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Thread: Seeing an in-network doctor

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    #1

    Seeing an in-network doctor

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    I just moved to my current location to have my baby in the upcoming months. There is an air force base here. I went to their clinic to see what their OBGYN practices entail. They do not have a labor and delivery department so I would have to deliver at a hospital near the base. This hospital supposedly has no NICU. The AF clinics also do not have pediatricians, only family practitioners. The pediatrician I would want my baby to see does not have privileges at the AF (associated) hospital. The hospital is also about 30 minutes away. Last thing I have an issue with is that there are 5 doctors in the women's clinic. I will not be assigned to one doctor but to all five. Whichever one is on call the night I deliver will be delivering my baby.

    Needless to say, I would like to see another OBGYN and deliver at a hospital with a NICU. There are plenty of OBGYN's near me that are in-network. I am enrolled in Tricare-Prime.

    If I call TriCare, would I be able to go see a different OBGYN as long as they are in-network? I know that I will have co-pays for my visits. It also seems that I will pay $11 a day for an in patient care (delivery & hospital stay). I just didnt know if I have to get a referral from my family practitioner at the base first before I could see a different doctor. As long as they are in-network I thought I would be able to just go there.

    I was planning on calling Tricare tomorrow and still am, just thought maybe someone on here might have some experience with seeing an in-network doctor.
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    #2
    Definitely call Tricare. If you're being referred off base anyways they should be able to change your referral over the phone (I switched mine pretty easily because they had me seeing someone 30 minutes away when there were doctors closer at the hospital I wanted to deliver at). You should have no copays on prime at all, even the hospital fee would be paid for since they referred you out. You may face the issue of not knowing who would deliver you anywhere though, no one can work 24/7 you know?

    If you switch to Standard you could see whoever you want and not worry about it. You would have no copays while pregnant and just the small hospital fee.

    I doubt not wanting your child to see a family practitioner would make them refer you off base once the baby is born. Family practitioners see kids all the time. You may want to think about switching to Standard if you want more freedom and choices with you and your families healthcare though.

    Good luck! I've been in your shoes and ultimately switched to Standard, it fit the needs of me and my family better.
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    If you're on prime you have to get a referral from your pcm to go to an ob. The way it worked my last failed pregnancy was I went to get the referral and she asked me if I had a preference to who I wanted to see, I told her, and I got it. Being on prime if you can get the referral to go there you won't have any copays or have to pay anything for your hospital visit. If for some reason they won't let you get a referral to go to the one you want you can switch to standard and you still have no copays for anything pregnancy related, just a $50 copay for e4 and below, $150 e5 and up and something like $15 a day for when you deliver.

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    #4
    When I was in Georgia at college on tricare standard. I just looked on their website search for a OBGYN and started calling people to make an appointment. It was much easier than trying to stay on prime IMO.
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    #5
    Also as far as wanting your Ob to deliver you, unless you schedule an induction or c-section there's going to always be the possibility that that won't happen. As bub says they aren't on call 24/7.

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    #6
    Thanks for the replies! I am going to contact Tricare tomorrow and see what they say. I am sure it will be that I have to get a referral from my pcm, I was just hoping I didnt. That just means I will have to go to my pcm the appointment I have this friday and see about the referral. I was hoping to have my next appointment with the OBGYN I wanted. Ill just see how it plays out. Thanks again though!
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    #7
    Quote Originally Posted by caseychick View Post
    Also as far as wanting your Ob to deliver you, unless you schedule an induction or c-section there's going to always be the possibility that that won't happen. As bub says they aren't on call 24/7.
    They may be the ones you see every visit, but it does not mean they are going to be the one to deliever you.
    I was seeing the same obgyn for the last trimester, and she was not the one who delivered me!! Actually, my delivery doc changed half way through labor.
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    #8
    Quote Originally Posted by Tana Bear View Post
    They may be the ones you see every visit, but it does not mean they are going to be the one to deliever you.
    I was seeing the same obgyn for the last trimester, and she was not the one who delivered me!! Actually, my delivery doc changed half way through labor.
    That issue was not one of the bigger ones. I am more worried about there being no NICU at that hospital. If, heaven forbid, she would need NICU care, I'd rather not have to have her transported to another hospital, leaving me at the one I delivered at. Not expecting there to be any problems, but just in case. The whole reason I came home to have her was because I wanted there to be better healthcare in case something were to go wrong. It just seems counter-productive now that the hospital I will be delivering in also does not have a NICU, one of the reasons I left our installation.
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    #9
    Is there a hospital with a NICU nearby? That will accept tricare? And is there a dr with privileges there that accepts tricare?

    For me, the nicu is not even something I would think about if you have no foreseeable reason to think you will need to use it (I don't know your history so I don't know if there is a reason). I would be concerned with getting a dr or midwife I mesh with first and foremost and everything after that is gravy.
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    #10
    Quote Originally Posted by Southern-queen View Post
    Is there a hospital with a NICU nearby? That will accept tricare? And is there a dr with privileges there that accepts tricare?

    For me, the nicu is not even something I would think about if you have no foreseeable reason to think you will need to use it (I don't know your history so I don't know if there is a reason). I would be concerned with getting a dr or midwife I mesh with first and foremost and everything after that is gravy.
    Yes, there are OBGYN's that practice at the hospitals with a NICU. They accept tricare. I just didnt think that I could just go to them without getting a referral or something.

    I had my maternal screening test come back as positive for an increased risk of the baby having downs syndrome but when they did the anatomy ultrasound they said everything looked fine. It wasnt 100% but they didnt see anything to be worried about. My friends just had a baby and had no indications that anything would be wrong with the baby and he was born with issues having to stay his first 3 weeks in a NICU. I guess I am just scared from their experience.
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