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Thread: Tricare issue

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    Tricare issue

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    I received a bill in the mail today from my ultrasound saying Tricare denied it and that I'd have to pay the full bill.

    The bill was sent to my MAIDEN name, although it had my married/legal name on the actual bill itself.

    I was under the impression that tricare was approved for the ultrasound, so I was wondering if anyone knew why it might not be. My first thought is that maybe the name thing has something to do with it... but then again, it DOES still have my correct name on the bill (envelope addressed to maiden, bill has my name)

    Does anyone have any idea? Pretend I am utterly and completely stupid and may have missed something obvious here. Seriously.

    I already plan on making calls tomorrow to figure it out, but I thought I'd get a head start and some ideas tonight if anyone has them....
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    Check with the office to make sure they put the right code on the statement from their office to TRICARE. If they didn't code it as medically necessary you will have to pay it. Just have them refile if that is what happened
    An unconditional right to say what one pleases about public affairs is what I consider to be the minimum guarantee of the First Amendment.
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    Quote Originally Posted by Germanchick View Post
    Check with the office to make sure they put the right code on the statement from their office to TRICARE. If they didn't code it as medically necessary you will have to pay it. Just have them refile if that is what happened
    interesting.. okay, thanks
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    #4
    Quote Originally Posted by Germanchick View Post
    Check with the office to make sure they put the right code on the statement from their office to TRICARE. If they didn't code it as medically necessary you will have to pay it. Just have them refile if that is what happened
    Also double check that the referal for the ultrasound was put through to tricare.


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    #5
    referral for the ultrasound?
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    Tricare has on their website that they do NOT cover "routine" ultrasound (the 18-20-week u/s is the "routine" one). If your doc failed to indicate a "medical necessity" for that ultrasound, then it's not covered. most docs know this, so they indicate "medical necessity" using something like "smaller than gestational age" or "larger than gestational age."

    If your doc did not do that, it's routine, and not covered.

    I would call your doc's office and ask how they submitted the claim. They may be able to resubmit it with a different code to get it paid.
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    #7
    Quote Originally Posted by sarsie1 View Post
    Tricare has on their website that they do NOT cover "routine" ultrasound (the 18-20-week u/s is the "routine" one). If your doc failed to indicate a "medical necessity" for that ultrasound, then it's not covered. most docs know this, so they indicate "medical necessity" using something like "smaller than gestational age" or "larger than gestational age."

    If your doc did not do that, it's routine, and not covered.

    I would call your doc's office and ask how they submitted the claim. They may be able to resubmit it with a different code to get it paid.
    that is crazy!


    i hope you get it figured out!!!
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    okay, thank you
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    Quote Originally Posted by Germanchick View Post
    Check with the office to make sure they put the right code on the statement from their office to TRICARE. If they didn't code it as medically necessary you will have to pay it. Just have them refile if that is what happened
    Quote Originally Posted by sarsie1 View Post
    Tricare has on their website that they do NOT cover "routine" ultrasound (the 18-20-week u/s is the "routine" one). If your doc failed to indicate a "medical necessity" for that ultrasound, then it's not covered. most docs know this, so they indicate "medical necessity" using something like "smaller than gestational age" or "larger than gestational age."

    If your doc did not do that, it's routine, and not covered.

    I would call your doc's office and ask how they submitted the claim. They may be able to resubmit it with a different code to get it paid.
    technically speaking, coding something as "medically necessary" just so it's covered by insurance is insurance fraud.
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    #10
    Quote Originally Posted by rcwant2be View Post
    technically speaking, coding something as "medically necessary" just so it's covered by insurance is insurance fraud.
    completely 100% true, but I know that it is what majority of civilian doctors do. There are ways to get "around" the system and doctors know this. The 3 doctors I have seen here (there is no military OB here) all did this. But if your being seen on base with on-base ultrasounds then you should have no problem at all.
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