6 answers

Delivery Cost with Tricare Reserve Select

Hi. I live in Portland, OR and just found out that I'm pregnant. I'm hoping to deliver at Good Sam because my friend recommended Dr. Murray. But the problem is both Good Sam and Dr. Murray are out of network... Tricare told us that the cap is $3000/family/fiscal year, but can go above if I go to out of network hospital/doctor.

Does anyone have experience delivering at out of network hospital with out of network doctor using Tricare Reserve Select? Was the bill more than $3000 cap?

I know the easiest solution is to find in-network hospital/doctor, but I would like to stick with Dr. Murray and Good Sam if possible.

Thank you!

P.S
I meant "Out of pocket maximum" when I said "Cap". Sorry for the confusion.

What can I do next?

More Answers

I would shop around for a doctor in network. Just because your friend had a "good" experience does not mean that you will have one. Tricare is no fun when you go out of network and they do like to drag their feet even on in network.

Things may have changed since I had medical issues with son but they are no fun.

Congratulations and good luck to you.

The other S.

PS Don't look trouble in the mouth by going outside their system.

2 moms found this helpful

Do not have experience with Tricare, but you will certainly go way over the
$3000 mark. If I were you, I would go to an in network doc. God forbid
you or ba by have some kind of issues, you would want to go to the best,
in network or not. So what I am saying, is pregnancy and delivery are nothing out of the ordinary. A significant illness or condition you want the best. Save your dollars just in case.

2 moms found this helpful

I can't offer you any advice regarding this specific example, but I can tell you that Tricare does NOT make things easy to go out of network without a referral. My daughter was sick once while we were out of town so I called to see what I needed to do to see about getting her to a pediatrician locally, and it was going to take 3+ days just to get permission so they would pay for it. Ended up just taking her to the ER to avoid the red tape and time frame. :/

1 mom found this helpful

Go to an in network doctor. Hospitals are expensive and if you or your baby needs anything "extra" NiCu etc, it can 4 or 5 times the 3 grand. And we have Tricare too.

1 mom found this helpful

There is nowhere in the country, that delivering in a hospital won't be more then $3,000!!! Multiply that by 3,4,5, etc...then you're in the right arena. You will likely use up all your benefits just seeing the doctor your fist handful of appointments. Sorry :(

1 mom found this helpful

I don't have experience with that insurance, but I have a high deductible plan with an out of pocket maximum. Here's what I have learned - the max only applies to in network. For out of network, there is a separate max. With my insurance, only the money that they would choose to pay counts toward that out of pocket max. For instance, if they pay $800 for anesthesia in-network, then $800 of the bill for your epidural goes toward your out of network max. If the anesthesiologist charges you $1200, then $400 comes out of your pocket, but doesn't go toward the max. So even if your out of pocket max for out of network is $5000, you could end up spending double that.

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