Being pregnant is an exciting and transformative time in a person’s life. Along with the joy and anticipation, there are also many practical considerations, including insurance and healthcare coverage. Understanding the differences and making an informed decision can ensure that you receive the best possible care throughout your pregnancy journey. For me, I am currently on Active Duty orders with the Navy, which puts me on Tri-Care Prime insurance. This has been a huge pain for me so far since receiving my positive home test.
TRICARE Prime Insurance: Military Hospital or Clinic Care
TRICARE Prime insurance is offers medical care through military hospitals or clinics. If you’re more than 50 miles away from a base, you qualify for Tri-Care Prime Remote, in which case you are allowed to use civilian clinics vice the military clinics as your first source of care. Under either Prime insurance plan, your primary care manager (PCM) plays a crucial role in coordinating your prenatal care. Before seeking pregnancy care, you must obtain a referral from your PCM. This referral ensures that you receive appropriate and timely care from the military healthcare system.
To initiate the process, you schedule an appointment with your PCM to confirm your pregnancy. Your PCM will conduct a pregnancy test and, upon confirmation, refer you to a military hospital or clinic for further care. If there are no available military facilities in your area, your PCM will refer you to a network provider who participates in the TRICARE Prime network.
Once your prenatal care referral is confirmed, it is essential to contact the designated hospital or clinic to schedule your first appointment. During this initial visit, you can expect to undergo various assessments, such as lab tests, a comprehensive medical history review, and receive information about what to expect throughout your pregnancy journey.
It is worth noting that factors such as the availability and quality of care at military hospitals and clinics may vary depending on the duty station. Therefore, it is advisable to conduct thorough research about the healthcare facilities in your area to make an informed decision about the best option for your needs.
TRICARE Prime Remote Insurance: My Utter Frustrations
Unfortunately, it took me over 30 days to even be seen by my PCM once I called after my home pregnancy test. I found out I was pregnant on September 21st and called my civilian PCM immediately that day. The first available appointment for her was on October 23rd. I did have them add me to their waitlist to be called if an earlier appointment opened up, but that never happened. I was finally seen by my PCM today.
Base medical did a urine test in the time I was waiting. I took those results with me to my appointmenr today, hoping it served as enough proof to at least get me started with getting an OBGYN referral. Unfortunately, it did nothing for me so base clinic did a useless test on me.
Per my PCM, Tricare only proceeds with an OBGYN referral after a blood test. Despite knowing my appointment was because I was pregnant and needed an OBGYN referral for Tri-Care, the doctor’s office did not bother to give me a heads up that I would have to fast for labs today. Since I had already eaten, I couldn’t even do the blood test today. What sucks is that I have a history of passing out on any labs if I don’t eat and fully hydrate myself ahead of time. Being pregnant, I eat every 2-3 hours typically anyways. As such, I expect these fasting labs are going to be awful for me, but I will knock out the labs tomorrow. Once my PCM has my lab results, she has to have Tricare approve her to even send a referral. Then once that’s approved, she can send the referral, which then also has to be approved.
Why is it such a tedious and long process to set up seeing an OBGYN with Tricare?! I’m frustrated and annoyed beyond belief. By my estimation, I should be 9 weeks tomorrow and I still am not even able to get a referral to see an OBGYN, despite knowing for 5 weeks already that I am pregnant. I’ve felt like crap more days than no. All I want is to make sure I’m doing everything I need to do to keep baby and myself healthy. I want to know that my baby is healthy and nothing is wrong yet. This is such an inferiorating process with Tri-Care.
Conclusion
Know your insurance. Thankfully, I knew from the get-go that I needed a referral for an OBGYN and called them the same day I took my home test. It’s unfortunate it took so long for my PCM to see me. Honestly, looking back on it now, I wish I would have changed my PCM as soon as I called and they said it was over a month long wait to be seem. This does me no good if I get sick and can’t be seen.
What I didn’t know was that I had to have the blood test to even start getting a referral. If I had known this, I would have fought to have the base clinic when I was there to do the blood test. They did just enough to get it documented for me that I was pregnant so that I could get light duty during my Final Week of Chief season.
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