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06-08-2012 at 5:51 PM
alkvoelker
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Ultrasound or no ultrasound?

This is my first pregnancy.

So, I was told by the nurse at my OB's office that Tricare only covers two ultrasounds, first is usually done at 16 weeks and the second is usually done at 32 weeks. It seems that at many practices though, women choose to get an ultrasound done earlier to confirm their pregnancy, see the heartbeat, confirm the EDD. My question is, is it worth the money to confirm the pregnancy? I'm wondering if I should get an ultrasound done at 8 weeks (confirming pregnancy) and another at 20 weeks (confirming gender)? Do you pay out of pocket for additional ultrasounds?
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06-08-2012 at 8:05 PM
amazing88
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I had one done at my first appointment (14 weeks) and another done at my anatomy appointment (~20 weeks). Your anatomy appointment is definitely covered, so if baby cooperates you'll find out the gender then. I know many girls that had another one to confirm pregnancy around 8 weeks. We're all active duty and didn't pay for any ultra sounds done at NMC.
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06-08-2012 at 8:38 PM
alkvoelker
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My husband is AD, but the base clinic here doesn't do ANY prenatal care aside from confirming the pregnancy with blood work. That's why I was considering paying out of pocket for an 8 week and for an additional in between the 16 and 32 week appointments.
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06-08-2012 at 9:21 PM
LemonLover...
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TRICARE will cover any medically nessesary ultrasounds. Your doctor must code it correctly. 

 

 http://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Maternity+Care&topic=Women
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06-08-2012 at 9:29 PM
NavyPilotW...
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I've had 3 pregnancies, so I've had early care done at MTF's as well as civilian hospitals.  I've always had them cover an early one.  They do that one mainly for dating purposes and to make sure the baby is planted, where it should be.  They also cover the anatomy scan around 20 weeks.  I'm not sure what 32 week ultrasound you are talking about.  With DD2, I had a super quick one at 35 weeks to confirm that she was head down.

If you need additional ultrasounds for medical reasons, tricare will cover them no problem.  I had 6 done with DD1 and they were all covered. 
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06-08-2012 at 9:39 PM
MiahT
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I was told that for a normal pregnancy Tricare usually covers two ultrasounds, one early to establish EDD and one at 20 weeks.  Sixteen and 32 weeks seems odd, but it might be a hospital thing rather than Tricare?  I can confirm that Tricare will cover more ultrasounds if your OB considers them to be medically necessary.  This pregnancy is considered high risk so I've already had several, all covered so far.
 
06-08-2012 at 11:03 PM
Lissa832
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First of all, your nurse is wrong.  Technically, Tricare only covers the anatomy scan at around 20 weeks because it is considered medically necessary.  HOWEVER, most practitioners will do an ultrasound between 8-12 weeks to date the pregnancy.  This will also be covered by Tricare if it is coded properly.  As far as the third trimester ultrasound goes, most providers do not do them UNLESS it is warranted.  For example, I measured normal through all of my last pregnancy.  At 31 weeks, I stopped growing.  At 34 weeks, it was determined that an ultrasound was warranted to check to make sure that nothing was wrong. 

Also, most doctors won't do an anatomy scan before 18 weeks simply because they may not be able to get good measurements.  18-22 weeks tends to be the norm for the anatomy scan.

If you are being seen at an MTF, you will get what they give you.  If their policy is only one and done, then that's it.  I've had pregnancies at three different bases now, and each one always did a first trimester scan. If you are being seen by a civilian, then the nurse is likely giving you the information that she has.  It is usually not about Tricare.  It is about the doctor's preference.  A doctor who knows the ins and outs of Tricare can always get around coverage.
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06-08-2012 at 11:08 PM
Lissa832
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alkvoelker:
My husband is AD, but the base clinic here doesn't do ANY prenatal care aside from confirming the pregnancy with blood work. That's why I was considering paying out of pocket for an 8 week and for an additional in between the 16 and 32 week appointments.

Wait. . .you have just had confirmation, correct?  If the nurse you are speaking of is the nurse who performed the blood test, then you need to ignore everything she said.  If they don't provide OB care, then you will be referred out.  She clearly does not have the applicable knowledge to say what u/s are covered and when.  Get your referral and go from there.  In all likelihood, you'll have a scan between 8-12 weeks, and another around 20 weeks.  The anatomy scan is NOT to determine gender.  It is to check the anatomy.  Gender is a perk of the scan.  If you cannot get a clear view that day, Tricare WILL NOT pay to have another scan to check the gender because it is not medically necessary. You can pay out-of-pocket to have it done.  DH couldn't be at my anatomy scan for DD.  We went to the 3d ultrasound place nearby and paid just for a gender scan, which was approx. $75.  We wanted to find out together, and it was worth it.
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06-08-2012 at 11:41 PM
Lyndseylov...
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My H is AD and I go to a civilian doctor with Tri Care Standard.  They did an ultra sound to confirm at 8 weeks (vaginal), my NT scan at 12 weeks and my A/S as 20 weeks, all were covered.  I will not have anymore unless there is a medical reason.  This is what is standard at the practice I go to and what they would have done regardless of my insurance, it is was they consider and what they code as medically necessary.  As PP mentioned, they just need to code it properly.  I think that varies from practice to practice and situation to situation though.
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06-09-2012 at 12:22 AM
Ilumine
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http://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Maternity+Care&topic=Women

Ultrasounds: Doctors often perform ultrasounds at different times during pregnancy for different reasons.

TRICARE will cover ultrasounds used to:

  • Estimate gestational age
  • Evaluate fetal growth
  • Conduct a biophysical evaluation for fetal well-being
  • Evaluate a suspected ectopic pregnancy
  • Define the cause of vaginal bleeding
  • Diagnose or evaluate multiple gestations
  • Confirm cardiac activity
  • Evaluate maternal pelvic masses or uterine abnormalities
  • Evaluate suspected hydatidiform mole
  • Evaluate the fetus's condition in late registrants for prenatal care

TRICARE does not cover maternity ultrasounds for routine screening or to determine the sex of the baby.

To fulifill theses criteria, following the UNited States Standard of Care in obstetrics (TRICARE directive is to follow the US Standards), this usually means a dating/heartbeat U/S early on (another standard of care is to wait till the 9-10 week mark) and then another U/S to check on any abnormalities.  

Again, this is the Standard of Care throughout the US obstetrics community, not a TRICARE wanting to screw you decision.

As to the OPs question. Since you are at a clinic and seem to have not been to your PCM for the referral to OB or to the OB, why not wait till you see the doc.  I am not knocking nurses at all.  But there are so many rules/policies out there, that the Plebologist may not know the correct information, especially if they don't do OB care.  

I would, however, confirm that this is the policy for that individual clinic...if not talk to the PAtient Advocate and ask him/her to correct the misinformation so the next pregnant woman doesn't get the same confusing data. 
 
06-09-2012 at 5:46 AM
sweetpea20...
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Wait until you meet your OB to worry about this stuff. He or she will determine the ultrasounds you receive/need. The nurse in a non prenatal care clinic is a bad resource. 

And also, the anatomy scan is not to reveal/confirm gender. It is to determine if your baby is healthy. Finding the sex of your baby is a perk but certainly not why it is performed.  
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06-09-2012 at 7:43 AM
mandapie
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LemonLover33:

TRICARE will cover any medically nessesary ultrasounds. Your doctor must code it correctly. 

 

 http://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Maternity+Care&topic=Women

This.

The nurse @ the base clinic told me that it's one u/s (usually the a/s around 18-20wks) but that if  there are more required your PCM must order them. For example if your OB decides that it's medically necessary to have an u/s once a month I was to bring something from my OB and the PCM on base would put the referal through so that they were paid by Tricare. Otherwise I could (probably would) be stuck with a bill. 

My OB however sees a lot of military, since there is no pre-natal care @ the clinic on base,  and does a confirmation u/s the he writes off and doesn't charge for it b/c he knows that Tricare doesn't cover it and he feels that it's important also for dating purposes to do that first one. (Also I had a missed m/c @ around 12wks with my first pg and the baby measured around 7-8wks so he said with a history of loss especially he would've done it anyway.)
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06-09-2012 at 8:26 AM
hellopoppy...
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Lissa832:

First of all, your nurse is wrong.  Technically, Tricare only covers the anatomy scan at around 20 weeks because it is considered medically necessary.  HOWEVER, most practitioners will do an ultrasound between 8-12 weeks to date the pregnancy.  This will also be covered by Tricare if it is coded properly.  As far as the third trimester ultrasound goes, most providers do not do them UNLESS it is warranted.  For example, I measured normal through all of my last pregnancy.  At 31 weeks, I stopped growing.  At 34 weeks, it was determined that an ultrasound was warranted to check to make sure that nothing was wrong. 

Also, most doctors won't do an anatomy scan before 18 weeks simply because they may not be able to get good measurements.  18-22 weeks tends to be the norm for the anatomy scan.

If you are being seen at an MTF, you will get what they give you.  If their policy is only one and done, then that's it.  I've had pregnancies at three different bases now, and each one always did a first trimester scan. If you are being seen by a civilian, then the nurse is likely giving you the information that she has.  It is usually not about Tricare.  It is about the doctor's preference.  A doctor who knows the ins and outs of Tricare can always get around coverage.

This is all correct. I'd wait and see since most providers do a first trimester scan.  
 
06-09-2012 at 10:07 AM
alkvoelker
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I must not have made myself clear, I apologize. I went off-base to a local hospital to have my pre-op blood work done as I was going to have a lipoma removed surgically. The next day they called and told me that I was pregnant. I went to the base clinic and they didn't confirm the blood work because the blood work was already done off-base. They simply had the results faxed over from the hospital and gave me my referral off-base as the base clinic does not do ANY prenatal care other than confirming pregnancies. I went to the off-base doctor's walk-in clinic that I was referred to and the nurse there told me that only 2 ultrasounds were covered, one at 16 weeks and the other at 32 weeks. She also said that they only confirm the pregnancy and due date by feeling the uterus with their hand unless it is deemed necessary to have an ultrasound done (which doesn't seem like a very accurate way to date a pregnancy).
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06-09-2012 at 2:39 PM
sweetpea20...
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There is so much misinformation in this thread that I am scared to continue posting in it.

First of all, ultrasounds through Tricare Prime are not confirmed/billed through the PCM.  If an OB is "writing off" ultrasounds, he is an idiot.  All he has to do is code the ultrasounds properly and Tricare will pay for them. 

When a patient gets pregnant on Tricare Prime they usually get care through an MTF.  If that isn't possible, they are referred out into town to a civilian OB who takes Tricare Prime.  That civilian OB does not have to answer to a military PCM when deciding their standard of care.  That is literally backwards as a non OB PCM has no expertise in deciding who should get an u/s.  I had dozens of ultrasounds during my pregnancies and never had a single issue with Tricare nor did any person other than my OB have to approve them.

OP, you are literally 5 weeks pregnant.  Wait until you have met with YOUR DOCTOR (not some nurse taking blood) before you start researching private ultrasound places.  If you need an ultrasound and you have a good OB, you will get an ultrasound.  Tricare has nothing to do with it.  Tricare will cover whatever is medically necessary.  If you feel like you are getting substandard care, then go to a patient advocate and get switched.  But I would seriously wait until you have met with your actual OB before worrying about them dating your pregnancy by feeling your uterus.  Yes, they do palpate the uterus to guesstimate things.  And yes, some OBs only do one ultrasound between 17 and 20 weeks.

I would bet a whole lot that you are misunderstanding a bunch of things and being newly pregnant you are a little worked up.  Just let the next few weeks go by, go to your first appointment, ask a zillion questions, and if you still are confused/unhappy then work toward getting a different OB.
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06-09-2012 at 5:43 PM
mummyofsix
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sweetpea2003:

There is so much misinformation in this thread that I am scared to continue posting in it.

First of all, ultrasounds through Tricare Prime are not confirmed/billed through the PCM.  If an OB is "writing off" ultrasounds, he is an idiot.  All he has to do is code the ultrasounds properly and Tricare will pay for them. 

When a patient gets pregnant on Tricare Prime they usually get care through an MTF.  If that isn't possible, they are referred out into town to a civilian OB who takes Tricare Prime.  That civilian OB does not have to answer to a military PCM when deciding their standard of care.  That is literally backwards as a non OB PCM has no expertise in deciding who should get an u/s.  I had dozens of ultrasounds during my pregnancies and never had a single issue with Tricare nor did any person other than my OB have to approve them.

OP, you are literally 5 weeks pregnant.  Wait until you have met with YOUR DOCTOR (not some nurse taking blood) before you start researching private ultrasound places.  If you need an ultrasound and you have a good OB, you will get an ultrasound.  Tricare has nothing to do with it.  Tricare will cover whatever is medically necessary.  If you feel like you are getting substandard care, then go to a patient advocate and get switched.  But I would seriously wait until you have met with your actual OB before worrying about them dating your pregnancy by feeling your uterus.  Yes, they do palpate the uterus to guesstimate things.  And yes, some OBs only do one ultrasound between 17 and 20 weeks.

I would bet a whole lot that you are misunderstanding a bunch of things and being newly pregnant you are a little worked up.  Just let the next few weeks go by, go to your first appointment, ask a zillion questions, and if you still are confused/unhappy then work toward getting a different OB.

 All of this. Exactly.  
 
06-10-2012 at 3:42 PM
alkvoelker
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sweetpea2003:

There is so much misinformation in this thread that I am scared to continue posting in it.

First of all, ultrasounds through Tricare Prime are not confirmed/billed through the PCM.  If an OB is "writing off" ultrasounds, he is an idiot.  All he has to do is code the ultrasounds properly and Tricare will pay for them. 

When a patient gets pregnant on Tricare Prime they usually get care through an MTF.  If that isn't possible, they are referred out into town to a civilian OB who takes Tricare Prime.  That civilian OB does not have to answer to a military PCM when deciding their standard of care.  That is literally backwards as a non OB PCM has no expertise in deciding who should get an u/s.  I had dozens of ultrasounds during my pregnancies and never had a single issue with Tricare nor did any person other than my OB have to approve them.

OP, you are literally 5 weeks pregnant.  Wait until you have met with YOUR DOCTOR (not some nurse taking blood) before you start researching private ultrasound places.  If you need an ultrasound and you have a good OB, you will get an ultrasound.  Tricare has nothing to do with it.  Tricare will cover whatever is medically necessary.  If you feel like you are getting substandard care, then go to a patient advocate and get switched.  But I would seriously wait until you have met with your actual OB before worrying about them dating your pregnancy by feeling your uterus.  Yes, they do palpate the uterus to guesstimate things.  And yes, some OBs only do one ultrasound between 17 and 20 weeks.

I would bet a whole lot that you are misunderstanding a bunch of things and being newly pregnant you are a little worked up.  Just let the next few weeks go by, go to your first appointment, ask a zillion questions, and if you still are confused/unhappy then work toward getting a different OB.

 

Very much agreed, thank you. I am not very far along at all in this pregnancy and it may seem silly to more experienced mothers that I am wondering about the whole ultrasound situation.

I guess I am figuring if I do not need any ultrasounds aside from the two aforementioned (which seems highly unlikely from all of the information gathered), if it is worth it (seeing as how it is our first child) to pay out of pocket for additional ultrasounds at various points in the pregnancy? I will speak to my doctor regarding it when I see her this week.
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06-13-2012 at 10:31 AM
hansonam44...
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That might explain some of the flack I got at my u/s on Monday. I had an emergency u/s when I went to the ER but had already set up my 8 week ultrasound beforehand. Well when I went to the appointment they acted like it was a big deal and almost didn't give it to me but my husband quickly piped up and told them the ER dr wanted us to keep the appointment to do a follow up. (Actually no one told us anything). I was irritated at the fact that they were wanting to cancel it when I took the time off work to be there. They did allow me to have it though and I got to hear the heartbeat and see it; something I couldn't do with the emergency one. They told me that the next time they'd see me would be at 20 weeks to find out the gender. Maybe it depends on the hospital?
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06-15-2012 at 8:50 PM
alkvoelker
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I'm getting an ultrasound next week for dating purposes, so we'll see how we feel then!
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06-23-2012 at 8:53 PM
pazrana
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Tricare pays for whatever they deem medically necessary.  With my first I had a dating U/S around 12 weeks and the measurement one at 20.  With this one I have already have those two and will get them monthly from here on out to check her growth because there is some concern that she will be small.  My friend had a bunch with her son because they couldn't pin down a due date.
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