Tricare information

[Guest mitch23]

I'm late getting into this post, but if anyone in your family will ever need orthodontic work, then that's another whole ballgame with TriCare. Make sure you look into it. When my wife used this part of TriCare, dependents were only authorized coverage until they were 21 or 22 years old.

[ 11. May 2006, 20:19: Message edited by: mitch23 ]

[Guest nursejenn]

We have tri-care for dental through the ANG (our dentist is not tricare certified) and this is the low down if he is not certified...you pay the difference between the alotted amount by tricare. In otherwords...tricare will pay for the predetermined amount for said procedure and you pay the difference. Also should note that if you have dule coverage, tricare is ALWAYS secondary, in the case of the ANG

[Guest NDwife]

I am not pregnant yet but I have been trying to read about the Tricare benefits for pregnancies and have a question about the possibility of having an at-home birth.

I have Tricare Prime and I read that I am pretty much required to go to the MTF if they offer OB/GYN services. If you went to the MTF for your pregnancy how was your experience?

Also I was hoping to be able to have an at-home birth (God willing I have a low-risk pregnancy). Is this possible or is there anything I can do to make it possible (I would prefer not to switch to Tricare Standard)?

Thanks in advance for any helpful information you can pass along. Before anyone links it I will say I found this fact sheet: Maternity Fact Sheet but I don't think it has the info I need.

[Guest sbm]

I don't have info on the at-home birth part, but my experience at the MTF was WONDERFUL! My son was born at Womack, Fort Bragg (we're stationed at Pope AFB). From the minute I found out I was pregnant to the day I gave birth, the doctor's, midwives, and nurses were great. You'll hear stories both good and bad about giving birth no matter what kind of facility, civilian or military. You simply have to follow your heart and wishes. This is your moment both for you, your husband, and your child to be.

For more answers on the Tricare info, I would call the Customer Care Center or contact the rep on base. Good luck!!

[Guest nurselorber]

I had a good experience at Vance while on Tricare Prime. There is no OB/GYN on base at Vance, so once you have a positive preg test, they immediately refer you to a provider of your choice offbase. Did you know there is a freestanding birthing center in Enid? (The ONLY one in Oklahoma!) I had my son there and it was a wonderful, non-hospital experience. We paid NOTHING while on Prime. I highly recommend checking Birthwise out as a good alternative to a hospital birth if a home birth isn't feasible on Tricare.

PM me if you have more questions.

[Guest NDwife]

Thanks. I am actually at Vance now and I have heard about Birthwise and was really surprised since there are only a handful of these centers across the country and there is one right here in Enid. However to utilize Birthwise my husband would have to be faip-ed and not that that would be the worst thing to get but I am hoping that won't be the case.

Thanks for responding though I was wondering how the experience at Birthwise was.

[Skitzo]

Okay incredibly stupid situation here.

Wife had surgery to remove her gallbladder. After a month she had a terrible night of vomiting (in excess of 30 times) we were really worried because we thought it could be surgery related so we went to the ER.

She was diagnosed with gastroentiritis and we were sent along on our merry way. Coincidentally my wife had travel plans the next day. We had to rearrange flight plans and after she got to her destination her luggage was lost and we plain forgot about calling our PCM that was until we got a bill for 2800 dollars. We called immediately after getting this bill and tried to get a retroactive referral but the doctor refused because apparently someone had already briefed her that she was to call within 24 hours. I already know this but didn't know that they could deny a claim simply based on this, I always thought it was so that any subsequent followup treatment could be authorized and not necessarily the ER visit itself.

Anybody familiar with where to go from here? Is this something I can bring up the chain of command and see if a higher ranking doctor will authorize it?

Any advice at all?

Please refrain from telling me how stupid I am, I already realize this, hopefully someone can learn from our stupidity.

[Guest Rainman A-10]

Get your commander involved immediately.

Give him lots of info and hopefully he'll tear ass into TRICARE. If he has a nut he will tell them to resolve the situation ASAFP because they are reducing his combat capability since you are grounded due to the ORM stress scores.

[Guest juliecole]

I had a similar incident years back when my son and I both ended up in the ER. We did get a referral, we were on vacation at the time. There was a glitch in tricare/deers system that took forever to get worked out. All it took was the secretary in the tricare office to punch a few things into the computer to have it straightened out, after I spent nearly 3 months on the phone with tricare, doctors etc. Meanwhile I kept getting threatening notes from the hospital that we were going to be turned into a collection agency. Keep a detailed log og everyone that you have talked with, what they have said and keep the hospital informed. Good luck.

[Baseops.Net]

After this episode, you should have your family switch to Tricare Standard and sign up for MOAA Mediplus Supplimental Insurance -- then you will NEVER have to wait for a referral again!

Tricare Supplemental Insurance

[Guest doctidy]

Originally posted by Baseops.Net:

After this episode, you should have your family switch to Tricare Standard and sign up for MOAA Mediplus Supplimental Insurance -- then you will NEVER have to wait for a referral again!

Tricare Supplemental Insurance

:( :( :(

Every insurance company denies claims.

Every insurance company listens when they get it wrong the first time.

Get your commander AND your Flight Doc involved. He will be just as much your proponent as your commander.

BTW - if you do switch...don't bother getting either one involved, they will have no pull ;)

[Skitzo]

Update.

I went to my first line supervisor today and explained the situation. He called my flight doc and they referred me to the resource manager for the med group. She gave me the run around basically.

It was the doctor's decision to deny my wife's referral based on the fact that proper protocol was not used (did not call before going to the ER or within 24 hours) and based on the fact that it turned out to not be an emergency situation, thank GOD it wasn't.

So my next steps will be information gathering, how much exactly the hospital is billing us and then I will be making an appointment with my commander with as many of my ducks in a row as I can.

My one question is, why would the people who are supposed to be on my side, the flight docs, making this so hard? Can someone's career or OPR be affected based on this referral? I can understand if TRICARE wants to deny the claim but in my case, the doctor is refusing to sign the referral because of improper protocol and lack of an emergency. I don't know of anyone who would ask questions when you're wife is vomiting bile 30 days after having gallbladder surgery. I was following directions from the surgeon. Go to the ER!!!

There is absolutely no question in my mind that an emergency very well could have existed.

I guess this is to teach me and my wife a lesson but that seems to me to be an awfully expensive lesson and I'll really have to reflect on what I'm going to do the next time there is a gray area.

Was my wife's life in jeopardy? At the time, I thought it could be, was it no, it was stomach flu.

All I know is that I do admit some culpability, an honest mistake was made on my part I guess I should be glad that the bill isn't larger than it is.

[Guest Rainman A-10]

Supervisor isn't the same as Commander.

Get your Commander involved.

[Herk Driver]

BS. If you had a legitimate fear that your wife's life, limb or eyesight were at stake then you had a legitimate reason to go to the ER, especially if you're surgeon was telling you to go. It sounds like the Flight doc is standing his ground because you failed to call. In an emergency do you really want to sit on the phone asking permission. Go to your CC and be upfront, see what he says. I, personally, don't think that your CC will have any problem engaging with this topic.

I recently (back in Mar) had to go to the ER and had I called to ask permission I would have died. Long story short, I had surgery 12 days earlier. One night, late, I had an internal stitch that busted loose and I was bleeding internally. By the time I realized what was going on, I thought I had time to call my surgeon and did. He advised me to go straight to the ER. I got there and was put in line to see the triage nurse. About 10 minutes later, I passed out in the waiting room waiting to see the nurse. When I got into the ER, my blood pressure had dropped to dangerous lows by the time they got a cuff on me. The blood count showed that I had lost almost half of my blood. I had surgery that night and was in the hospital for about 2 days.

I called TriCare when I got out. No problem. So is it that the end result justifies the means? i.e. Mine was a no kidding ememrgency so missing the 24 hour rule is OK versus yours??? I don't see it that way and I doubt your CC will either. It sounds like you have done more to work this on your own than most people would have. Go see your boss and let us know what happens.

[ 22. August 2006, 09:58: Message edited by: Herk Driver ]

[Skitzo]

Just to follow up, My SQ/CC took it up the chain and the head doctor(s) think it unethical to authorize the referral so far after the actual date. Kind of funny to turn this into an ethics debate. I've admitted that I was in the wrong all along.

So don't ever do this, they might not help you out / be able to help you out due to medical ethics.

Tricare paid the 50% under the POS option and fortunately for me, the hospital discounted the remaining portion of my bill.

So I didn't end up owing anything, thank goodness for the kindness of strangers.

[Guest Rainman A-10]

Don't tell anyone about the "discount" from the hospital. I'm pretty sure there's a clause in the TRICARE contract about not accepting such a thing. That is pretty standard boilerplate.

I'm glad it worked out. Too bad it was the hospital and not your chain of command coming up with the answer.

[Guest Mrs Hog]

You might get lucky if someone on here can actually answer your questions, but here are my two suggestions to knock this one out:

1) Go to Tricare's web site and look up the benefits for yourself...(not my first choice, but...you should at least be armed);

2) Carve out the time next week to call, and then walk in to the Tricare office on the AFB that is near you and have them explain it to you in person.

3) As with any service, if it's obvious you're dealing with a clueless person, go right around them and ask for their supervisor...don't waste your time.

[Guest JerseyGirl]

I don't know how specific I can answer your questions, just what has been my experience....

We pay a monthly dental coverage fee (we have the family plan, so its like $20ish a month), that even though we are overseas we are still paying. My daughters and I do go to the dental clinic on base...I forget why we were told that we have to keep paying the coverage fee, but we were told that we had to continue paying it, by multiple folks.

When we were stateside (and that included Alaska), I always went to a civilian dentist. I think I could have gone to the dentist on base up in Alaska, but I would have been Space A and the cattle call began at 7 in the morning....it was always easier for me to get a good dentist off base and avoid the cattle call and getting bumped out for active duty. I would imagine that if dependents were seen at the dental clinic (it would be the bottom of the priority list would be my guess), she could go to the Army clinic....I don't think it matters Air Force or Army.

Hope this helps, though don't quote me on it!!

[Herk Driver]

CONUS on-base dental is Space A for dependents. Get the United Concordia/Tricare dental and go to off-base provider unless you want tons of @sspain.

OCONUS, dependents are seen on-base, if a facility is available. You do NOT have to continue paying for the Tricare dental coverage. When you decline though, there is a restriction from signing back up with 12 months, I think?? In addition, unless you are at a main base, like Ramstein, you may be required to go to an off-base provider for some care. If you go off-base without the Tricare dental covergae, you will pay large amounts of money out-of-pocket and in most places, you have to pay when services are rendered.

That is the reason that most people continue paying the dental coverage fee. However, I spent 3 years at Ramstein and ditched the coverage to save a few bucks. They can do it all at ETAR. Other places, like where I am now are not as capable. You have to decide based on what is available at your location.

My 2 cents. If you have kids that are in need of orthodontics, I would keep the coverage overseas. More than likely, you will be seen off-base or on a Space A basis. The expense is far too great to not have the dental plan.

[Guest doctidy]

Herk is on target.

- OCONUS...there is no where else to go, so people get seen on base

- CONUS...dependents are space A

- Army...God help you. Have you ever looked at their teeth? They don't take anywhere near the care of active duty's teeth we do...you think they are gonna see dependents?!

[Guest jillian1506]

My husband and I have been discussing when we want to start having kids. He is in ROTC right now and will be commissioning next May. At that point we most likely will start to build our family. Does anyone know how Tricare deals with maternity? Is there maternity coverage for the spouse of an active duty member do I have to get my own insurance coverage?

[Guest AFwife62406]

I don't know a whole lot about this, but I do know that my friends that are or were pregnant switched to Tricare Standard so they could go to doctor's offbase. I'm sure you could find lots of info online about what Tricare covers though.

[Guest ACJ7464]

I don't know a whole lot about this, but I do know that my friends that are or were pregnant switched to Tricare Standard so they could go to doctor's offbase. I'm sure you could find lots of info online about what Tricare covers though.

Many a child has been born on Uncle Sams dime. We had our second son during UPT and since there was not an OB/GYN doctor on base we chose our off base doctor while staying on Tricare Prime. The pregnancy/delivery/followup vists were covered 100%.

Good Luck.

[Guest sierrahotel]

There are different "kinds" of Tricare- Prime, which covers 100% of everything is you go through your base, or get referrals for off-base docs. Tricare Standard allows you to choose who you go to and sacrifice a co-pay of some sort.

With Prime, you can have all the babies in the world and they're free! You go to an OB/GYN on base, or get a referral for an off-base one if there isn't one on base (pretty common I guess.) If you get a referral, you get like 18 office visits approved, and a follow-up or two afterward. The hospital costs are totally covered, except things not really necessary like a private room, etc. All we ended up forking over was like $40 for the private room. Anything "medically necesarry" is covered.

You'll hear a lot about people getting doulas, or wanting to have a kid somewhere other than a hospital (a birthing center, at home, etc.) Tricare has to approve all of that I think, and I'm not sure what they cover if you go that route.

The base will usually provide free classes on pregnancy, raising kids, breastfeeding, etc. so you should be good there.

UPT is a good time to get pregnant. (You may hear people say not to, just to avoid added stress.) But if you plan it so that the kid comes near the end, or after Phase 2 at least, it won't be so stressful on the family.

[Herk Driver]

All of the above is good advice and spot on.

1st child was born at NAS Pensacola. Had great pre-natal care at Whiting. The birthing part left a little to be desired but we made it alright. All covered 100% by Tricare.

2nd child was born in North Little Rock, AR. LRAFB doesn't have the facility to provide for baby deliveries and therefore we got a referral to a provider downtown. We chose which Dr we wanted and, once again, Tricare covered 100% of the costs.

3rd child...well there won't be one of those...thanks to another off-base provider in the NLR area...100% covered by Tricare as well

You can go the route of Tricare Standard, if you want...deductibles, co-pays and more paperwork possibly, but check out what is offered by the on-base facility first. You may be able to choose your Dr anyway based on no facilities on-base to give birth, etc. Whatever you do make an informed decision based off of what is offered/available at your MTF and your desires.