S.A. asks from Mukwonago, WI on June 06, 2009
Question for Moms with Tricare Prime Remote
Hi, my husband and I found out we are pregnant again almost 2 weeks ago. Our insurance has changed since our last pregnancy, with our last we could see whoever we wanted. This time around it seems as though we can only see providers that are covered providers, however, we still need a referrel from our primary physician. My problem is that the dr who is listed as my primary physician is someone I've never even seen before and is only my primary because I see the physician assistant that works in that same office. But he is also certified as an obgyn. So, I guess my question is how did other mom's find an ob/gyn that they liked with strict limits on who you can choose from? And is there any way around having to drive 30 minutes to deliver at a hospital that is covered or 5 minutes from the hospital that is right by my house and delivered at before? So if anyone has any experience with Tricare Prime Remote, I would love to hear your experiences with this type of thing or any info on things that I can do. Thank you.
C.G. answers from Chicago on June 06, 2009
I was on Tricare Prime (active duty) at the beginning of my last pregnancy. I wanted to see a nurse-midwife and because I am not allowed to change from Prime as active duty I had to drive all the way to Milwaukee to see someone.
If you are a spouse you can elect to use Tricare Standard instead of prime which will allow you to see any provider who is credentialed by Tricare (it seems most providers are credentialed, it's generally anyone who accepts Medicare). You can also use the point of service option to see anyone you want but it results in out of pocket charges.
On standard even if your provider opts not to contract with Tricare you can pay up front and get reimbursed by Tricare- that's what I did with my kids because I wasn't willing to see any of the local Tricare contracted physicians, they were awful.
There is a maximum distance you cannot be forced to drive beyond to see your provider- I want to say it is no greater than 45 miles or one hour. Not positive on that and it is very hard to get them to agree to transfer you. I was forced to wait 8 months for a referral to a specialist because they were trying to send me to St Louis (at my own cost) because there was no one in the local area. So frustrating!
There is a Tricare office at Great Lakes and one person who works there named Christina was always very helpful to me. Calling Tricare is generally worthless because you will get a different answer every time you call- be sure to write down the name and the date/time you talked to someone. I made a congressional complaint and Tricare actually lied about the number of time and dates I had called- luckily I kept a log of my calls. They ultimately apologized.
Good luck- I actually left active duty for a civilian career about 1.5 years ago and a large part of my deciding factor was how terrible my health care was on Tricare in this area. If I can be of help in any way please send me a message.
J.S. answers from Sioux City on June 07, 2009
Hi there S.,
I went on Prime Remote about half way through my first pregnancy b/c my husband was deployed. He is in the Army Reserves and was activated to deploy. We were using Tricare Reserve Select before he deployed. Anyway, we live over 3 hours from the nearest Military Treatment Facility and I never had a problem picking a Dr. However, like I said, I was halfway through my pregnancy when our insurance changed.
I have never had a problem seeing any doctor in the area that I live. I am pregnant again and I am still able to see the Doctor that I saw before. And the plus side when we had this insurance, we didn't have to pay for anything dealing with my Maternity care or the deilvery process:)
The way I understood Prime Remote to be, was that it was designed for the mom's like us who live too far from a MTF. This way we can use our own doctor. But, I could be wrong. Hopefully you got something out of my rambled mess!
J.L. answers from Davenport on June 07, 2009
Hi, S.. Where do you live at? We are in Eldridge, so that's where my primary physician is located. One thing to make sure of, is when you go to your PCM for the pregnancy test/referral, make sure they call it in and find out what paperwork they need to fill out and send to Tricare. All Tricare told me was I needed to get a referral. So I got one, and now am having to backtrack and have my PCM do paperwork so I won't start getting charged for my OB. The referral paperwork is the key thing. I know a lot of Military Spouses that are being seen at the OBGYN group at Paul Revere Square. They have both midwives and physicians. I go to the midwives and really like them. They deliver at Genesis East. I also know someone who went to Trinity on 74 HWY, and liked it there too. Let me know where you are at and I'll see what I can find out for you? Are you new to the area? There is a good playgroup at the arsenal I can get you info on if you haven't already found your way there. Congratulations!
M.S. answers from Minneapolis on June 07, 2009
Bout the drive to the hospital - stay at home as along as possible during labor! Hire a doula and she can help gauge your progress, and you can learn to check your self. Or unless you have midigating circumstances - hire a midwife and have baby at home. In the Minneapolis/ St Paul area they range between $2-$4K for all care. I know you're not here, but worth something to think about.
Or, find a few doc's that sound like you might like them, and ask your primary for a referral to them. Good luck!
J.G. answers from Minneapolis on June 07, 2009
Just curious, why are you having such limitations in your plan? Have you thought about switching to Tricare Standards instead of Tricare Prime? Tricare Prime usually only works well when you live near big military posts where you have easy access to a military hospital.
I'm a wife of an active military soldier and have lived in MN for 5 years. I switched my coverage to Tricare Standards from Tricare Prime right before I moved to MN. I always have seen a doctor of my choice without any referral from my "primary physician" or restrictions - my two children were born here, and my Tricare covered the most of the medical costs.
I would suggest that you should call Tricare to make sure that you're getting the right kind of plan for you....