Tricare Question — The Bump
Military Families

Tricare Question

Hey all... I normally only post in 1st trimester, So please excuse my random posting... however I am wondering if anyone over here can help me find an answer. I have been going to the OB on base, and im not convinced they know what they are talking about with my current pregnancy. I was wondering if I am allowed to go off base to be seen by someone else for a second opinion? If so, what steps do I take to do so and will Tricare Prime cover that for me? The way Tricare explained things to me was that if the naval hospital has room for me, I have no other options but to be seen there. From what I have been told by a few people was that that is not correct... advice, opinions, experience? Thanks in advance.

Re: Tricare Question

  • which naval hospital are you going to? You can always get a second opinion at the naval hospital. if you do not like your provider request another doctor. The surgeon general mandated that military hospitals have a duty to recapture care and not let prime patients go out i town if they can see them at the mtf so it is going to be had to go in town but you can always switch to standard or ask for a different mil doctor

    Married 11/27/09 and TTC right away
    Dx: Complete septate uterus with cervical duplication, endometrial polyps, PCOS, endometriosis, hypo thyroid, luteal phase defect
    4 uterus surgeries to correct my complete septum and to remove polyps and 2 years of seeing the RE, medicated cycles and IUIs
    Baby 1 and 2: BFP 3/3/11 with 2 babies EDD 11/1/11, M/C 4/6/11
    Baby #3: 8/11 pregnant EDD 4/27/11 and m/c:(
    Baby #4: 10/12/11 BFP! EDD 6/16/12m/c 10/26/11
    Baby #5: 3/13/12 BFP! EDD 11/25/12 ANOTHER m/c :(

    Baby #6: 2/14/13- BFP! EDD 10/24/13, CP 2/19/13
    Baby #7: 3/15/13- BFP! EDD 11/27/13, another CP
    Baby #8.  BFP 5/19/13 EDD 1/22/14. 8 was not our lucky number

    4th septum resection on 5/31/13.
    Baby #9: 6/29/13 BFP. C section scheduled for March 5th!

    My miracle baby was born March 5 at 9:33am. He was 8 lbs 12.5 oz and 21.25 inches long!

    image"">

  • Loading the player...
  • imageufsandra85:
    which naval hospital are you going to? You can always get a second opinion at the naval hospital. if you do not like your provider request another doctor. The surgeon general mandated that military hospitals have a duty to recapture care and not let prime patients go out i town if they can see them at the mtf so it is going to be had to go in town but you can always switch to standard or ask for a different mil doctor

     

    I am being seen at Camp Lejeune Naval Hospital... Thanks for the input also, Im definitely going to be looking into all my options.

  • Loading the player...
  • I'm at Fort Hood (Army) so I don't know if the same rules apply but....

     As long as the on post hospital has space, I have to be seen on post. Unless I switch to tricare standard and then I can go wherever I want.

    Baby Birthday Ticker Ticker
    LaciJaxx
  • With Prime, you go where they tell you. In your case, that is on base. You dohave options. If you are displeased, you can switch to Standard and choose your own doctor.
    Lilypie Kids Birthday tickers Lilypie First Birthday tickers
  • I replied on first trimester, but it seems most responses are of the idea that you don't have a choice except to switch to standard, and unless base is full thats where you are stuck. I really don't think this is the case. Ive never been seen on base I have always asked for a civ pcm and I have always been granted that request. 

    I would try filling out a PCM change request form (can be found on their website) and fill in a pcm out in town that you would like to see. They give you a 1st and 2nd choice option. They don't technically have to approve your change, but I haven't ever had any problems with this. Once your PCM is changed, most civilian providers will allow you to choose what ob you want and just make the referral to match for tricare approval. As I said in my last post I wrote down my first choice when we moved here and then put my second choice as "anything other than MTF" and I was granted my first choice.

     

    I really would try this before switching to standard. Standard costs can really add up. Even though prime is sometimes a pain the full coverage is really worth it in most cases 

     

    Edit: just realized you are at camp lejeune, I just wanted to add so am I. The main place tri-care patients get seen if not on base is jacksonville womens clinic and its HORRIBLE. I would stay on base if thats my only option. Thats where I was assigned when we first got here and it was the worst doctors office I have ever had to deal with. I requested a switch and am now seen out in swansboro/morehead and will be giving birth at carteret hospital. 

    Lilypie Pregnancy tickers
    Lilypie First Birthday tickers
  • ehnastoehnasto member

    imageLissa832:
    With Prime, you go where they tell you. In your case, that is on base. You dohave options. If you are displeased, you can switch to Standard and choose your own doctor.

     

    This is not the experience I have had with Tricare Prime. I just asked my PCM (general physician) if I could go to a specific doctor off base. She had no problem writing the referal for me. I also plan to ask for DS to see an off base doctor. I have been doing research into this and all I really have to do is ask. Sometimes they will make you write a letter, but they are apparently pretty accomidating, at least where I am.

  • imageehnasto:

    imageLissa832:
    With Prime, you go where they tell you. In your case, that is on base. You dohave options. If you are displeased, you can switch to Standard and choose your own doctor.

     

    This is not the experience I have had with Tricare Prime. I just asked my PCM (general physician) if I could go to a specific doctor off base. She had no problem writing the referal for me. I also plan to ask for DS to see an off base doctor. I have been doing research into this and all I really have to do is ask. Sometimes they will make you write a letter, but they are apparently pretty accomidating, at least where I am.

    This is exactly opposite of my experience from the last 9 years. While at CL, I had a civilian PCM due to the base being overcrowded. My ds also had a civilian pedi. This was 100% due to the base not having room. When I became pregnant, I requested to be seen off base. My PCM entered the referral with a specific doctor. Tricare denied the referral off base because OB had space available for new patients. I was seen on base. I had zero choice while on prime.

    At Cherry Point, it was the exact same deal. I had a grievance with OB on base due to my treatment during my first pregnancy/miscarriage (this was in 2005-2006. They don't offer pregnancy care anymore). I was still referred on base. I spoke directly with the head of OB as well as the ombudsman. My request was unequivocally denied. I was told that I could request never to be seen by the particular doctor I had been grieved by, but I had no choices when it came to delivery. If she was on call, tough titty. Guess who delivered me?

    Now at Quantico, when we arrived, I was on Prime. Quantico was full, so they sent me to a family care clinic 30 minutes away. I requested a civilian doctor in town. I was denied. When I became pregnant, I requested to be seen locally. I was denied. My pregnancy care would be done at the same Clinic. I would deliver at the hospital an hour away (an hour with no traffic). I asked if I could go to the local hospital if I went into labor. I was told that if I didn't deliver within a few hours, the claim would be denied by Tricare. If you know anything about NoVA, you know that during certain times of the day, it could take me HOURS to get to my OB or the hospital. I switched to standard, and I haven't looked back since.

    Lilypie Kids Birthday tickers Lilypie First Birthday tickers
  • imageehnasto:

    imageLissa832:
    With Prime, you go where they tell you. In your case, that is on base. You dohave options. If you are displeased, you can switch to Standard and choose your own doctor.

     

    This is not the experience I have had with Tricare Prime. I just asked my PCM (general physician) if I could go to a specific doctor off base. She had no problem writing the referal for me. I also plan to ask for DS to see an off base doctor. I have been doing research into this and all I really have to do is ask. Sometimes they will make you write a letter, but they are apparently pretty accomidating, at least where I am.

    This is not the norm.  It depends on the post, but if there is room for you to be seen on post, they will not issue a referral.  However, pregnancy is almost 100% covered through Standard.  My out of pocket expenses totaled just over $30.  Yep, $30 for the entire pregnancy, labor and delivery.  I'd say that is well worth the doctor of my choice.   

    Warning No formatter is installed for the format bbhtml
    LaciJaxx
  • imageLissa832:
    imageehnasto:

    imageLissa832:
    With Prime, you go where they tell you. In your case, that is on base. You dohave options. If you are displeased, you can switch to Standard and choose your own doctor.

     

    This is not the experience I have had with Tricare Prime. I just asked my PCM (general physician) if I could go to a specific doctor off base. She had no problem writing the referal for me. I also plan to ask for DS to see an off base doctor. I have been doing research into this and all I really have to do is ask. Sometimes they will make you write a letter, but they are apparently pretty accomidating, at least where I am.

    This is exactly opposite of my experience from the last 9 years. While at CL, I had a civilian PCM due to the base being overcrowded. My ds also had a civilian pedi. This was 100% due to the base not having room. When I became pregnant, I requested to be seen off base. My PCM entered the referral with a specific doctor. Tricare denied the referral off base because OB had space available for new patients. I was seen on base. I had zero choice while on prime.

    At Cherry Point, it was the exact same deal. I had a grievance with OB on base due to my treatment during my first pregnancy/miscarriage (this was in 2005-2006. They don't offer pregnancy care anymore). I was still referred on base. I spoke directly with the head of OB as well as the ombudsman. My request was unequivocally denied. I was told that I could request never to be seen by the particular doctor I had been grieved by, but I had no choices when it came to delivery. If she was on call, tough titty. Guess who delivered me?

    Now at Quantico, when we arrived, I was on Prime. Quantico was full, so they sent me to a family care clinic 30 minutes away. I requested a civilian doctor in town. I was denied. When I became pregnant, I requested to be seen locally. I was denied. My pregnancy care would be done at the same Clinic. I would deliver at the hospital an hour away (an hour with no traffic). I asked if I could go to the local hospital if I went into labor. I was told that if I didn't deliver within a few hours, the claim would be denied by Tricare. If you know anything about NoVA, you know that during certain times of the day, it could take me HOURS to get to my OB or the hospital. I switched to standard, and I haven't looked back since.

     

    This does happen a lot, but it doesn't mean than requests aren't ever allowed if there is room on base. Tri-care doesn't HAVE to approve the request and unfortunately sometimes they don't but I have been approved to be seen off base even when base wasn't full.

     

    OP I think your best option is to call tri-care and see if you can talk to a patient advocate. I would made it very clear that you don't feel your getting proper medical care, and not just trying to switch willy nilly. No guarantees but it can't hurt to at least try to get off base 

    Lilypie Pregnancy tickers
    Lilypie First Birthday tickers
  • imageiluvmytxrgr:
    imageehnasto:

    imageLissa832:
    With Prime, you go where they tell you. In your case, that is on base. You dohave options. If you are displeased, you can switch to Standard and choose your own doctor.

     

    This is not the experience I have had with Tricare Prime. I just asked my PCM (general physician) if I could go to a specific doctor off base. She had no problem writing the referal for me. I also plan to ask for DS to see an off base doctor. I have been doing research into this and all I really have to do is ask. Sometimes they will make you write a letter, but they are apparently pretty accomidating, at least where I am.

    This is not the norm.  It depends on the post, but if there is room for you to be seen on post, they will not issue a referral.  However, pregnancy is almost 100% covered through Standard.  My out of pocket expenses totaled just over $30.  Yep, $30 for the entire pregnancy, labor and delivery.  I'd say that is well worth the doctor of my choice.   

    Yep, this!  I paid about $50 out of pocket, but that is because I was in recovery longer due to a c-section.  The only thing I paid for was a daily fee when I was in recovery (about $17/day).  I was able to see the mid wife I wanted and deliver at the hospital I wanted to, it was totally worth it and I have stayed on Standard even though now I do have to pay a bit out of pocket.  I like having options.

    Image and video hosting by TinyPic Baby Birthday Ticker Ticker Baby Birthday Ticker Ticker
  • the mandate from the surgeon general is that if you are a dependent of ACTIVE DUTY  or AD yourself and on prime you are supposed to be seen on base if they have room. they are a lot more lax for retired, tricare for life etc. there are always exceptions that people have had but in the last 2-3 months the government has really been cracking down. people get around this rule by if they had been seen off base previously the provider can request continuity of care and get past the rules. we tell people if you want to be seen off base go to standard. this is the new way of military healthcare, especially with the milti service markets that are emerging. there are a lot of changes ahead and they are examining everyone who goes off base to try to pull the care back in

    Married 11/27/09 and TTC right away
    Dx: Complete septate uterus with cervical duplication, endometrial polyps, PCOS, endometriosis, hypo thyroid, luteal phase defect
    4 uterus surgeries to correct my complete septum and to remove polyps and 2 years of seeing the RE, medicated cycles and IUIs
    Baby 1 and 2: BFP 3/3/11 with 2 babies EDD 11/1/11, M/C 4/6/11
    Baby #3: 8/11 pregnant EDD 4/27/11 and m/c:(
    Baby #4: 10/12/11 BFP! EDD 6/16/12m/c 10/26/11
    Baby #5: 3/13/12 BFP! EDD 11/25/12 ANOTHER m/c :(

    Baby #6: 2/14/13- BFP! EDD 10/24/13, CP 2/19/13
    Baby #7: 3/15/13- BFP! EDD 11/27/13, another CP
    Baby #8.  BFP 5/19/13 EDD 1/22/14. 8 was not our lucky number

    4th septum resection on 5/31/13.
    Baby #9: 6/29/13 BFP. C section scheduled for March 5th!

    My miracle baby was born March 5 at 9:33am. He was 8 lbs 12.5 oz and 21.25 inches long!

    image"">

  • FWIW I was seen off post for my first pregnancy because I moved here st 20 weeks so the on post hospital was full. My off post PCM put in a referral for me to continue care off post and it was denied because I found out so early in the pregnancy that the on post hospital had space available.
    Baby Birthday Ticker Ticker
  • If you are on Prime, and the naval hospital has space for you, yes, you go there.

    You can switch to standard. 

    I have done this with both pregnancies as I refuse to go to our naval hospital. 

    With Standard, you are still covered for basically everything with the pregnancy.

    Tricare however does not cover the 20 wk ultrasound. So be aware of that.

    With my first pregnancy,, I delivered at the hospital of my choice while on standard and paid a total of $25 (some hospital admin/room thing....)

    They tell you it's like a max of $16 a day or something. 

    You just need to find a doctor that will "accept assignment with Tricare", which basically means, they accept what tricare will pay them and blah blah blah. 

    I've had no issues being on standard with this pregnancy or with my first pregnancy.

    I will say that when talking to someone at tricare, a good half of them don't have a darn clue.... so I tend to call and talk to at least 4 people.

    Depending on where you live, I'm in CA, and Triwest has changed a little recently, but I still have not run into any issues.

    Feel free to PM me if you have any questions.

     

     

     

     

    Warning No formatter is installed for the format bbhtml
  • imageufsandra85:
    the mandate from the surgeon general is that if you are a dependent of ACTIVE DUTY  or AD yourself and on prime you are supposed to be seen on base if they have room. they are a lot more lax for retired, tricare for life etc. there are always exceptions that people have had but in the last 2-3 months the government has really been cracking down. people get around this rule by if they had been seen off base previously the provider can request continuity of care and get past the rules. we tell people if you want to be seen off base go to standard. this is the new way of military healthcare, especially with the milti service markets that are emerging. there are a lot of changes ahead and they are examining everyone who goes off base to try to pull the care back in

     

    oops sounds like rules are changing. I was however, in the past, allowed to be seen off base, while my husband was on ACTIVE DUTY and there was room on base at the time. I guess though, I have just been really lucky when it comes to tri-care. 

    Lilypie Pregnancy tickers
    Lilypie First Birthday tickers
  • Just wondering...were you with TriWest/United Health Care? the numbers that I was seeing if I switched to Tricare standard looked a lot higher than this...and I would LOVE if it is really this cheap!

  • I'm only going to chime in on two things as so much has been said already ...

    If you choose to switch to standard, do your research first. At a certain rank (e-5 in the army I believe) you are locked into standard for a year.

    Next, I am tricare prime remote, active duty spouse, and tricare did pay for my 20 week ultrasound. It's all in how they code it in billing.

    Best of luck to you!!!
    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
  • Sorry ladies this is a thread from may, unfortunately we lost the baby in june and I no longer need an answer this question.. Thank you.
  • :-( So sorry to hear.
    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
This discussion has been closed.
Choose Another Board
Search Boards