Figuring Out Tricare

As the spouse of an active duty service member, I am covered by Tricare insurance. I am not one of those people who despises Tricare, though I know many who do. Sometimes Tricare makes total sense to me. Other times I find navigating its rules totally baffling.

When we first got married, I had the version of Tricare, called “Standard,” that allowed me to choose all of my own doctors, but I had to pay copays at least until meeting an annual deductible. When we got to Monterey, after the copay for a regular annual ‘healthy woman’ exam (before we were even trying to conceive) was nearly $200, I switched to Tricare “Prime.” Under Prime, there is very little out of pocket cost, but it’s HMO style so I have to get a referral from my Primary Care Manager (PCM) any time I want to go to a specialist, so it takes a little more maneuvering.

This was the first time we’ve moved since I switched my coverage type. With Standard, all I had to do was update my address online in the military personnel benefits database thing, and then look up doctors who are in the Tricare network and call one up. So I made that change online, and then about a week before we left North Carolina for the last leg of the move, I called up the hotline to find out who my new PCM would be so I could set up that appointment right away so I could get my obstetrical referral quickly.

Oh silly, silly me.

It turns out if you move from one Tricare “Region” to another (there are three, North, South, and West, and indeed I was crossing boundaries), you have to submit a whole new application for Tricare enrollment. Faxing this thing in is the fastest way to get it processed (4 days), so we braved the blizzard to Brendon’s mom’s office – closed due to inclement weather – to use the fax machine. The next day I called to make sure it had been received, and the nice lady I spoke to said she would try and expedite my form in between her phone calls. Last Friday, while we were driving up, I called again to check on the status, and it was all good to go and I got my new PCM’s name and number.

Another feature of Tricare Prime is that if military medical services are available, you have to use them. Our last duty station did not really have a huge military population, so all of the care for dependents was civilian provided. Here at the new duty station, there is a Navy clinic. That’s where my new PCM is based. When I called the clinic, they said they don’t actually do “meet and greet” type appointments for new patients, and I didn’t actually have to see the doctor in order to get a referral. Awesome! But there is a particular nurse there who deals with pregnant patients and she would have to call me back. Since Monday was a government holiday, she called back on Tuesday. I found out that I would need to have a blood test to confirm the pregnancy before Tricare would authorize my prenatal care, and, ok, that makes sense. Tuesday afternoon I went to the clinic, had this same nurse enter me into the local system, and had my blood test.

Guess what: it came back positive! Hooray!

So, yes, there is a Navy clinic here that offers some services, but obstetrics is not one of them. Also, there is not a Navy hospital. This is important. It means I get a referral to a civilian doctor and get to deliver in a civilian hospital. Really great stuff. I went back to the clinic Wednesday to talk to Referral Management and got my new obstetrician’s name and number. I am authorized for up to 16 visits without needing to deal with this tangled referral web again.

Ahhh, the happy outcome of this overly detailed boring story – I have an appointment with the OB on Monday afternoon.

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