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Working with Tricare

post #1 of 10
Thread Starter 

Not sure if this is the right forum for this...  I posted in my local tribe about finding a provider and I have one I'd really like to see, accepts my insurance (Tricare) and all.  Problem is I can't figure out how to get the actual referral.  When we moved here, I just let them sign me up on base for my care instead of requesting a civilian provider.  When I went for the "pregnancy confirmation" they told me they just do an automatic referral to Bethesda.  I'm not comfortable traveling around DC traffic in labor because of my quick labors.  On top of that, their "required intake appointment" is 4 hours long.  Why?


Anyway, I called Tricare and they told me there's nothing they can do, I have to work it out with the folks at Bethesda.  I'm not having any luck getting them on the phone to talk to me.  So my option with that I guess is to go ahead and schedule that awful 4 hour appointment (which is more like 6 with the driving time and I'll have to find childcare for my older two and bring my little nursling).


But I really really don't want to do that unless I just have to.  So, I had a thought.  Has anyone just gone ahead and even after they've had a referral like this, called and changed their PCM, gone to see the new provider and requested the referral they REALLY want?  I didn't want to post this local because I'm wondering if anyone has done this with Tricare in general?  I figure I could find a decent, even somewhat natural-minded civilian family doctor for my PCM and use them for the referral to the midwife I want.  Thoughts?

post #2 of 10

If you've found a provider who deals with Tricare, you've won more than half of the battle already.


To get the actual referral, you probably have to make an appt with a regular doctor (your current PCM), or maybe even someone in Ob/Gyn, and tell them you'd like to use a civilian provider who's closer to you (for convenience).  Since you're in the DC Metro, it shouldn't be too hard to sell them the "I don't want to drive around in DC traffic" story.


An initial appt is often lengthy (because of all the bloodwork/testing that is done), but a 4-hour intake seems excessive, unless they're counting the wait time to be seen (and the wait time for the results) too. ;)


Calling Tricare probably won't be very effective in getting this moving.  You probably have to show up somewhere in person--maybe Bethesda, but hopefully not.  You could try to change your PCM before initiating the other requests. That might work as well as anything...


Good luck, Tricare is notoriously bureaucratic in the same way that all govt things tend to be.

post #3 of 10
Thread Starter 

Yeah, my regular PCM is the on base folks and all they will do is the direct referral to Bethesda.  Tricare says they can do nothing for me and that I have to work with Bethesda.  Bethesda doesn't answer the phone. :( :(


I think I'm going to call and try for a new PCM.  I've been through the military system 3 times before and never had this kind of run around, but I've also never been referred somewhere this far away/through traffic.  I've also NEVER had a 4 hour appointment.  Never.  I cannot possibly imagine what would take 4 hours unless they're doing a hospital tour/orientation.


This is insane...

post #4 of 10

Good luck!  I know all this bureaucracy can be tedious and bothersome.  (I'm currently playing phone tag with my insurance and the federal government as we speak...).  I've never gotten anywhere with phone calls, I usually end up having to go somewhere in person, and that seems to make all the difference in the world.

post #5 of 10

I had my first baby on tricare at an air force base.


My initial "appointment" was a group format pregnancy information and filling out paperwork sort of session.  Perhaps it could be something like that?  The first "real" appt was at 10-12 weeks.


I don't have any experience using a civilian provider instead, but I do think it would be worth it!  I was in TX, it might be completely different for you.  But the OB and L&D staff were completely different.  Not only could you not pick, you couldn't even meet the person till they were ready to catch the baby.  I ended up with a group of 5 residents.  It wasn't a great experience.  So different when we had regular insurance and I found an awesome midwife. 


Good luck.

post #6 of 10
post #7 of 10

I have deal with Tricare  a wholte freaking lot. How you go about your medical network depends on which Tricare plan you have, the area you're in, and a couple of other things. Also, you should have a Tricare Liaison attached to your duty station for helping you answer these kinds of questions.


If you have Tricare (regular) it's' much like a POS system, you choose your docs, pay the copay/coinsurance, no referrals needed.


If you have Tricare Prime (like I do), it's not as simple but there's not (at least there didn't used to be, it's changed since January 1, 2013) any copays/coinsurance. With Tricare Prime, your PCM puts in for a referral, and Tricare assigns you to a specialist. Fighting who they pick for you is a losing battle. The first trimester of my last pregnancy was spend doing that for legitimate reasons and they still didn't allow it.


Here is the link they have on the Tricare Website for finding a doctor: Find a Doctor

Edited by ladykelacy - 1/24/13 at 6:38pm
post #8 of 10

Well if you have tricare prime i would switch to standard. it will give you more options in chosing a provider you want and not having to use a military doc or pick from a list of people they want you to see. with standard you most likely will not need a referal but just in case you should double check. its been five years sence i had tricare and i always kept standard so i could choose who i wanted to see. good luck :)

post #9 of 10
Thread Starter 

I figured I'd hop on here and update - sorry I didn't come back sooner!!


So, this is a little long, but I was simultaneously seeking allergy care for my 2 YO due to an anaphylactic reaction she had.  Her (civilian) ped put in the referral for a local allergist.  I got a call from Tricare that they would ONLY see her at Bethesda because they had openings there.  When I heard that, I realized I was going to get the same treatment if I tried for the change PCM/refer to my midwife option.  I knew then what I had to do.


I am VERY lucky to live in an area of the country where the US Family Healthcare Plan is available.  It's only available in a few areas of the country, but basically it's still Tricare Prime only you don't see ANY military providers and ALL your care is on the local civilian network.  In my case, it's through the John's Hopkin's network.  Amazingly they even cover one of the midwife groups I was considering (even though I don't think they are technically affiliated with John's Hopkins).  I know I'm really lucky here.  So I'm getting to see midwives I mostly trust and it's all covered.  Amazing.  And my daughter will be seen by a civilian allergist that isn't halfway across the state.  I'm so happy.  Anyway, mainly updating in case anyone is in a similar situation - if you are blessed enough to be in an area with the US FHP, do it. Immediately.  It's like a slightly restrictive Tricare Standard.  Or like Tricare Prime Remote (if anyone's familiar with that).  It's awesome. :)  I only regret I didn't change us over sooner.  I'm having some blood sugar issues and could really use to have seen a midwife by now.  But I'll manage ok - I'm watching it, and being careful... :)

post #10 of 10

As of the end of February, certain parts of the country will no longer have Tricare Prime available, just heard.

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