New - Tricare/Testing/PCOS Any experiences here?

bnc 0526 · February 2013

Hi all! My husband is AD Army. I have had limited interaction with Tricare, thus far. However, my OB wants to run some tests to confirm PCOS. DH and I are anxious to start a family. And after our first loss, and with my reproductive health in serious question, we want to start sooner rather than later. Now, I know that infertility is a word Tricare doesn't like to hear. I know they don't cover anything coded as infertility. Because the testing isn't really for infertility, but rather the diagnosis of PCOS, what coverage can I expect? According to the insurance lady at the OB's office, Tricare is "crap" and won't cover any of the testing. (By testing, I mean CD3 bloodwork, HSG, and CD23 bloodwork.)

So, I called TriWest and the CSR said that the OB has to put in for prior authorization for the testing. Makes sense. I guess my questions are, what is your experience? Did Tricare cover testing? What can I do to help make this work in my favor? Once I get a diagnosis, will Tricare cover any meds to increase the chances of ovulation?

Thanks so much for any input you have! I really appreciate it!

BLT20051 · February 2013

Are you Prime or Standard? Is your OB on post or off?

bnc 0526 · February 2013

Oh, should have included that! I have standard, and the OB is off post.

bnc 0526 · February 2013

quartermisses:
I have no experience with PCOS or infertility, but "crap" is never an adjective I have ever heard associated with Tricare Prime, before. We have the best coverage we have ever had (I had outstanding Kaiser coverage through my employer before our last PCS), and with the exception of some long wait times in the MTF pharmacy, we've had nothing but good experiences. We've been told Tricare will cover anything that is medically necessary, and I have had extensive testing both on and off post for my Hashimoto's.

And if I am not mistaken, there is a post down the page a little written by someone asking about the reproductive specialists office at one of the biggest MTFs on the west coast. It may be worth reading through to see if her experience offers any insight.

Thanks! I will take a look at it. Also, to clarify, I'm not saying Tricare is "crap." That was the word the insurance lady chose to use. I found it odd, but I don't have a whole lot of experience with Tricare, so what do I know. I'm just happy to have any sort of insurance. I also have Standard, not Prime. I'm not certain of the specific differences, other than referals. I'd rather be able to pay a little out of pocket and pick my own doctor than not. Just me. Anyways, thanks again! I appreciate the input!

ufsandra85 · February 2013

pretty much everything they told you was wrong, they cover all testing and everything related to infertility. the 2 things they do not cover are IUI and IVF. But there are even exceptions to those things. I have been seeing an RE for 3 years and have had over 100k of infertility treatments and I havent paid a penny.

ufsandra85 · February 2013

https://www.facebook.com/groups/216032457783/

this is a great group. it is a military wife infertility group

MzCurnett8886 · February 2013

My PCM got approval from TriWest for several tests with PCOS. I went and explained that I was working out 6days a week, eating very healthy/drinking only water, had irregular cycles and was still gaining weight. My doctor did bloodwork and then put the referral in from there. They were going to cover my medications, and everything for infertility up until IUI and IVF.

Lissa832 · February 2013

After dealing with Tricare for close to a decade,I believe I agree with the lady in your OB's office. Tricare tends to be a big cluster f*ck. with that said, Tricare will cover all diagnostic testing. They will cover Clomid. They will cover HSG testing. They will not cover injectibles or IUI or IVF procedures.

I have had Prime and Standard. Standard is 100% the way to go from my experience. You have OOP expenses, but flexibility. The flexibility is worth the extra money.

bnc 0526 · February 2013

You're all wonderful! Thanks for the words of wisdom! And thanks for the link to the Facebook group. I will check it out!

KDS1987 · February 2013

If you live near a MTF that has an infertility clinic I would consider switching to prime so you can do IUI and have all those lovely perks without the out of pocket expense. I realize that is not an option for everyone, but if it is then it's something to think about! Good Luck!

ufsandra85 · February 2013

Lissa832:

After dealing with Tricare for close to a decade,I believe I agree with the lady in your OB's office. Tricare tends to be a big cluster f*ck. with that said, Tricare will cover all diagnostic testing. They will cover Clomid. They will cover HSG testing. They will not cover injectibles or IUI or IVF procedures.

I have had Prime and Standard. Standard is 100% the way to go from my experience. You have OOP expenses, but flexibility. The flexibility is worth the extra money.

Tricare does cover injectables and IUI if you go to an MTF. the only thing you have to pay for is the sperm washing. We pay 110 for my IUI

NikiP81 · March 2013

I don't have experience with Tricare Standard, since I am on Prime and go to a military hospital but they covered my PCOS tests and paid for my clomid (which worked in the first month).

I had heard they won't start treatments (under age 35) unless you have been trying for a year, so I waited nearly that long before pushing for an OB appointment only to hear from my doctor that in my case he could have started me sooner...

New - Tricare/Testing/PCOS Any experiences here?

Re: New - Tricare/Testing/PCOS Any experiences here?

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