Anybody A Pro At Dealing With TRICARE?

[stuckinoki]

I'm in Japan and my DH and I are ready to step up our fertility treatments to more than just Clomid. I can't seem to find any information on what all TRICARE covers at an "In Town" Fertility Specialist??

I had heard that some things are covered [blood tests, part of HCG trigger shots] and that some things are not [IUI/IVF].

Are office visits covered?
Ugh...it's so confusing. lol

I need help figuring out what all is covered and what's not.
Can somebody help me out?

 

[CrystalLight]

You're speaking my language...
I have Tricare and I have successfully figured out how to jump through all their hoops! First things first, always get a referral for any kind of "out in town" specialist from your PCM (primary care physician) on base. They will ask you to come in so they can get specifics of your referral, or I've been lucky and gotten my referral right over the phone. The referrals are usually processed within 24-28 hrs. After that you can schedule your appt. with an infertility specialist, it has to be specifically the one your referral is for and it has to be scheduled within a certain amount of time the referral is written for. My referrals are usually good for 4 office visits. I call my PCM back after I've used up my visits to do this process all over again. So, once this is done EVERYTHING from office visits to uterus scans to blood tests to medication is pretty much covered. Word of advice, chose to get your medication at a pharmacy outside of base- you will have to pay a few dollars out of pocket ($3-$9 per prescription) but it's worth not waiting forever with the processing through the military. You have the co-pay for things like clomid/femara and Menopur/Follistim because these medications alone cost anywhere from hundreds to thousands of dollars. I hope these answered your ?'s, if you have any further questions just private message me. So, start doing research on fertility specialists around where you live!

 

[stuckinoki]

Thanks so much! Ugh! I knew there was somebody here that could answer my questions!!!

There's only one fertility treatment center where I'm at that speaks English [pretty important to me as my Japanese is sub-par!]. All of my clomid so far has been free, I work at navy dental and the pharmacy at medical just sends my RXs upstairs when they're ready

My RE on base is PCSing and I just emailed him for the referral in town...I was seeing a specialist on base but he's leaving and there is nobody filling his position as of yet. I was just scared to make an appointment for the specialist without knowing for sure it's covered! Nothing like showing up and being told you have to pay out of pocket!

I'm sure my RE will email me back tomorrow, he's kind of been pushing me to go out in town anyway because they can't do trigger shots or injectables on base but I was just scared that if I went in town they were going to immediately start pressuring us to do IUI [not covered, lol]

 

[wantanerd]

Tricare is sometimes a battle to deal with but they have been pretty good with covering my treatments with a fertility specialist. Last week they sent me into a panic when a referral I asked for never made it to tricare and I was supposed to get my HCG shot the next day. I dealt with my pcm's nurse and he was able to push through a referral that day to make sure I was able to get my shot. There are ways to get them to cooperate but it involved me going down to my clinic twice before they pushed a referral through. Usually referrals take 10 days - 2 weeks and usually to see a FS off base you need to get a referral for your hubby as well. usually they like to see you together the first time.

 

[Armywife84]

So let me get this straight if you have Prime, then they'll cover everything but the process of IVF itself? The shots, ultrasounds, etc.

I have Standard and they still covered my bloodwork and ultrasound from the gyno, I just paid the 15% I'm required to pay. But when my husband got his sperm analysis on base, he then called to see if he could get a referral for a urologist and they told him he would have to pay for it out of pocket. They don't cover fertility testing. Which makes no sense because they covered mine.

 

[wantanerd]

The won't cover the IUI procedure either. And Prime covers fertility testing.

 

[TiggerToo]

Just in case I end up doing it, any information on what happens if it's the ACTIVE DUTY member? I happen to be at Lackland and could probably find out, but I'd rather hear it from someone on the outside first, if you know what I mean...

(And if I can find anything out on my end, I'll pass it on.)

 

[CrystalLight]

If your husband is active duty then any kind of procedure should be covered. The military hospital should have a urologist that he can go to. If not, I'm pretty sure there's a referral process for active duty folks too.

My husband has had two SA, one from the military hospital which was paid for and one from our fertility specialist which was not paid for. It was explained to us that the data from the SA that was done at the military hospital would be near impossible to get because there's a lot of complicated paper work and processing. Our fertility Dr. also said that sometimes the military hospital doesn't do a thorough job for SA. In my particular instance, I trusted this information because my Dr. used to work at the military hospital. When we paid out of pocket with our fertility Dr. the SA cost us $100.

 

[wantanerd]

Just in case I end up doing it, any information on what happens if it's the ACTIVE DUTY member? I happen to be at Lackland and could probably find out, but I'd rather hear it from someone on the outside first, if you know what I mean...

(And if I can find anything out on my end, I'll pass it on.)

Lackland is one of the places you can get IVF through the military. It's much cheaper and if they do IVF, there's a good chance they do IUI for free or for low cost.

 

[TiggerToo]

If your husband is active duty then any kind of procedure should be covered. The military hospital should have a urologist that he can go to. If not, I'm pretty sure there's a referral process for active duty folks too.

My husband has had two SA, one from the military hospital which was paid for and one from our fertility specialist which was not paid for. It was explained to us that the data from the SA that was done at the military hospital would be near impossible to get because there's a lot of complicated paper work and processing. Our fertility Dr. also said that sometimes the military hospital doesn't do a thorough job for SA. In my particular instance, I trusted this information because my Dr. used to work at the military hospital. When we paid out of pocket with our fertility Dr. the SA cost us $100.

Actually, I'm the active duty member. I was wondering if they'd balk at deliberately making someone nondeployable.

 

[wantanerd]

I don't think they will balk. I actually had an active duty person tell me the air force paid for her IUI while she was active duty. She was stationed in Alaska though. From what I have heard, fertility treatments for the active duty tends to be easier to attain than for spouses. Talk to your gyno or pcm.

 

[MrS. MaBrEy]

tricare and the military view infertility as a treatable condition, they cant use your active duty status against you because it is discrimination. my husband is about to get "infertility" treatment for his low sperm mobility, they cant deny him that. so by covering his infertility cost they force themselves to cover yours too. as long as you jump through the tricare hoops your fine.

 

[Armywife84]

tricare and the military view infertility as a treatable condition, they cant use your active duty status against you because it is discrimination. my husband is about to get "infertility" treatment for his low sperm mobility, they cant deny him that. so by covering his infertility cost they force themselves to cover yours too. as long as you jump through the tricare hoops your fine.

Do you mind me asking what infertility treatment is he getting? And is it going to be fully covered by Tri-Care? Because when my husband called Tri-Care to get a referral to a urologist they told him it wouldn't be covered. Which is bs, because they'll cover women's fertility testing and SA's but not further fertility testing for active duty?

I read on their website that they'll cover some male infertility treatment.. dealing with ED. In which I didn't think ED was classified as infertility. Obviously you can take Viagra, or some other form of it.