New LO's Insurance Process

[laurelita42]

Background: Where we're stationed, there is no OB care so I am out in town even though I'm on Prime. The clinic here is fine for me and for DD1, since we rarely have issues that need attention, but I know how often we all end up dragging tiny babies in to get check out for one thing or another. My clinic is small and I have never been able make a sick appointment for the next day- say, I call and say "Hi, DD1 looks to be getting an eye infection, can I make her an appointment to get checked this week?" they will tell me to call back at 7am the next day and wait in the phone queue to try and get a same day sick appointment, and that's it. They won't slot me in for any other time during that week, it's just call back tomorrow. They only schedule the normal well visits ahead of time. I have had to take DD to urgent care many times and call the clinic afterwards to get approval. I haven't experienced anything quite the same in all my MTF adventures.

Okay, so now my question. I know this new LO will automatically have 60 day coverage on Prime. When DH adds her to his Page 2 the day she's born I can call this clinic and try and get her first slew of appointments scheduled. But I'm a little wary of the whole thing, reflecting on how difficult it's been to get DD1 seen when needed. So how do I go about putting DD2 on Standard? I've heard good things about the Johns Hopkins plan, too. Do I need to call Tricare and tell them I will want DD2 on Standard right now? Or can I interview with pediatricians now, find a good one and get her assigned to him/her ahead of time, and then call Tricare and switch her to Standard after birth?

I feel totally clueless. Prime has always been fine for our family in the past, and so I never paid attention when anyone asked these questions before. If someone can enlighten me, you will take a big worry off of my plate!

[hlm184]

I don't know how it works everywhere, but this is what happened with us.

I was also seen in town while on Prime since our base has no OB care. When DS was born, they scheduled him for some follow-up appointments with the hospital pediatricians and we saw them for the first month or so. Meanwhile, DH registered DS and once his own coverage kicked in we switched to the pediatrician on base. There were no issues.

I can pretty much guarantee that you can't get her into standard before she is born, because they will need a social. I would talk to your OB about initial pediatrician care until you can get standard set up.

[LizInFL]

I'm kind of late in responding to your question, but to me, paying the extra for Standard is so worth it laurelita42. We opted for Standard for our 16-month old when he was born, and I liked being able to choose his pedi, and be able to get a day-of appointment if necessary with no hassle.

Your H will enroll the new baby in DEERS once s/he is born. You don't need a SS#, since you usually don't get one for a few weeks, but you will have to have some sort of letter/whatever from the hospital (certificate of live birth? or something) When you enroll the child in DEERS, I believe at that time you'd choose Standard if that is what you decide. Otherwise, enrollment in PRIME is automatic, but expires after 60 days and switches to Standard unless you previously selected Prime.

[racegurl87]

Kinda late to the party here, but from what I was told before I delivered is that as soon as the baby is added in DEERS they're automatically on Tricare Standard. In order to be on Tricare Prime your H would have to call and enroll them. I'm on Standard and we're keeping DD on Standard too, I think it's worth it because you don't have to go to the clinic for care and you don't need a referral if you need to see Urgent Care.

[kaeguri]

laurelita42, I'm late! I'm on Standard already, so LO will automatically be on Standard. But overall, I think it's easier than Prime, bc we can go almost anywhere without waiting on a referral so I can pick any pediatrician that accepts Tricare or if I'm out of town and it's an emergency, it's easy to get it covered too. And if she or I ever need a specialist, no waiting for referrals. Most of the time in my past, I'd get a referral fairly fast (3-5 days), but if it's my child that needs the care, I'm going to want it much faster than that.

[Mom2Ms]

Agree with PP. I had DS 9 weeks ago. I believe he was automatically enrolled in Standard.... Super easy!