Pregnant on Tricare Standard-Does this make sense??
arcook0307
member
Last pregnancy (gave birth 12/31/11) I was on Standard and didn't pay anything for prenatal care or delivery. That was in Virginia.
Fast forward to now in North Carolina. Second pregnancy and a new OB practice. Still on Tricare Standard yet I get a bill for my first visit of $84.
I call the doctor's office. She says they used to write the deductible off and they don't anymore. They now choose to bill the patient for what Tricare doesn't cover. She says this is a change within their practice, NOT Tricare. Okay....so I call Tricare.
Tricare says they billed it as "medical" instead of "maternity" and said if she coded it "maternity" I would not have a bill. I call the doctor's office back. She says she'll re-submit it but can't guarantee they will change anything on Tricare's end. She also forewarned me that the way they code the delivery, I will be billed $200....when I paid nothing before.
Anyone understand this??
Re: Pregnant on Tricare Standard-Does this make sense??
When I had dd2, the first visit was to establish pregnancy, not a prenatal visit. So even though I knew I was pregnant, that was the way tricare saw it, so the normal rules applied. I called tricare and had no luck having that changed, that was their procedure in '09.
Every other visit was covered 100%. I did pay something under $100 for my hospital stay. I think they had a daily charge, and that was clear in the policy.
HTH
If it was a billing error that they are going to fix then you're lucky. With Standard you have a yearly deductible you have to hit before everything is covered, which is a small price to pay to have choices. If you want 100% free you need to be on Prime.
This is not true when it comes to maternity. Maternity care is 100% covered under Tricare Global Maternity. For care that is not maternity related (i.e. you get sick and need to visit a general practitioner while pregnant) then you will be responsible for the deductible. There are other women who are more well versed on the ins and outs of Tricare but I know that maternity is 100% covered whether you are Prime or Standard.
I have been on Standard for both of my pregnancies and the only thing I paid for was the hospital stay. Something like $16.50 a day per day in the hospital.
ETA: OP, my very first visit was not considered maternity because it was establishing pregnancy. I think I was charged about $50 for that visit and then $20ish for labwork. Everything after that was covered 100% as long as it was coded maternity.
I also had to pay the deductible for my very first visit to establish the pregnancy and OB care, and then the global billing started. Any bloodwork ordered is also billed separately since it's through a private company and I'm responsible for a deductible.
I guess I worded my post poorly in typing too fast. I took this as her first appt for confirmation of the pregnancy which in many cases is not covered 100%.
This has happened to me.
You have got to keep at them about this.
I had to call my docs office and explain over and over that they needed to submit a global maternity authorization form to Tricare and blah blah blah....
Codes needed to be fixed and a bunch of other stuff but eventually everything got fixed.
Tricare also told me that if for some reason the docs office made me pay anything to them directly, to get proof of that and then Tricare would pay me back.
Standard for my first pregnancy and for this one.
But, if my docs office didn't get their act together and figure this crap out, I was prepared to go to a different doc.
Good luck!