Tricare Standard Anyone?

[shayr]

So I am having trouble finding information on the coverage of NT scans and maternal blood screenings through Tricare standard. I called and they said they don't cover testing like that except for MAYBE the CF testing and that my doctor should submit a form to see if they do in fact cover it. I'm not sure of this includes the Quad screenings. Has anyone had any luck with getting helpful answers with tricare or know what they actually cover? Thanks ladies!!!

[2dumbdogs]

I don't have Tricare, but just in general getting answers from insurance people is a pain. There is likely a person that specializes in negotiations with insurance at your docs office - I would try to get in touch with them and ask them for help.

[shayr]

Jan 23, 2015 15:44:06 GMT -5 2dumbdogs said:

I don't have Tricare, but just in general getting answers from insurance people is a pain. There is likely a person that specializes in negotiations with insurance at your docs office - I would try to get in touch with them and ask them for help.

Very True. I think I'll look into tracking this person down! When I called tricare they read verbatim what I read online so I'm not sure she knew much more than what she was told to read. Thank you!

[divinemsbee]

I'm Tricare Prime and my NT scan is covered. However, I'm also seen at a MTF (which I love and is a highly regarded hospital). It's part of why I'm not on Standard (at least where I am with my options right now) is that it's so confusing to find out what's covered and what's not.

I do know that they do not recommend the NIFT (or NIPT, whatever the MaterniT21 and all that jazz is) for women under the age of 35 unless there's other testing that makes it necessary, so that is not covered by Tricare and I'd imagine it's the same on Standard. But NT scans and blood draw, Quad draws, and all of that is covered if I opt for it.

I don't know where you're stationed or what your experiences are, but I do know that military hospitals and doctors get a bad rep that's not always deserved. We had a bunch of people (who had never actually used it) talk shit about delivering/care at our MTF and ours is so awesome. Again, if you've had bad experiences, I get that, but if you haven't, I think Prime's pretty great.

[laurelita42]

My friend was on Standard (I'm on Prime) and I do believe her scan was covered... eventually. I think she was billed for it at the beginning, and went back to her OB and had them code the scan differently so that it showed as medically necessary rather than optional, and then Standard paid it. I'm not sure if her office was just really obliging or if that is pretty normal procedure. I would ask your office if they can/will code the scan as necessary, then you should be all set in the billing department.

[bebeglow3884]

I'm also tricare prime so everything is covered, try calling tricare, if they can't help you they might be able to direct you to someone who can. Where I live there's a tricare representative on base. I don't know much about tricare standard though, sorry. Good luck!

[shayr]

Jan 23, 2015 15:56:08 GMT -5 divinemsbee said:

I'm Tricare Prime and my NT scan is covered. However, I'm also seen at a MTF (which I love and is a highly regarded hospital). It's part of why I'm not on Standard (at least where I am with my options right now) is that it's so confusing to find out what's covered and what's not.

I do know that they do not recommend the NIFT (or NIPT, whatever the MaterniT21 and all that jazz is) for women under the age of 35 unless there's other testing that makes it necessary, so that is not covered by Tricare and I'd imagine it's the same on Standard. But NT scans and blood draw, Quad draws, and all of that is covered if I opt for it.

I don't know where you're stationed or what your experiences are, but I do know that military hospitals and doctors get a bad rep that's not always deserved. We had a bunch of people (who had never actually used it) talk shit about delivering/care at our MTF and ours is so awesome. Again, if you've had bad experiences, I get that, but if you haven't, I think Prime's pretty great.

I have heard horror stories regarding the naval hospital where we are stationed. The one about 45 minutes away is great, but that drive is a but much. That's why I've stuck to standard. It does seem to be a pain finding anything out and you kind of just get a run around. Even the doctors office said it's forever changing. I suppose I probably wouldnt get the MaterniT21 since I'm under 35 and have never been pregnant before.

[shayr]

Jan 23, 2015 16:07:30 GMT -5 laurelita42 said:

My friend was on Standard (I'm on Prime) and I do believe her scan was covered... eventually. I think she was billed for it at the beginning, and went back to her OB and had them code the scan differently so that it showed as medically necessary rather than optional, and then Standard paid it. I'm not sure if her office was just really obliging or if that is pretty normal procedure. I would ask your office if they can/will code the scan as necessary, then you should be all set in the billing department.

Thank you! I think I will speak to them about the coding. I had someone give me the billing codes so I will be calling Tricare and giving them the codes directly to see what they cover.

[mommakc]

Tricare is oh-so-fun, eh? I don't know the answer, but if your doctor is close to post/base, it's likely they'll know exactly how to handle them. Good luck!

[divinemsbee]

Jan 23, 2015 16:51:01 GMT -5 bebeglow3884 said:

I'm also tricare prime so everything is covered, try calling tricare, if they can't help you they might be able to direct you to someone who can. Where I live there's a tricare representative on base. I don't know much about tricare standard though, sorry. Good luck!

I agree that if your base or the hospital has a Tricare rep, get an appointment and talk to them. A lot of times things are made much more clear in a face to face.

[snyder124]

I switched to standard for the soul purpose of avoiding the OB on post . It was awful . I ended up filing a complaint for violating hippa and releasing inaccurate information over the phone.. I'm sure every post is different but I'm happy with my choice .

In regards to your question, I worked in medical billing . Request the exact test codes from the office that will perform the test, then call tricare and speak to someone in the CLAIMS department. Ask them to quote you exactly what the out of pocket cost would be with that test code. Be sure to get a person's name and reference number for the call.

[shayr]

Jan 24, 2015 2:23:47 GMT -5 snyder124 said:

I switched to standard for the soul purpose of avoiding the OB on post . It was awful . I ended up filing a complaint for violating hippa and releasing inaccurate information over the phone.. I'm sure every post is different but I'm happy with my choice .

In regards to your question, I worked in medical billing . Request the exact test codes from the office that will perform the test, then call tricare and speak to someone in the CLAIMS department. Ask them to quote you exactly what the out of pocket cost would be with that test code. Be sure to get a person's name and reference number for the call.

Thank you! I will be doing this for sure!