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Tricare and 20 week ultrasound question.

Posted by on Aug. 2, 2013 at 9:50 AM
  • 52 Replies

We are currently at a base where there are no military facilities for family members.  We are seen in town by civilian providers which is great.  Overall I love Tricare and my complaints are few and would be similar to any other medical insurance.  Just found out I am expecting which is great, we are excited.  However I have been told about 20 times that Tricare does not cover the 20 weeks ultrasound.  I completely understand the unimportance medically of finding out gender however I thought that is when they checked organs and growth, along with heart valves and chambers and such.  Am I missing something?  

I mean in the grand scheme of things if that is the only thing I have to pay for then no big deal.  However I would much rather they covered this than the first ultrasound which is considered diagnostic.

by on Aug. 2, 2013 at 9:50 AM
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Replies (1-10):
jas_momof2
by アニメの雌犬 on Aug. 2, 2013 at 10:12 AM

They do cover it - who told you they didn't?

SierraLynn
by Just Me on Aug. 2, 2013 at 10:14 AM
Tricare does cover the 20 week ultrasound.

But only the one unless there is a medical reason for more then 1. My last pregnancy I got monthly ultrasounds because of my hypothyroidism which can cause heart problems for baby and grow very large quickly. They were all covered and I was on Tricare standard.
HarleyMom4599
by Member on Aug. 2, 2013 at 10:14 AM
They covered it when I had ds about 1 1/2 yrs ago
Arib107
by on Aug. 2, 2013 at 10:15 AM
I believe they do
SJG1013
by Member on Aug. 2, 2013 at 10:18 AM
They covered mine.
I know that asking for any extra will come out of your pocket. (At least when I was pregnant).
TippyD
by Gold Member on Aug. 2, 2013 at 10:35 AM

whoever has been telling you that, is lying. The ultrasound at 20 weeks is covered for testing. 

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. If you have ANY questions about coverage, please contact your regional contractor.

this was taken directly from tricares website:
 http://www.tricare.mil/CoveredServices/SeeWhatsCovered/MaternityCare.aspx

SlapItHigh
by Platinum Member on Aug. 2, 2013 at 10:36 AM
They don't cover it. Tricare states try don't cover the 20 week diagnostic ultrasound because the evidence shows that it does not improve outcomes and is not recommended by ACOG (or AIUM for that matter). Ultrasounds are ONLY covered by Tricare when there is a medical indication. Most providers do the 20wk ultrasound anyway and just lie and bill it under another code.
SlapItHigh
by Platinum Member on Aug. 2, 2013 at 10:36 AM
Try should say they.
SlapItHigh
by Platinum Member on Aug. 2, 2013 at 10:38 AM
It says right there that they do not cover routine diagnostic ultrasounds. That would be you standard 20 wk ultrasound.


Quoting TippyD:

whoever has been telling you that, is lying. The ultrasound at 20 weeks is covered for testing. 

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. If you have ANY questions about coverage, please contact your regional contractor.

this was taken directly from tricares website:
 http://www.tricare.mil/CoveredServices/SeeWhatsCovered/MaternityCare.aspx


TippyD
by Gold Member on Aug. 2, 2013 at 10:39 AM

also, I had 2 with my first, and have had 2 with my second already, with my 20 week one still a few weeks away. all have been covered so far. *mine have all been needed for medical reasons, my first I was having abdominal pain so they did one at 6 weeks, and one at 20 weeks to check growth/development and so far with this one: one for bleeding, one to check for heartbeat, and we will be having one at 20 weeks to check growth/development*

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