Military Significant Others and Spouse Support - MilitarySOS.com
Page 1 of 2 12 LastLast
Results 1 to 10 of 12

Thread: Tricare Prime and annual exams

  1. Banned
    Moxie's Avatar
    Moxie is offline
    Banned
    Join Date
    Aug 2009
    Location
    El Paso, TX
    Posts
    4,875
    #1

    Tricare Prime and annual exams

    Advertisements
    Soooo last year I scheduled my pap for October, but the doctor rescheduled me TWICE so I didn't get in until December. They told me next time to schedule my appointment in October to make sure I'd get in before my scripts ran out. I made an appointment a couple weeks ago and had my appointment today. They told me that Tricare may not cover it because it hasn't been a full 12 months since my last pap. I know that lots of insurances are like this, but I am hoping Tricare is maybe a little more flexible and does it by calendar year, not 12 month period? I told them to go ahead and do it because that office is terrible, not only are they never able to get you in in a timely matter, but you wait no less than 1 hour to even get into your appointment, so I REALLY didn't want to reschedule and have to go through it all again.

    Soo, anyone know? Will I be charged or will Tricare cover it because I've only gone once per calendar year?
  2. MilitarySOS Jewel
    tremblingturtle's Avatar
    tremblingturtle is offline
    MilitarySOS Jewel
    Join Date
    Apr 2008
    Location
    Missouri
    Posts
    14,195

    #2
    Lol I have had three paps in the past year, one on base and two off. All three were covered.
    Then again, they all were done in pregnancy/post pregnancy check ups.


    And, three in one year.... is waaaaay too much. They could not keep my medical records straight.

    I am hoping they dont make me do another pap when I go in to my appt tomorrow lol
  3. I just can't even...
    Hottie.'s Avatar
    Hottie. is offline
    I just can't even...
    Join Date
    Mar 2010
    Location
    Alerbamer
    Posts
    18,159
    Blog Entries
    2
    #3
    I wasn't able to schedule an appt with my OBGYN until it had been 12 calendar months since my last appt.

    If you have any doubts I'd call Tricare and ask to be sure, but most Dr. offices will prescribe you (or give you samples if they have any) enough until your next appt if you run out.





    ETA I definitely think you have to wait 12 Calendar months between yearly paps.
  4. Account Closed
    Lynn's Avatar
    Lynn is offline
    Account Closed
    Join Date
    Mar 2011
    Location
    It could be worse.
    Posts
    29,398
    #4
    If it's not medically necessary, they've always told me to schedule 1 year plus 1 day apart. I hope they cover it for you.
  5. Banned
    Moxie's Avatar
    Moxie is offline
    Banned
    Join Date
    Aug 2009
    Location
    El Paso, TX
    Posts
    4,875
    #5
    Crap...Oh well I guess they're only like $80 anyways. If they charge me I'll try to dispute it and then just pay it I guess.

    They did send me for a pelvic ultrasound because my periods have gotten more painful and heavier, so maybe I can talk Tricare into thinking it was medically necessary.
  6. I just can't even...
    Hottie.'s Avatar
    Hottie. is offline
    I just can't even...
    Join Date
    Mar 2010
    Location
    Alerbamer
    Posts
    18,159
    Blog Entries
    2
    #6
    Quote Originally Posted by Moxie View Post
    Crap...Oh well I guess they're only like $80 anyways. If they charge me I'll try to dispute it and then just pay it I guess.

    They did send me for a pelvic ultrasound because my periods have gotten more painful and heavier, so maybe I can talk Tricare into thinking it was medically necessary.
    If your Dr referred you to do it then it would be considered medically necessary and should be covered.
  7. Account Closed
    Lynn's Avatar
    Lynn is offline
    Account Closed
    Join Date
    Mar 2011
    Location
    It could be worse.
    Posts
    29,398
    #7
    Quote Originally Posted by Moxie View Post
    Crap...Oh well I guess they're only like $80 anyways. If they charge me I'll try to dispute it and then just pay it I guess.

    They did send me for a pelvic ultrasound because my periods have gotten more painful and heavier, so maybe I can talk Tricare into thinking it was medically necessary.
    Pelvic exam and PAP smear are two different things. You can have a pelvic exam and not have a PAP. If they try to say that they won't pay, fight them to only have to pay for the lab portion that is the PAP test. Doctors can do a pelvic exam to check for abnormalities and if you are having problems with your period it sounds like they would have wanted to do that even if they weren't doing the PAP part of the exam. They would have wanted to do a pelvic exam before referring you to a pelvic ultrasound.
  8. Banned
    Moxie's Avatar
    Moxie is offline
    Banned
    Join Date
    Aug 2009
    Location
    El Paso, TX
    Posts
    4,875
    #8
    Quote Originally Posted by Hottie. View Post
    If your Dr referred you to do it then it would be considered medically necessary and should be covered.
    Well last year I was told to schedule my next pap early because I was so pissed off at them for rescheduling me twice. She didn't refer me to get the ultrasound until I'd already completed my pap. Meh. Whatever, I'll definitely try to dispute it if they don't cover it but maybe they'll just cover it anyways. It's so stupid that 3 weeks makes a difference to insurance companies.
  9. Banned
    gunsgirl's Avatar
    gunsgirl is offline
    Banned
    Join Date
    Jul 2007
    Location
    lost
    Posts
    17,275
    #9
    it is actually 12 calendar months- my GYN never has me schedule for 12 months and 1 day-

    I always schedule the end of july- my birth month.

    I also do my mamograms at the same time.

    you can try to fight it - but if it was not 12 full months and it was coded as your annual exam you will pay out of pocket for it.
  10. Banned
    Moxie's Avatar
    Moxie is offline
    Banned
    Join Date
    Aug 2009
    Location
    El Paso, TX
    Posts
    4,875
    #10
    Sooo, I was never billed

    I know it could still be coming, but it seems like if they weren't going to cover it I should have been notified by now...
Page 1 of 2 12 LastLast

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •