Sunday, November 7, 2010

Tricare and IVF

I thought in this post I would explain what my experience has been with our military insurance Tricare and IVF for those of you who have Tricare and are wondering what they cover. 
First, we have Tricare Prime, not sure how Tricare Standard works although it might be the same.  Just because Tricare doesn't cover anything to do with IVF doesn't mean that they won't cover SOME of what you need, which has saved us hundreds of dollars! 

It is true, Tricare doesn't cover anything to do with the IVF procedure, but Tricare WILL cover everything leading up to IVF!  Believe me, it wasn't without substantial research and asking many many questions, not only questions but the "right" questions in order to get the info I needed to figure out all this stuff, so that is why I thought I'd share it.  Maybe you already know, maybe you don't.

First, you need to go see your gynecologist that you are referred to by Tricare, explain to that doc that you are having problems getting pregnant.  Then they will send you and give you are referral to an RE (reproductive endocrinologist) which is an IVF doc. 

Tricare will pay for that visit with the RE, and any others as well and any tests leading up to IVF that your RE may want you to have.  Then once a "diagnosis" is given by your RE, IVF being one of the only ways to treat it possibly, Tricare will pay for all your office visits, bloodwork, and ultrasounds leading up to your IVF procedure date.  This is where it gets tricky.  ONCE you begin the stimulant drugs Tricare STOPS paying until you are done with your transfer.  This is where your out of pocket expenses with IVF are substantial obviously in paying for IVF and all the fees and medications.  After your transfer, Tricare picks back up again.

As far as medications and what Tricare will cover, with IVF, Tricare covers none of the stimulants.  In my case, that was menopur and follistim-of course the most expensive drugs, almost $3,000 out of pocket.  As far as medications go, Menopur and Follistim were the ONLY things I had to pay out of pocket, Tricare covered the rest.  Yep, Tricare will pay for some of your IVF meds!  Tricare covered my Lupron, all of my needles, syringes, alcohol wipes, antibiotics, birth control pills, PIO's (progesterone in oil injections), aspirin, sharps containers, prenatal vitamins, I think that was everything.  Basically everything was covered BUT my follistim and menopur. 
Now, you obviously still have to pay the majority of the expense, but with everything Tricare did cover, it saved about $600 if not more.

The other thing I couldn't believe is that Tricare will cover Patient Travel.  Basically, if you have to travel over 60 miles (I believe-somewhere around there) then Tricare will reimburse your gas, meals, tolls, parking, etc. associated with your appointment which for me was approx. $50 a visit.  So everytime I go to my appt. Tricare pays me $50.  Nice huh!?  Patient Travel Reimbursement...who knew?!?  You have to submit the appropriate paperwork of course, but it is super easy and so awesome they do this for us having to travel so far to go to our appointments.  Hey, when you're going to the RE office every other day (when you're on stims) that $50 adds up!!! 

Well, I hope I didn't leave anything out, but that's my experience with Tricare and IVF so far!  :)

14 comments:

  1. Where did you go and how much did the whole thing end up costing, if you dont mind me asking.

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  2. Sure, I went to an office in Dallas that my PCM referred me to, it was the only office in Dallas that took Tricare, so I was limited. The entire thing for us beginning to finish cost $12,000.

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  3. For your drugs did you get them from your MTF or did you use an online Fertility drug pharmacy? Also how did you submit travel, I have never heard of that!

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  4. I actually went through the Walgreens online pharmacy (suggested by my RE), believe it or not at the time they were the cheapest compared to all the others I researched! They were great and worked with billing Tricare for me. It worked out wonderfully! Yes-Travel! Tricky little benefit you never are told about...just through the patient travel office in the hospital or clinic on base! :) Hope that helps!

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  5. Hi! We just visited an RE yesterday that is not a tricare network provider. Do you know if the RE has to be network in order for them to cover the pre u/s, SA, and blood work and all that? We have standard, not sure if that makes a diff.... I'm hoping the office themselves will have answers and be able to help, but I am learning that no one seems to know! (and calling triwest left me more confused, ugh!)

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  6. I have a question regarding your travel. We will be traveling 300-350 miles each way for our appointments. We actually plan on going out for 1 week and staying in a hotel since it will be easier than going back and forth for monitoring. This is my 7th IVF and I NEVER knew that we could submit a claim for meals/gas/parking ect. I am so curious now. What paperwork do you need to sumbit for that? Will they pay for hotel stays or just the gas? I would love to ask you some more quesitons in regards to all this, if you wouldnt mind!!

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  7. Hi there, wishing you all lots of luck!! To Anonymous and AmaznGrace: Yes, your RE must be in-network to get fully covered (up to what they'll actually cover anyway). Tricare does make it very confusing, and most tricare reps don't really know the answers-why? I don't know. It is with a lot of research, talking to the right people (finally) and asking the right questions that I found out the info I found out, which I wrote in the blog. Go on base to the hospital (or clinic if it's a smaller base) and find the "Patient Travel" office, they'll have the "Patient Travel Reimbursement" forms there you need to fill out. Although first, you must have a referral from your PCP to your RE-that's in network, and then once your referral is approved (which will be approved for a "diagnosis" as to why you can't get pregnant, and for an initial evaluation visit-maybe 1-3 other visits after the initial eval) so once the referral for the RE is submitted by your PCP (even if you think you know the reason you can't get pregnant tell your PCP you aren't sure why, and then the dr will submit the referral for an RE to get "tests" done and/or a "diagnosis") and once that referral is approved from Tricare with the in-network RE, you're golden! Go from there! :) Hope that all makes sense and helps! Tricare definitely makes you do your research and work for that coverage!! :/ Good luck to you!!!! Sending you lots of baby dust!!! :)

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    1. Oh also, sorry forgot to answer your other question-I don't think they will cover hotel cost, but gas, parking, meals, yes!!! :)

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  8. Hello, my housband and I try to get pregnant for 2 years . We Just move to Colorado Spring Air Force base. We are thinking about to use IUI treatment. My question is if I call for appointment, what type of appointment I have to tell them? and what type of clinic? Thank you.

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  9. Did anyone ever mention anything to any of you about in-vivo? I was told both my tubes are blocked therefore my only choices for achieving pregnancy are surgery to -un-block my tubes or in-vitro. My Dr. friend mentioned in-vivo to me tonight but I had honestly never even heard of it. Just wondering if you or anyone you know has heard of it.
    We will be headed to Brooks Army Base in Houston to attend the "orientation" for their in-vitro program. There are a select few MTF that will do in-vitro on site and you end up saving (depending on what meds you need, etc.) at least 50%. I would like to know more about the in-vivo before I travel from OK, to Houston! :) Any help would be awesome!

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  10. Thank you very much for sharing for journey.

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