Pregnant on Tricare Standard-Does this make sense?? — The Bump
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Pregnant on Tricare Standard-Does this make sense??

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?? 

BabyFruit Ticker

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 

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  • I actually just called Tricare and they said that the OB tried to code the routine tests for venereal disease (which are standard for them to do during pregnancy I guess) as if I walked in thinking I had caught something (routine medical visit) instead of it being a screen for pregnancy.  She said to call the OB back and to tell them exactly what they coded wrong, that I know they have 6 years to resubmit a claim, that all she has to do is call or fax and it would be fixed so "please do so" so I am not billed for this.  The Tricare lady couldn't believe they would bill me for it and said it makes sense bc most people would just pay the bill.  They are not about to get $84 for a clerical error if I can help it.  The Tricare lady was really helpful!
    BabyFruit Ticker
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  • 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.  

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  • imageBeachy730:

    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've always understood Tricare Standard to be that you can go to whoever you would like but you will have to pay a percentage UNLESS you are further than 30 minutes from the nearest base hospital. Tricare Prime covers everything but you have to go to doctors choose. I am forced to have Tricare Prime because there is no naval hospital at the base my husband is stationed at. The clinic on base is only family practice so I have to get referrals to an OB. I wish I could be more of a help with your situation but I don't have much personal experience with standard. I hope you get it all figured out though!
    Anniversary Pregnancy Ticker
  • imageJENandJEH:
    imageBeachy730:

    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%.

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  • 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! 

     

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  • Omg. I've delt with this so many times with tricare standard. Prior to our pcs and even after I've been billed for visits because of coding issues. It. Takes months to take care of. Twice it was because of a well woman exam. That kind of visit is supposed to be covered 100 but because the doctors didn't use a code that was acceptable to tricare I received a bill. Each time it took my doctors submitting the claim at least 34 times and 6 months to take care of. This is why so many doctors do not want to work with tricare and why I don't want to ever be on tricare standard again. The red tape wears you out. Once I switched to tricare prime and started going on base I never had any more issues! I couldn't be more happier!
  • It's supposed to say "3 to 4" times. My doctor had to submit the claim several times before tricare accepted it. Sorry about the typo.
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