Tricare infertility testing

Honeydewchestnut · May 2013

I know, I know, I'm calling the 1800 # in the morning, but I figured I would ask here as well. I have had 2 m/c this year and I was just referred to a civilian fertility clinic for testing from my PCM (I have Prime). On the referral, the care covered is maternity, but I am no longer pregnant, so I won't be receiving any maternity care. Is fertility testing covered by maternity, or does my PCM need to refer me for a different reason?

sweetpea2003 · May 2013

Yes, infertility testing is covered by Tricare.

Infertility treatments, generally speaking, are not.

LaBellaVida · May 2013

sweetpea2003:
Yes, infertility testing is covered by Tricare.
Infertility treatments, generally speaking, are not.

Infertility treatments are also covered by Tricare- I was in the process of going through with fertility treatments. I was seen out at a military hospital, that has fertility specialist however; not sure if that makes a difference. Can't imagine it would make a difference though.

meltoine · May 2013

brandilc84:
sweetpea2003:
Yes, infertility testing is covered by Tricare.
Infertility treatments, generally speaking, are not.
Infertility treatments are also covered by Tricare- I was in the process of going through with fertility treatments. I was seen out at a military hospital, that has fertility specialist however; not sure if that makes a difference. Can't imagine it would make a difference though.

It does make a difference. There are a handful of MTFs that do IUI and IVF, and if you are close enough to go there you can take advantage of it. If you're not able to go to one, procedures are not covered, though drug therapy is.

HisChamaoleGirl · May 2013

meltoine:
brandilc84:
sweetpea2003:
Yes, infertility testing is covered by Tricare.
Infertility treatments, generally speaking, are not.
Infertility treatments are also covered by Tricare- I was in the process of going through with fertility treatments. I was seen out at a military hospital, that has fertility specialist however; not sure if that makes a difference. Can't imagine it would make a difference though.
It does make a difference. There are a handful of MTFs that do IUI and IVF, and if you are close enough to go there you can take advantage of it. If you're not able to go to one, procedures are not covered, though drug therapy is.

Some of the treatment is covered and some is not. DH and I are active duty and obviously on Prime. All of our testing was covered and the referrals were in a military hospital. This of course is based on location. Some of the treatments and mediation were not covered completely and we were required to pay for a portion of them ourselves.

APotterHead · May 2013

***Butting in from 3TC***

All infertility testing is covered. Just make sure your referral is worded correctly.

Tricare's official standpoint on IF treatment is that they don't cover anything related to ART. That means meds and screening leading up to IUI or IVF. They will cover corrective procedures, such as a lap to "fix" something, or surgery on your DH if he has a varicocele, etc. Now, if your RE codes things correctly they can be covered. For example, if you are on Progesterone to treat you IF, but also your PCOS... then they code it for PCOS and not IF so that it is covered. Same with ultrasounds, blood work etc. Its all in the coding. Also, do as much testing as you can at the MTF. For example, if you need bloodwork have them write it out and take it to the lab at your MTF, or take your Rx's there also. More likely they are covered.

Also, there some some MTF's that have RE's and provide IVF, etc at a VERY discounted rate.

Basically, make sure your RE's office is familiar with dealing with Tricare!

GL to you!!!!

ufsandra85 · May 2013

To answer your question yes you need a seperate referral. I see an RE and when I get pregnant they put in an emergency expidited referral to see me for pregnancy. Infertility treatments and maternity care at the RE are seperate referrals.

Also intertility treatment is covered. I have been getting treatment for over 2 years and have only paid 330 total. That included 3 iui, 7 medicated cycles, all which were monitored ( so like 5 ultrasounds per cycle) and 4 surgeries. Over 200k spent and i have paid 330 dollars

sweetpea2003 · May 2013

brandilc84:
sweetpea2003:
Yes, infertility testing is covered by Tricare.
Infertility treatments, generally speaking, are not.
Infertility treatments are also covered by Tricare- I was in the process of going through with fertility treatments. I was seen out at a military hospital, that has fertility specialist however; not sure if that makes a difference. Can't imagine it would make a difference though.

It isn't free. IUI is cheap at MTFs (I was seen at Walter Reed for a period of time) and IVF is also a lot cheaper than with a private practice, but it isn't free. IVF has a cost and the meds are typically covered by a grant.

Tricare's official stance is that ART is not covered. Recently they made a change where if the infertility was caused due to an injury sustained in the military that they will cover it (which is awesome and frankly a no brainer to me!) and I know some people have had a lot of luck getting things done for extremely cheap, but it isn't "covered" officially.

When I did IVF I had civilian insurance from my own job and it literally had coverage (up to $100,000) in print about IVF and IUI. Tricare's statement is "no".

sweetpea2003 · May 2013

ufsandra85:
To answer your question yes you need a seperate referral. I see an RE and when I get pregnant they put in an emergency expidited referral to see me for pregnancy. Infertility treatments and maternity care at the RE are seperate referrals.

Also intertility treatment is covered. I have been getting treatment for over 2 years and have only paid 330 total. That included 3 iui, 7 medicated cycles, all which were monitored ( so like 5 ultrasounds per cycle) and 4 surgeries. Over 200k spent and i have paid 330 dollars

I'm assuming you are at an MTF. Either that or your RE is using fraudulent code.

It also has to do with what you consider "infertility treatment". Yes, if you have a septate uterus or endometriosis they will cover that corrective/exploratory surgery. But they will not cover IVF or IUI in full. The drugs are a gray area and really based on who you are seeing (MTF vs. civilian) and the code used by the RE.

From the horses mouth: https://www.tricare.mil/CoveredServices/SeeWhatsCovered/InfertilityTreatment.aspx?sc_database=web

ufsandra85 · May 2013

I am seen at an MTF. techincally tricare isnt paying for the meds and stuff, the hospital is. but i dont pay anything. the only thing we pay for is the sperm wash which is done at a civilian facility. BUT my monitored medicated cycles were all paid for (legally) by tricare at a civilian facility

there are a lot of fertility treatments before iui and ivf that are paid for

cristi3236 · May 2013

I had the opposite problem. I was being seen for infertility and when I got pregnant the infertility dr did an ultrasound to check to see if it was viable. Tricare wouldn't pay for it because my referral was for infertility and not maternity care and since I was pregnant I fell under maternity care. I would ask to have it changed just so that you don't have to jump through hoops later.

ufsandra85 · May 2013

TO make it even more confusing every time you get pregnant you need a new referral. so you can see your same re for fertility treatment between pregnancies but as soon as you get pregnant again ( even if you were pregnant with a different baby just the month before) you need a new referral and have to go through the terrible tricare process every single time. Lots of fun if you have had a ton of miscarriages

Tricare infertility testing

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