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! :)