Prenatal Testing & Insurance (TriCare)...Please give me your stories/advice?

Question

Ok, I'm completely stressing out about this!!! I recently had a miscarriage. My OBGYN sent me to the hospital to have all the bloodwork done (Prenatal Panel: CBC, Hepatitis, ect.) I also had to get a shot of Rhogam because I'm RH-negative. TriCare is my insurance (for military families) and I had authorization to see this OBGYN for prenatal care, and she was the one that sent me to the hospital for these tests. I recently saw the bill from TriCare showing that the hospital charged them $440 for these blood tests, and TriCare only paid $28!!! I have a feeling that the hospital is going to bill me for the rest! If I end up paying the rest, that's 94% of the bill. Why wouldn't the insurance pay at least 50%?? What's the point of having insurance. These blood tests are standard when a woman is pregnant, it's not like the doctor had me do something out of the ordinary. Does anyone have TriCare and has this happened to you? I'm almost terrified to get pregnant again in fear that they won't cover me!

Answer 1

Tri-Care is usually pretty good about covering people. I wouldn't worry about it, they'll bill the insurance again and send you a notification that they billed them. It should cover the blood tests and there could easily have been a mess up in the system or something. Don't worry about it, and if you have to, call your doctors office and talk to the billing office and they can make sure they sent in the right diagnosis codes and stuff.  

Answer 2

Hi!

I'm on tricare prime too - working on my second kid under their insurance!

If you're prime I believe everything should be covered - but tricare does have some issues with the codes that doctors patch through.  Call the doctor first and ask about it.  Then call tricare.  

I had an issue a while back where the doctor put in the wrong SSN and the claim was rejected, then I had an issue at one point where the wrong code was input - for example, it's not for an emergency hospital visit, it's for OBGYN and it's been pre-approved!

You just have to keep calling both parties.  The way it worked for me is I found out what was done wrong through tricare then I had to call my doctor and have one of the secretaries call the hospital billing center to fix the code...

Such a pain!  But worth not paying for!

Answer 3

I have Tricare and I get many of the same things on my bills. But I have never had to pay a dime.

If you have Tricare Prime, you should not have to pay anything. Oftentimes, insurance companies have it worked out with the hospital to not have to pay the full price for the procedures. If you do get a bill that says your patient responsibility is for the other 94%, appeal it and do not pay it. If you were referred somewhere by your Tricare Prime PCM, you should not be responsible for the bill, as long as it is a procedure that is covered by Tricare and I believe what you have described is covered by Tricare as it would be considered routine bloodwork for your situation.

Answer 4

im in the army now... if u were reffered by ur doctor, tricare WILL pay for all of it. if they dont, u need to speak to jag!

Answer 5

I have Tricare, and they told me that as long as I was referred by my doctor and Tricare approved it - then they would pay for it. You should definitely call Tricare and see if there is just a mistake, or if they are going to charge you. If your doctor referred you, I don't know why they wouldn't cover it. I know if you go to a different doctor without a referral, they make you pay a deductible. Sorry I have no personal experience, I never have had to be referred out - but I read about it not long ago and the Tricare consultant I talked to explained. Hope this helps and you get it sorted out!

And they will cover your next pregnancy, as long as you go to a military hospital or get referred and approved to go to a Tricare approved hospital!

Best of luck!

Answer 6

tricare sucks.

i used to work in the hospital registration dept.  and dealt with tricare. they suck, they never want to pay for anything. some people came into the hospital and the day they need to see a surgeon, they are told tricare will not cover them.  the referrel didn't go through.  its annoying.