prior authorization question... - Military Benefits

wife-n-mommy · 05-21-2008, 07:07 PM

Ok, so I carry a gene for hypophosphatasia and we had genetics counceling today. The genetic councelor found a lab that can do the test with just a blood sample and wants to have my husband tested because if he isn't a carrier then there is no need for further testing on me and the baby. The test costs $1500. She's trying to get Tricare to authorize the test but isn't sure if they will. Has anyone else dealt with genetic testing and getting Tricare to cover the cost?
I'm a little worried because the lab doing the test requires us to provide a credit card number in case the insurance doesn't pay our card will be charged... and we don't even have a card with that much money available on it.
any experiences with getting things like this covered?

Victoria · 05-21-2008, 07:10 PM

Personally, even if I knew Tricare was covering a service, I wouldn't feel comfortable handing over my billing information over like that. Good luck Katie!!!

rosebud* · 05-21-2008, 07:55 PM

First you should call Tricare ( before they do any blood draw) to ask if they cover that specific test. Talk to as many people as possible and get everyones name. THEN make sure you ask them for the correct code and what not so you can relay that to the lab ( so you won't wind up with bills coming and what not) Also inform the lab you don't have a credit card ( even if you did I would advise the same thing) because if tricare did cover the test and the billed it wrong they would charge your card and then you would have to fight like hell to work it out.

wife-n-mommy · 05-22-2008, 07:23 AM

The thing is that there is only one genetic lab in the entire united states that offers the test (which will prevent me from having to have testing done on the baby now or after birth) and this lab requires a credit card number even if there is prior authorization from the insurance company. When I was pregnant with Kylee, we chose not to have any testing done, and they didn't offer such things as testing my husband for the gene. He had an alkaline phosphate test done which came back low, meaning he COULD be a carrier for the gene. I was tested when I was 2 and I am a carrier for the gene. The test that was provided back then was long and drawn out and is no longer offered.
I'm trying to decide whether to have any testing done at all.
ETA: The lab at the base hospital will not draw the blood until Tricare has authorized it.

wife-n-mommy · 05-22-2008, 08:41 AM

i added a poll... what would you do??

mackenziesmommy · 05-22-2008, 09:09 AM

will the outcome fo the test change anything with your pregnancy???if not why do it???

I'm a firm believer that if the testing they do won't change the outcome I'm not doing it...I don't do any of the AFP or anything while I'm pregnant.

rosebud* · 05-22-2008, 09:14 AM

Originally Posted by mackenziesmommy

will the outcome fo the test change anything with your pregnancy???if not why do it???

I'm a firm believer that if the testing they do won't change the outcome I'm not doing it...I don't do any of the AFP or anything while I'm pregnant.

good point. I personally would not hand over my CC info to the lab. No way would I possibly pay a 1500 dollar lab fee.
It is up to you but if the testing won't change anything why torture yourself?

Victoria · 05-22-2008, 09:17 AM

I wouldn't get the testing done either, for reasons MM mentioned. Sure the results may prepare you for the worst, but it wouldn't change the outcome...

kitkat · 05-22-2008, 09:30 AM

note: i'm not on tri-care yet... so i'm not sure who they work

but from what i've noticed between life experience, and what i've learned in class: 'if it's not common, then it's not covered' is a good thing to go by, at least when it comes to new procedures.

i wouldn't do it until i knew it was covered, it just seems really weird they want a credit card number.

Berkley · 05-22-2008, 09:32 AM

I really have no idea what I would do. Let me think on it some more and then I'll vote

View Poll Results: In this situation, what would you do?
have the blood test done, provide credit card info	0	0%
have the blood test done, not provide card info, hope to recieve the results anyway	2	25.00%
not have the test done, have aminio done to test baby instead	2	25.00%
not have any tests done, just wait and see	2	25.00%
I have no idea what I would do	2	25.00%
other (any other suggestions...)	0	0%
Voters: 8. You may not vote on this poll

05-21-2008, 07:07 PM	#1 (permalink)
wife-n-mommy Senior Member Join Date: Jul 2007 Posts: 3,428 Blog Entries: 1 Classifieds: (0) Activity: 0% Longevity: 43%	prior authorization question... Ok, so I carry a gene for hypophosphatasia and we had genetics counceling today. The genetic councelor found a lab that can do the test with just a blood sample and wants to have my husband tested because if he isn't a carrier then there is no need for further testing on me and the baby. The test costs $1500. She's trying to get Tricare to authorize the test but isn't sure if they will. Has anyone else dealt with genetic testing and getting Tricare to cover the cost? I'm a little worried because the lab doing the test requires us to provide a credit card number in case the insurance doesn't pay our card will be charged... and we don't even have a card with that much money available on it. any experiences with getting things like this covered? __________________ Katie- Mommy to Kylee 10-30-05 (loving big sister, Ms. independent, intelligent, princess) and Auriana 09-17-08 (miracle baby with down syndrome, heart defects, hearing impairment, digestive problems, tube fed since birth, but determined to succeed, strong, loving, happy) Ask me about Congenital Heart Defects... 1 in 100, it could be your child... Ask me about Down Syndrome... more common than you think... Wife to a Disabled Army Veteran... been there, done that, moving on

05-21-2008, 07:55 PM	#3 (permalink)
rosebud* i didn't realize that the USSR was back. Join Date: Nov 2005 Location: [communist china] Posts: 32,708 Classifieds: (0) Activity: 9% Longevity: 69%	First you should call Tricare ( before they do any blood draw) to ask if they cover that specific test. Talk to as many people as possible and get everyones name. THEN make sure you ask them for the correct code and what not so you can relay that to the lab ( so you won't wind up with bills coming and what not) Also inform the lab you don't have a credit card ( even if you did I would advise the same thing) because if tricare did cover the test and the billed it wrong they would charge your card and then you would have to fight like hell to work it out. __________________ I will miss you SOS... Please be wary of what you post remember OPSEC is not just another acronym.

05-22-2008, 07:23 AM	#4 (permalink)
wife-n-mommy Senior Member Join Date: Jul 2007 Posts: 3,428 Blog Entries: 1 Classifieds: (0) Activity: 0% Longevity: 43%	The thing is that there is only one genetic lab in the entire united states that offers the test (which will prevent me from having to have testing done on the baby now or after birth) and this lab requires a credit card number even if there is prior authorization from the insurance company. When I was pregnant with Kylee, we chose not to have any testing done, and they didn't offer such things as testing my husband for the gene. He had an alkaline phosphate test done which came back low, meaning he COULD be a carrier for the gene. I was tested when I was 2 and I am a carrier for the gene. The test that was provided back then was long and drawn out and is no longer offered. I'm trying to decide whether to have any testing done at all. ETA: The lab at the base hospital will not draw the blood until Tricare has authorized it. __________________ Katie- Mommy to Kylee 10-30-05 (loving big sister, Ms. independent, intelligent, princess) and Auriana 09-17-08 (miracle baby with down syndrome, heart defects, hearing impairment, digestive problems, tube fed since birth, but determined to succeed, strong, loving, happy) Ask me about Congenital Heart Defects... 1 in 100, it could be your child... Ask me about Down Syndrome... more common than you think... Wife to a Disabled Army Veteran... been there, done that, moving on

05-22-2008, 08:41 AM	#5 (permalink)
wife-n-mommy Senior Member Join Date: Jul 2007 Posts: 3,428 Blog Entries: 1 Classifieds: (0) Activity: 0% Longevity: 43%	i added a poll... what would you do?? __________________ Katie- Mommy to Kylee 10-30-05 (loving big sister, Ms. independent, intelligent, princess) and Auriana 09-17-08 (miracle baby with down syndrome, heart defects, hearing impairment, digestive problems, tube fed since birth, but determined to succeed, strong, loving, happy) Ask me about Congenital Heart Defects... 1 in 100, it could be your child... Ask me about Down Syndrome... more common than you think... Wife to a Disabled Army Veteran... been there, done that, moving on

About Us

MilitarySOS Shortcuts

MilitarySOS Help

About MilitarySOS

05-21-2008, 07:10 PM	#2 (permalink)
Victoria Senior Member Join Date: Aug 2006 Posts: 35,064 Classifieds: (1) Activity: 2% Longevity: 57%	Personally, even if I knew Tricare was covering a service, I wouldn't feel comfortable handing over my billing information over like that. Good luck Katie!!!

05-22-2008, 09:09 AM	#6 (permalink)
mackenziesmommy Senior Member Join Date: Feb 2006 Posts: 3,068 Classifieds: (0) Activity: 6% Longevity: 66%	will the outcome fo the test change anything with your pregnancy???if not why do it??? I'm a firm believer that if the testing they do won't change the outcome I'm not doing it...I don't do any of the AFP or anything while I'm pregnant. __________________ Online Ordering 24/7 now available at www.partylite.biz/abiglercandle

05-22-2008, 09:17 AM	#8 (permalink)
Victoria Senior Member Join Date: Aug 2006 Posts: 35,064 Classifieds: (1) Activity: 2% Longevity: 57%	I wouldn't get the testing done either, for reasons MM mentioned. Sure the results may prepare you for the worst, but it wouldn't change the outcome...

05-22-2008, 09:30 AM	#9 (permalink)
kitkat Senior Member Join Date: Oct 2007 Posts: 2,262 Blog Entries: 2 Classifieds: (0) Activity: 0% Longevity: 38%	note: i'm not on tri-care yet... so i'm not sure who they work but from what i've noticed between life experience, and what i've learned in class: 'if it's not common, then it's not covered' is a good thing to go by, at least when it comes to new procedures. i wouldn't do it until i knew it was covered, it just seems really weird they want a credit card number.

05-22-2008, 09:32 AM	#10 (permalink)
Berkley Account Closed Join Date: Jan 2006 Location: Pope AFB, NC Posts: 30,001 Blog Entries: 2 Classifieds: (0) Activity: 0% Longevity: 66%	I really have no idea what I would do. Let me think on it some more and then I'll vote