Jan
2
TRICARE Maternity Coverage
January 2, 2010 | 6 Comments
If you think you are pregnant, or have gotten a positive result from a home pregnancy test, you will need to go to your PCM to have the pregnancy confirmed. You must have your pregnancy confirmed by lab results before TRICARE will cover any prenatal care.
If you have a military PCM, you will have to go to the lab. Most military labs do pregnancy tests on a walk in basis so you do not need to make an appointment. The lab technicians have up to 48 hours to get back to you with your results. If you call the lab before they close the same day that you did the lab pregnancy test, someone may be able to give you your results sooner.
If you have a civilian PCM, you will need to contact the provider’s office to see how they handle pregnancy tests. Once your civilian PCM has confirmed your pregnancy, you can select your provider for your prenatal care.
TRICARE covers:
- All supplies, care, and lab work needed for prenatal care, labor and delivery, as well as postpartum care.
- Pain management during delivery, including epidurals.
- Medically necessary ultrasounds.
- Hospitalization for delivery and post delivery care at TRICARE-authorized hospitals and birthing centers.
- Medically necessary cesarean sections.
- Minimum stay of 48 hours after vaginal birth.
- Minimum stay of 96 hours after cesarean section.
- All postpartum care for 6 weeks after delivery.
TRICARE does not cover:
- Frequent ultrasounds that are not medically necessary to monitor a high-risk pregnancy.
- Ultrasounds to find out the sex of the baby.
- Any use of Home Uterine Activity Monitoring.
- Treatment of recurrent spontaneous fetal loss through lymphocyte or leukocyte immunotherapy.
- Detection of preterm labor through the use of salivary estriol tests.
- Treatment of preterm labor with drugs not FDA-approved for preterm labor.
- Personal comfort items that are in addition to the hospital’s or birthing center’s usual care regimen (e.g. private rooms, television, etc).
- Elective cesarean sections. Coverage will be the same as what would have been provided for a vaginal birth. Any charges over this amount will be paid for by the patient.
- Collection and storage of umbilical cord blood.
If you have signed up for Prime, your MTF offers prenatal care, and they are taking new patients, you will receive your prenatal care from a military obstetrician (OB). You will need a referral for your maternity care if it is not offered by your MTF or the OB department is not accepting new patients. Referrals for maternity care are global referrals. This means that one referral covers all medical treatment associated with the pregnancy. This includes prenatal care, labor and delivery, and postpartum care for the mother. If you do go to a civilian provider, the cost will be covered 100% by TRICARE, just as if you were seeing a military doctor.
Your PCM will work with TRICARE to get your referral in place. You can call your TRICARE regional contractor to check on the status of your referral. Once your referral is in place, you can make your first appointment with your chosen doctor. Your referral should be in place within a week of your PCM confirming your pregnancy.
If you signed up for TRICARE Standard, you can choose any civilian doctor. There is a 20% cost-share for non-network doctors and 15% cost-share for network doctors. When it gets close to your due date, your civilian doctor will have to set up the admission referral with the TRICARE regional contractor.
If you already have a civilian doctor that you want to use, then TRICARE Standard may be the best plan for you. Choosing TRICARE Standard will make sure that you can see the doctor of your choice. With TRICARE Prime, you can only choose a civilian doctor if the MTF doesn’t offer OB services or is not taking new patients. If you switch from TRICARE Prime to TRICARE Standard, you will not be able to switch back to TRICARE Prime for one year.
If you want to switch TRICARE plans, visit the closest TRICARE office. Any changes you make will not take effect until the first day of the next calendar month. When switching from Standard to Prime, the 20th of the month rule applies. For your coverage to start the next month, you need to make the switch before the 20th of the current month.
Comments
6 Comments so far
Find It!
Custom Search
Just want to say what a great blog you got here!
I’ve been around for quite a lot of time, but finally decided to show my appreciation of your work!
Thumbs up, and keep it going!
Cheers
Christian, watch south park online
very well
information you write it very clean. I’m very lucky to get this information from you.
Wonderful journey and experience!
One again, your article is very nice
Enjoyed reading
the report – most informative thanks
Thanks for making my morning a little bit better with this great article!!