Tricare Maternity Cost increase

In 2018, Tricare underwent many changes. Some made being health easier, like not needing a referral from urgent care. But along with these changes came hikes in co pays and prescription fees that haven’t been easy on many military families.  What’s shocked me the most has been the astronomical increase in costs for maternity care.

In 2012, I gave birth to our first child on Tricare Prime in Danbury, CT. All of my routine prenatal care was covered by a local OBGYN practice with the exception of the 20-week anatomy scan. We chose to pay out of pocket for that ultrasound so we could find out the gender of our baby [and they got it wrong, but that’s a different story]. At the end of the 9 months and after my routine hospital delivery, we received a $30 bill. In 2014, the next baby arrived, along with the very same bill. Two years later, we welcomed our third baby in a home birth covered under Tricare Standard, and guess what the bill was? $30!

Now, in 2018, we’re expecting to pay much, much more. Instead of a $30 copay for all the prenatal care, we have a copay per visits. So that’s $30 x 15 visits for a total of $450 and THEN there’s the additional $150 hospital fee, bringing the total cost of care to $600. I hate to complain because I know that that cost is nominal compared to what some have to pay for maternity care, but when VA income is didn’t increase at remotely the same rate, this pay hike hurts! AND it gets a whole lot worse…

Being well over an hour away from a military base has left us three maternity providers that Tricare works, but due to the changes, NONE of them will take on new patients with Tricare. So, I had to get on Medicaid maternity care as a secondary insurance plan. I found a local provider that takes Medicaid, but because Tricare is my primary insurance, they’re too concerned with taking me on as a patient because they think if the my federal health insurance denies the claim, then the state-run insurance will also deny it, so they asked us to pay $7,500 up front and then they’d reimburse us for what insurance pays. Despite my calls to Medicaid which confirmed they’d pay what Tricare denied, we don’t have that kind of money to shell out ahead of time, and that just seems silly when you have not one, but two insurances.

So this endless cycle of “no, we don’t work with Tricare anymore” and “Sorry, we don’t know if Medicaid will pay…” have landed me 8 weeks behind in maternity care. I was finally able to see a provider, but the drive is nearly an hour without traffic, which is longer than my last labor, so I might have to go with I-84 for a middle name if I don’t actually make it to the hospital.

Insurance is always a headache, and Tricare has driven me crazy many, many, times. But, between the cost hike and the ridiculous drive, I think we’ve hit an all-time low.  At 26 weeks, I feel like my quest for quality maternity care ​is just getting started… even though many practices don’t take patients after 28 weeks…