Quick intro - my hubby is a pilot in the Air Force. We have a 2 yr dd and I'm pregnant with our second.
I'm using a new OB practice with this pregnancy - referred off base. This office offers the NT scan at 12 wks as they have the equipment and trained personnel to do it. It was not offered at my previous OB. Will Tricare Prime cover this scan?? Anyone have experience with this? I called tricare, the lady I spoke with was about as helpful as tits on a bull (sorry lol that's my moms expression). All she kept saying was only scans that are "medically necessary" are covered. Soooo how does one determine that? Is it all in how the dr office codes the scan when submitting the claim?
Thanks in advance for any input!!
Married 8.1.2010 DD #1: Arrived 10.7.2011 TTC #2 Since March 2013 BFP 5.20.2013, EDD 1.26.2014, natural mc @ 5 wks 5.25.2013 BFP 6.21.2013, EDD 3.14.2014, Twins - missed mc @ 7w6d, D&C 8.6.2013 BFP 10.7.2013, EDD June 20 2014 - It's a GIRL!
I'm seeing an on-base OB, and they offer NT scans for everyone.
I would imagine that it depends on how your off-base OB codes the ultrasound. If it's coded as "medically necessary" then you should be covered. You might even talk to the billing person at your OB office to see how they normally handle this for Tricare patients. And maybe try calling Tricare back hoping you can speak with someone more helpful this time :-)
@Avion22 Sometimes I wish we had on-base OBs here as it seems like it would make all of this simpler!! That's a great suggestion, I'll talk to billing at the practice. I'm going in Thursday for my intake, so I'll try to get to the bottom of it then... Maybe they can tell me. It really seems like if they code it appropriately as medically necessary than it should be covered!
Married 8.1.2010 DD #1: Arrived 10.7.2011 TTC #2 Since March 2013 BFP 5.20.2013, EDD 1.26.2014, natural mc @ 5 wks 5.25.2013 BFP 6.21.2013, EDD 3.14.2014, Twins - missed mc @ 7w6d, D&C 8.6.2013 BFP 10.7.2013, EDD June 20 2014 - It's a GIRL!
Agreed. I think its all in how they code it. I am tricare prime remote (no MTF within 70 miles) and they covered all my scans. Because I had a miscarriage previously, I had a scan about 6, 12 and 20 weeks. I also had a 4d at 30 weeks which was not covered. My OB ran a few extra tests and so there were a few things here and there that was not covered but overall we can't complain. I'd say less than $100 through both pregnancies. I would call and talk to the tricare lady at the clinic. Ours knew right away if it was something we would have to pay for. Good luck!!
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
Estimate gestational age Evaluate fetal growth Conduct a biophysical evaluation for fetal well-being Evaluate a suspected ectopic pregnancy Define the cause of vaginal bleeding Diagnose or evaluate multiple gestations Confirm cardiac activity Evaluate maternal pelvic masses or uterine abnormalities Evaluate suspected hydatidiform mole Evaluate the fetus's condition in late registrants for prenatal care
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Estimate gestational age Evaluate fetal growth Conduct a biophysical evaluation for fetal well-being Evaluate a suspected ectopic pregnancy Define the cause of vaginal bleeding Diagnose or evaluate multiple gestations Confirm cardiac activity Evaluate maternal pelvic masses or uterine abnormalities Evaluate suspected hydatidiform mole Evaluate the fetus's condition in late registrants for prenatal care
Yes.... This what the lady I spoke with at tricare read to me, from the internet. But she could not tell me if the NT scan fell under one of these categories - just back to is it medically necessary or not.
Married 8.1.2010 DD #1: Arrived 10.7.2011 TTC #2 Since March 2013 BFP 5.20.2013, EDD 1.26.2014, natural mc @ 5 wks 5.25.2013 BFP 6.21.2013, EDD 3.14.2014, Twins - missed mc @ 7w6d, D&C 8.6.2013 BFP 10.7.2013, EDD June 20 2014 - It's a GIRL!
I think it would be covered under "conduct a biophysical evaluation for fetal well-being".
I'm having one on Jan. 2nd and I hope it'll be covered. My doc said most insurance companies will cover it when they submit the claim. I'm not even going to bother to call Tricarw about it because I know they'll give me a run around answer.
Re: NT scan & tricare prime
That's a great suggestion, I'll talk to billing at the practice. I'm going in Thursday for my intake, so I'll try to get to the bottom of it then... Maybe they can tell me. It really seems like if they code it appropriately as medically necessary than it should be covered!
Married 8.1.2010
DD #1: Arrived 10.7.2011
TTC #2 Since March 2013
BFP 5.20.2013, EDD 1.26.2014, natural mc @ 5 wks 5.25.2013
BFP 6.21.2013, EDD 3.14.2014, Twins - missed mc @ 7w6d, D&C 8.6.2013
BFP 10.7.2013, EDD June 20 2014 - It's a GIRL!
Estimate gestational age
Evaluate fetal growth
Conduct a biophysical evaluation for fetal well-being
Evaluate a suspected ectopic pregnancy
Define the cause of vaginal bleeding
Diagnose or evaluate multiple gestations
Confirm cardiac activity
Evaluate maternal pelvic masses or uterine abnormalities
Evaluate suspected hydatidiform mole
Evaluate the fetus's condition in late registrants for prenatal care
Married 8.1.2010
DD #1: Arrived 10.7.2011
TTC #2 Since March 2013
BFP 5.20.2013, EDD 1.26.2014, natural mc @ 5 wks 5.25.2013
BFP 6.21.2013, EDD 3.14.2014, Twins - missed mc @ 7w6d, D&C 8.6.2013
BFP 10.7.2013, EDD June 20 2014 - It's a GIRL!
I'm having one on Jan. 2nd and I hope it'll be covered. My doc said most insurance companies will cover it when they submit the claim. I'm not even going to bother to call Tricarw about it because I know they'll give me a run around answer.