Upon arriving at my first prenatal appointment at my OB’s office, they promptly handed me a fact sheet about Tricare not covering routine ultrasounds. Well geez! If Tricare doesn’t cover ultrasounds, which I believe are a necessity when it comes to assessing a developing baby’s health, what else don’t they cover?
For background info, I am several hours away from a MTF (military treatment facility) thanks to being on recruiting duty. I have found that civilian providers are either familiar or completely unfamiliar with Tricare – Prime or Standard. Fortunately, my provider is familiar.
We all have heard stories from other spouses about getting conflicting information on what’s covered based off their experiences. Some spouses feel that having to get a referral to receive medical care is absurd and a burden. Others believe that Tricare coverage is bare bones.
Now at the end of my second pregnancy – this one considered high risk – I am here to tell you that Tricare may cover more than you think when it comes to maternity care. After all the monitoring I’ve been through, I bet Tricare is ecstatic that I’m almost at the end!
What Tricare Really Covers
Tricare’s website states that routine screenings are not covered. What? How can that be? Perhaps the wording is bad, but Tricare covers ultrasounds for medically necessary reasons. For example: determining the gestational age of the fetus and to evaluate fetal growth (which are routine by the way).
• Other Tests
Fetal stress tests, amniocentesis, and other tests performed when a pregnancy is considered to be high risk are covered.
• Routine Appointments
o When located near a MTF, you should receive your prenatal care by providers at that location. Should a provider not be available, you’ll be referred off base.
o Tricare Standard users can receive prenatal care from any authorized Tricare provider without a referral and you’ll be responsible for your portion of what Tricare does not cover; just the same as other care you receive.
o Tricare Prime Remote users will need a referral (Gasp! That horrible “r” word!). It’s as simple as your PCM filling out the referral form and sending it in to Tricare; you don’t have to do anything. If you run out of appointments, no biggie. Let your provider know and they’ll call Tricare to authorize more appointments.
• Labor & Delivery
Tricare covers all medically necessary procedures and pain management during this exciting time. However, Tricare may not cover a C-section if you elect to have one out of preference or convenience. Similar to other insurances, Tricare won’t cover non-proven procedures and drugs.
• Alternative Birthing Methods
There is some gray area here. Tricare will not cover non-registered nurse midwives but certified midwives are covered. Tricare may cover a portion of a birthing center (non-hospital) but to be safe, it is best to call and speak with a representative.
It is pretty nerve wracking to be told that Tricare doesn’t cover more than one ultrasound, or hear that your neighbor received numerous bills from her OB throughout her pregnancy. As a person who is being seen and monitored twice a week at my OB’s office, I can assure you that Tricare will make sure you receive the necessary care so you and your bundle of joy are properly taken care of.
Should you receive an unexpected bill from your provider or hospital, be sure to call Tricare as well as the billing department of your provider’s office. Often times there is an error made in the insurance coding that can easily be corrected. If you feel that you are not receiving or are being denied necessary care, reach out to Tricare to find out what options are available to you so you receive the care you deserve.
*For any maternity care questions, it is best to call Tricare and verify the information for yourself.
*For basic coverage information, check out Tricare.mil.