin 1500mg + Novarel trigger + IUI #1 = BFN
    Nov-Mar 2012- Break due to DH ship schedule
    April 2012 - Femara 7.5mg + Metformin 1500mg + Novarel trigger + IUI #2 = BFFN
    May 2012 - Femara 7.5mg + Metformin 1500mg + Trigger + IUI #3 = BFFN
    June 2012 - Femara cycle cancelled - No response
    Jul-Aug 2012 - Break, getting our financials in order
    September 2012 - IVF w/ ICSI and AZH
    9/11/12 - ER (34 retrieved, 24 mature, 18 fertilized)
    9/16/12 - ET - 5dt of 2 perfect blasts and 7 frosties!!!
    Beta #1 - 10/1/12 - BFP!!! 2000+
    Beta #2 - 10/3/12 - 4881
    Beta #3 - 10/5/12 - 8570
    First u/s - 10/9/12 - 6w0d - 2 sacs!!!
    Second u/s - 10/16/12 - 7w0d - 2 babies with 2 strong hbs!!
    First OB appt - 11/5/12 - "Baby A" looks great, good hb and movement, measuring 10w0d
    "Baby B" stopped growing at 8 weeks :0(
    12/5/12 - Baby looks great at 14w2d - 165bpm heartrate!
    January 4th, 2013 - Lost our Baby Girl, Faith at 18w3d
    Emergency D&C to clear infection
    We love you and miss you little one
    image
  • YankeeNavy: Thanks so much, that helped a lot since we are in the same area.  My DH is at NAS Oceana.  Would you mind recommending your PCM to me?  Id rather choose off of a recommendation then just picking a random doctor again.

    Thanks! 

     

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  • I actually wrote an article about what Tricare does and doesn't cover with regards to fertility treatments and IVF.  We went through a Military Treatment Facility for all our IUI's and IVF's (Madigan for IUI's and then Womack for IVF's)

    Tricare Coverage of Infertility
    Christa
    Adopted a baby girl in January 2013 via domestic infant adoption
    "One and Done!"  Now we spend our time traveling the world as a family

    My Blog: Travel Fearlessly
  • You're completely right.  Because going through 2 IUI's, 2 IVF's, and 3 FET's through the military, not to mention genetic testing, gives me NO expertise on the matter of what Tricare covers.  I was only trying to help
    Christa
    Adopted a baby girl in January 2013 via domestic infant adoption
    "One and Done!"  Now we spend our time traveling the world as a family

    My Blog: Travel Fearlessly
  • LaciJaxxLaciJaxx member
    edited November 2013
    You won't likely be allowed to switch to tricare prime remote if you have MTF's in the near vicinity. I am remote right now because the closest is 75 miles away. That being said, I am not aware of there being any difference in prime and prime remote. Best of luck!!!!

    Edit: Sorry, I was mobile before. Here is the info on prime remote, from the tricare website: "TRICARE Prime Remote is a managed care option available in designated remote locations in the U.S.; usually more than 50 miles or one hour's drive time, from a military hospital or clinic." Also, "TRICARE Prime Remote is only available to active duty service members (which includes activated Guard/Reserve members) and their families who live and work in designated remote locations." 
    Lilypie Premature Baby tickers

    imageimageimage

    Pregnancy #1 EDD 1/20/13, D&C for unexplained miscarriage at 12w
    Pregnancy #2 EDD 8/28/2013, Carson was born on 6/28/2013 at 31w - spent 37 days in the NICU
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