Question about OBs and hospitals

[kaeguri]

So I'm getting married in 2 weeks, my fiance is in the Navy, so I'll be on Tricare Prime after this. Question is, I know the PCM is assigned to me, but is the OB assigned too? Or can I pick any OB in the network? Or am I limited by distance? The nearest hospital to me has a high rate of C-sections and epistomies so I want to go somewhere else. Thanks!

[racegurl87]

I'm on Tricare Standard so things are a bit different for me, but I believe it has to do with where you're stationed. The AFB where we are doesn't have a hospital or the ability to do OB care. From what I know, once you're PG you go to the clinic to confirm and then your PCM starts the referral process to the OB that is in network. I believe as long as you have a referral and they're in-network you can see whatever OB you choose. If you look on tricare.mil you can see if the OB practice/hospital you'd like to deliver at is in-network or not.

[kaeguri]

There's no OB care on the base we're at, so I know I will have to go off base. I have my records from my current OB, it seems silly to me to have to go to a PCM and be like hi I'm pregnant, gimme an OB. But the military doesn't make sense often with these things so. I was hoping I could find an OB in-network and just ask for a referral to that one. The hospital I want is just further away, so not sure if they'll let me. I guess I'll find out soon. Thanks!

[kaydee0402]

My husbandman is Navy too and I'm 39+6 with our first. He's stationed in Portsmouth, VA and there's a huge Naval Hospital here, so I can only speak from the experience of being in a big Navy area.

While I was on Tricare Prime, I had an assigned OB at the Naval Hospital. We had an ultra sound at 7 weeks to confirm the pregnancy. Then I had a few complications, it ticked me off the way the doctors and nurses at Portsmouth handled it, so I switched to Standard.

At that point, I was allowed to pick any OB I wanted so long as they accepted Tricare (Hampton Roads is a huge military area, pretty much everyone takes Tricare).

I picked an OB practice that is big on natural, low intervention, med free births that delivers at one of the best hospitals in the area. The hospital has a significantly lower C-section and episiotomy rate than the Naval Hospital, and I have not had to pay anything out of pocket since Tricare Standard cover prenatal care.

I don't know what area you're in, but if you don't like the OB Tricare is telling you to see, you can switch to Standard, select who you want and not have to worry about paying an arm and a leg for an OB you're happy with.

[kaeguri]

kaydee0402, I'll have to look into that. I always assumed Prime was better than Standard but maybe not. We're in a small Navy area, NNPTC school in Charleston. The nearest base is Joint Base, but since we're not technically stationed there, I won't be at the military hospital. I'm just worried they'll make me go to the nearest hospital to deliver, and they have the highest c-section rate in the area. And the labor and recovery rooms aren't private.

[Deleted]

I am on Prime and I have never seen my PCM here. We don't have OBGYN at our naval clinic here so I am at a hospital out in town...I just showed up with my records and got a referral submitted that day through the naval clinic's referral dept. If you do research ahead of time on hospitals and doctors in the area you can request a specific practice. I hadn't done that so they just dd a referral for one of their popular providers in the area.

[kaeguri]

Feb 19, 2015 22:28:14 GMT -5 @jraeohyeaaa said:

I am on Prime and I have never seen my PCM here. We don't have OBGYN at our naval clinic here so I am at a hospital out in town...I just showed up with my records and got a referral submitted that day through the naval clinic's referral dept. If you do research ahead of time on hospitals and doctors in the area you can request a specific practice. I hadn't done that so they just dd a referral for one of their popular providers in the area.

Oh I didn't think about that. So I can go to the clinic on base and just get a referral? I did find an OB in-network I want. I have all m medical records on me too. Sweeet thanks!

[honeylemon]

Feb 18, 2015 12:46:11 GMT -5 kaeguri said:

There's no OB care on the base we're at, so I know I will have to go off base. I have my records from my current OB, it seems silly to me to have to go to a PCM and be like hi I'm pregnant, gimme an OB. But the military doesn't make sense often with these things so. I was hoping I could find an OB in-network and just ask for a referral to that one. The hospital I want is just further away, so not sure if they'll let me. I guess I'll find out soon. Thanks!

We're a little different because we have Tricare Prime Remote. When we moved here, I was already 24 weeks pregnant with my second baby. I was assigned a PCM by Tricare, had to make an appointment with the PCM, showed up with my obvious pregnant belly, and asked for a referral to my preferred maternity provider. It was silly, but that's how it goes a lot in my experience.

Good luck!

[tjr42px]

Most of you seem all set, but for future reference if you don't like prime, standard, or you PCS and don't like your care...consider US Family Health Plan. It functions like TriCare because it is. You have many more options on that network though. The customer service is amazing. My wife and son switched to it after we PCS'd in Sept. Reps come to base, your home, or are actually available by phone. I know amazing! I'm on a first name basis with the two that cover our joint base. There are no office visit co-pays or premiums to pay, the only difference is you can't use MTF services for one year after enrollment, but if you choose it you aren't going to use them anyway or you would have stuck with your original plan. They do have med co-pays, but the plan requires you to use mail order Rxs. So you pay $5 for a 90day supply that is delivered to your home via us mail. The plans do not cover the whole US in that if you are at a base with awesome services, US Health Plan probably isn't in your area, but like other Tricare plans they cover you anywhere for emergency services once enrolled with them. It isn't offered to AD members just dependents. The plan is an option where specialty care is limited for dependents at MTFs.

I should feel bad routing services to the network, but typically this plan is only offered in areas that have few dependent services to begin with. So from a quality care perspective why see 5 docs all over when you can see them all as part of one hospital clinic team? It's just better care.

[Mom2Ms]

I'm on Standard as well. We live in Southern California so I had no problem finding and picking an OBGYN who took the insurance. I'd highly recommend Standard if you want to choose your doctor and where you deliver. I've had no issues whatsoever.

[hlm184]

I did prime with my first (no OB care on base) and was able to select a provider who met my needs.

My second (soon, hopefully) I refuse to go on base where prime would send me, so I am switching to standard so I can choose.