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Thread: TRICARE Annoyances

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    Rizzle Mizzle's Avatar
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    TRICARE Annoyances

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    We are getting ready to PCS, and I wanted to go for my 1st appt (for the baby) before we got on the road. But, I hate military doctors, and wanted to be seen off-post. Since we have been at Bragg, I have not had to be seen, ever, by a doctor, so I am not in the system there. However, when we got here, I called TRICARE and without a waiver of any sorts, was able to get a civilian PCP off-post. One day I tried to call and change doctor's, and TRICARE then told me I needed a waiver before I could go off-post, even though I was already being seen off-post per their permission the first time.

    Well, I send my husband on-post to try and get this "waiver" since I am now pregnant and wanting to be seen. All he is able to get is some guys email address who works at the hospital, and they tell us to write the guy. So, I write him and request permission to be seen off-post.. blah blah blah. Here is what he tells me:

    If you are enrolled in TRICARE Prime to a civilian primary care provider you can ask for a referral to a network Ob/Gyn for your pregnancy care.
    If you are TRICARE Standard you may choose the OB provider of your choice without approval from Womack.
    Okay, so he said if I am enrolled in Prime to a civilian provider, which I am, then to ask them for a referral to a network Ob/Gyn, right?

    Well, I called my PCP and set up an appt to come in, get a pregnancy test done, and get a referral. After I do that, I later get another email from this guy saying this:

    Since you are TRICARE Prime, your request for civilian OB care will have to be approved through Womack and the answer will depend on the estimated number of deliveries projected for your estimated delivery month. I will forward this request to the Chief Dept of OB/GYN for a decision.
    What the hell?! Am I crazy, or did he tell me the exact opposite of what he originally said? I am so confused.

    My question is, would it be easier for me to just switch to Standard, so I can see whoever I want without dealing with all of this? I don't know anything about Standard vs Prime, and wanted some feedback if anyone has any to offer. Anything is appreciated, as time is of the essence and I need to be seen.

  2. hurry up and wait....
    Jennifer's Avatar
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    If you switch to standard, you cannot switch back to prime for one year. I would just suck it up and wait it out for them to decide, or see a military doc for one visit before you PCS
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    well he didn't contradict himself he just didn't give you the whole answer the first time. You can get a referral but it has to still be approved.
    If you switch to Standard you will have to be on that for a whole year before you can switch back to prime.

    ALL referrals have to be approved first. just because you get one doesn't mean you can go and see the Doctor right then and there. kwim.


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    I was Tricare standard throughout my entire pregnancy and only paid to have dd. The total bill was $80. Since we are OCONUS both dd and I are prime, but once we get back to the states we will be standard again. I just prefer it that way.
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    Quote Originally Posted by rosebud* View Post
    ALL referrals have to be approved first. just because you get one doesn't mean you can go and see the Doctor right then and there. kwim.
    Yes, the lady at my DR's office told me that it would take a few days for TRICARE to approve the referral, before I am actually able to be seen. But, she didn't say anything about how/why TRICARE would or would not approve the referral.

    I am just confused.
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    Quote Originally Posted by Mick's Wife View Post
    Yes, the lady at my DR's office told me that it would take a few days for TRICARE to approve the referral, before I am actually able to be seen. But, she didn't say anything about how/why TRICARE would or would not approve the referral.

    I am just confused.
    basically if you can be seen on base they would rather do that then pay for you to be outsourced. It does come down to money. Its cheaper for you to be seen at the MTF then at a civilian office.


    I will miss you SOS...
    Please be wary of what you post remember OPSEC is not just another acronym.

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