Any Military Wives Knowledgeable About Tricare?

Updated on June 29, 2007
J.M. asks from Monterey, CA
4 answers

Hi guys, I was just wondering if anyone out there knew the ins and outs of how tricare worked. My husband and I are trying for our third child and would like to receive care outside of Portsmouth Naval Hospital,(we've had issues w/them in the past when my daughter had to be hospitalized). With my oldest I had Tricare Standard at the time and so had the opportunity to get civilian care. After she was born I switched us over to Prime. We lucked out with our second because there weren't any beds available and so they actually authorized outside care. So here is my question, should I switch over to Standard now? And if so, is that even allowed after I already switched from Standard to Prime? Or wait until after we get pregnant? Do they allow us to change after the "existing condition"? Or just leave it to chance like my second pregnancy and hope they'll actually authorize outside care? Any advise in this matter would be greatly appreciated. Dealing w/insurance companies, esp. Tricare is sticky enough:) So any light you guys can shed on this would really help. Thanks in advance!

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D.G.

answers from Norfolk on

J.,

I'm in the same situation and have been doing some research about it. The midwife clinic at Depaul currently does not take tricare prime. They are having an internal meeting this month, so that may change by next month. I'm not pregnant yet either, so I'm going to wait until next month and see if their poclicy changes. Hopefully it will. The only issue with prime is that fewer dr.'s will take us because tricare pays them less than it costs to take care of us, which makes us have fewer selections and I believe, in general, that the more qualified doctors don't take tricare prime. Standard has a higher deductable. It really doesn't make that much differnce with the pregnancy, but if you had to go to the emergency room you are responsible for the bill, I think up to 1000.00. That's a chunck of change for us. You can call tricare and they will talk to you about it and answer any questions that you have. They also have a booklet online. Hope this helps.

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J.J.

answers from Norfolk on

I am not sure how it all works with Tricare but I do know I have standard and when my son was born in 2004 I went to a civilian Dr and delivered at Virginia Beach General and all I ever paid was $50 for the hospital $25 for me and $25 for my baby (that I ended up getting back). Hope that helps and Good Luck.

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T.M.

answers from Norfolk on

Sorry to be short, but we were going to have to give birth at the naval hospital with our first born, but we didn't want it and asked how to get out of it, they said we would have to switch insurance, so we did, so its possible.
Just make sure to see who covers the switch.

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M.M.

answers from Norfolk on

I refuse to birth at NMCP again. They refused to listen to me when I told them my water wasn't broken and induced me without checking at 37 weeks.

With this pregnancy, I'm opting to have a homebirth. Since the military does not provide that service, I'm getting a referral to a civilian midwife that does that service. I'm staying on Prime and TriCare should reimburse most of the costs.

If you don't want to do something like that, you can drop down to Standard and see whoever you like. Some places you'll have to pay out of pocket and submit the paperwork to get your money back. I believe the midwives at DePaul work this way.

Third option is to hold off on prenatal care for a few months and hope that they are full. If you're low risk, it's might be worth it. They don't really do anything the first couple of months and prenatals are easy to find.

You can switch to Standard at any point in time that you'd like and see a civilian. Your insurance carrier isn't changing, only your doctor and your plan. The only thing is you have to wait a year before going back to Prime.

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