Tricare Prime Maternity!!

Replies to This Discussion

Permalink Reply by SubWife2011 on May 5, 2011 at 10:48am

I have never heard of anyone on Tricare Prime having to pay for any medical bills (up front or after the fact).  All of my friends that have had babies while on Prime never had to pay a cent.

Permalink Reply by Richelle(Nuke Wife)Ship2 Div929 on May 5, 2011 at 10:54am

thats what i was told also. but when my pcm told me diff i got a little worried lol. thank you

Permalink Reply by SubWife2011 on May 5, 2011 at 11:11am

no problem! You could always go to the Tricare office or call Tricare just to make sure too.....just on the off chance that I am wrong.

Permalink Reply by motherinlawtobe on May 5, 2011 at 12:36pm

I'm interested in hearing what they say - I can't call and ask, but my daughter and her fiance are getting married soon and they are expecting.  She is on Medicaid right now, so if it would be  better for her to stay there than get on his insurance, then that's what we will do.

Permalink Reply by Richelle(Nuke Wife)Ship2 Div929 on May 5, 2011 at 12:39pm

I still have my medicaid as my secondary! Completely forgot about that! So even if they do try to charge me it won't matter. Lol thanks for reminding me!

Permalink Reply by Anti M on May 5, 2011 at 2:01pm

http://www.tricare.mil/factsheets/viewfactsheet.cfm?id=381

Medicaid is still your primary insurance.  Personally, I'd dump it.  We found having another insurer resulted in higher costs!  You may find your situation to be different.

Are you using care providers who do not accept Tricare, or you are not seeking authorizations?  Then you WILL pay half the costs. That's the Tricare Point of Service Option.  

http://www.tricare.mil/factsheets/viewfactsheet.cfm?id=183

I am on Prime as a retiree.  My co-pays for an authorized appointment are $12; I rarely have to pay that on the spot.  I was just in the hospital for three days and I doubt I'll pay more than $50.  The difference is I did not get a choice of providers, I went where I was sent.

Most PCMs are NOT Tricare experts.  Paying that amount sounds much more like Tricare Standard or Prime's PSO.  I would suggest a phone call to be 100% certain you won't get stuck with high co-pays.

http://tricare.mil/mybenefit/home/overview/WhatIsTRICARE/NewtoTRICA...

http://tricare.mil/mybenefit/home/LifeEvents/NewbornAdoption?

Permalink Reply by STSWife on May 5, 2011 at 3:07pm

I have Tricare Prime and in January went to the hospital in an ambulance for a broken leg and I didn't have to pay a cent.  I also had to see an orthopedic surgeon actually two different ones and didn't pay a cent for either of them. I had to get a referral to go see either of them that was a pain in the butt, but I would rather that then pay any bills. If you see a doctor that is in the Tricare network and your PCM gives you a referral you should have to pay a thing, that's the benefit for having Prime and not standard.

Permalink Reply by Nancy on May 5, 2011 at 3:09pm

For Tricare Prime all your costs are covered for maternity care with no share of cost. Prime only allows you to use an approved PCM. The only thing you might pay for is prescriptions that are not filled at a military facility. For Tricare Standard, you'll be under Global Maternity which means there is a share of cost but the doctor will bill you AFTER you deliver. It's said the entire cost is $16.00 and some change for each day you spend in the hospital so the total for a two day hospital stay is about $33.00 total for your entire maternity care including doctor visits. Maternity care under Standard is different than their regular doctor visits where there is a share of cost for each visit. However, you don't have a PCM under Standard. You can see any doctor. I'm on Standard Global Maternity right now and didn't pay for my doctor visit or ultrasound. I'm still awaiting birth to see what the actual total cost is. If you have Medicaid already, Tricare will tell you that they're your primary insurance. Your best bet is to call Tricare and ask just to make sure.

Permalink Reply by EmilyFCwife on May 5, 2011 at 6:42pm

Nancy, I would be really surprised if they made you pay anything, I just delivered on Standard, and didn't pay anything. It was 100% covered.

Permalink Reply by Nancy on May 5, 2011 at 11:42pm

Good to know! I hope I don't pay anything but Tricare did tell me I would pay about $16 per day at the hospital. Guess I'll find out in August. By the way, congrats on your newborn!

Permalink Reply by EmilyFCwife on May 6, 2011 at 12:42am

Hmm...That's interesting, they never said that to me. I would wait and see. Tricare can be really stupid sometimes. And thank you. When are you due??

 

Permalink Reply by EmilyFCwife on May 5, 2011 at 6:40pm

I was on Standard when I delivered, no cost at all. Or on Prime, Maternity care is 100% covered by Prime AND Standard. It even says it in their hand book that they give you. As long as you are using a doctor who is covered in the Tricare network.

I delivered on April 7 of this year. And even got bounced to a different hospital then what I had my referral in for. And still no out of pocket costs. 

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