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Tricare standards

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panda soup 2
Maleficent 3
namenotalreadytaken 4

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namenotalreadytaken --- 9 years ago -

minus the s after standard

Yes I know there's a ton of threads but this is getting irritated and the tricare reps I am talking to keep giving me different information.

I moved and now have to switch to the north region. I cannot have prime where I am located so first I have to disenroll correct?

Then right after that can I just find a network provider (I need to get scheduled with a obstetrician asap) and make an appointment myself or does it take time to get enrolled in standard or how does that work?

Once at the appointment what information do I need to provide so that tricare covers all that it should and I just have the percentages and copayments?


Thanks for any clarification 

Maleficent --- 9 years ago -

Okay- Do you have a tricare office anywhere or are you no where near a base or anything? If you are near a tricare office it's easy to disenroll from prime and enroll into standard. If not, I think there is a lot of faxing etc that goes on which can take time.

Once you have made the switch though you are free to make an apt anywhere in network (you can do out of network too you may just end up paying slightly more. Maternity care is covered 100% though after the copay whether it is in network or out of network unless you see a midwife at a birthing center or something outside a normal hospital/office. You never need referrals or anything to go to anyone.

Once at your first appt they just need your military ID as your insurance card and you fill out the paperwork with your sponsors info for insurance info just the same as you would prime. Hope that helps! 

namenotalreadytaken --- 9 years ago -

Unfortunately there isn't a base anywhere near but yes that helps a ton, thank you!

Are the copays something I'll be paying every visit?

And on one of the papers I saw after the baby is born there will be a 250$ fee plus a percentage of something else I wasn't familiar with. Any idea what that is all about?

This is the first time I've ever really had to deal with insurance at all so its kind of overwhelming! Thanks so much Maleficent! 

panda soup --- 9 years ago -

Why can't you have prime where you are going?

If you want to switch to standard, you are right. Fill out the disenrollment form and fax it to Tricare. The date you sign the disenrollment form is the date that you start on Standard. Sometimes it does take a few days for them to change your info in the system, but they will back-date the changes to match the date you signed on the disenrollment form, so you don't have to worry about a lapse in coverage.

For maternity care it doesn't matter if your provider is in network or not, everything is covered under the global maternity fee (or whatever it's called). That's everything except your initial appointment to confirm your pregnancy and your delivery. The delivery will be a flat fee per day and the initial appointment will be the usual copay you have with standard. 

namenotalreadytaken --- 9 years ago -

Prime isn't available where I'm living.

I already had the confirmation visit at the naval hospital, so I won't have to pay for anything other than delivery? 

Maleficent --- 9 years ago -

The copay is yearly and apparently does not apply to maternity care unless you deliver at home of as an outpatient with the exception of a birthing center delivery. However, if you have to go to a regular doc for anything you will have to pay the annual co pay. The amount varies by rank and is on page 4 of the fact sheet. This is as of 2013. Hospital stay is $17.35 per day. This includes delivery and everything.

Here is a sheet that should help you as well. This opens a PDF which is why it looks ridiculous.
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CC8QFjAA&url=http%3A%2F%2Fwww.tricare.mil%2F~%2Fmedia%2FFiles%2FTRICARE%2FPublications%2FFactSheets%2FMaternity_FS.ashx&ei=dcmaUfapHMmWiQLC_4GgDQ&usg=AFQjCNGH9kzO7TDmaGvFfSsIdomun6p2dQ&sig2=Zp7VQvJCjRdfl1qZL4ob7g&bvm=bv.46865395,d.cGE&cad=rja 

panda soup --- 9 years ago -

That's right, everything else is covered, but I'm guessing you will still have to pay a copay for your first visit to your OBGYN. They will want to follow their usual protocol of starting maternity care, instead of relying on an early confirmation from another place. Unless you are farther along than patients usually are when starting maternity care. But if all you've had is a pregnancy test at the naval hospital, I would plan on having to start everything over at your new place. The only reason you have a copay on that initial visit is because they are not coding it as a maternity care visit, since they have yet to confirm your pregnancy. After it's confirmed, all other visits will be coded as maternity care, so they'll be covered with no more copays. 

namenotalreadytaken --- 9 years ago -

Oh wow so its actually super affordable, that's great, one less thing to worry about!

Only one more question. With out of network I know it says online I have to file my own claims while in network they do all that for me. Have either of you ever done out of network and had to file claims yourself? Is that enough of a hassle to where it'd be better to go a bit farther away from where I live to a network provider and not have to worry about that?

Again, thank you both so much 

Maleficent --- 9 years ago -

All they have to do for your first visit is do a vitality check and it will be covered with no copay. :) That's what I did with my doc at Scripps. I did not need to start over at all.

You can call the doc and ask if they will file for you. Most will. If not though, yeah it would be much better to find an in network. 

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