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Patient Advocacy, Infertility and Referrals
As you can see from my siggy, my husband and I struggle with unexplained infertility. We are at the point in our journey where we need to move on to IVF. We are at Fort Lewis and the hospital on post has an infertility clinic. This is where all our treatment has taken place thus far. The waiting list for the IVF program on post is a year long. We won't be able to cycle until July 2012. Who knows if my husband will even be here in a year?
This morning I had my appointment with my PCM to seek a referral for an off-post infertility clinic. How stupid I was to be hopeful that something with Tricare would be easy! know someone who has done IVF through this particular clinic, had all her meds and ultrasounds covered by Tricare and the cost for the actual IVF was significantly less than on post because this RE gives a 50% discount to military.
I saw my PCM less than three hours ago and my referral has already
been denied. What I didn't know about the referral process is that my
doctor on post would have to sign off on it. How is that fair when I'm
requesting a second opinion!?!?!
The head nurse from the IF clinic on post just called and
said that they won't refer people off post because "Tricare doesn't
cover infertility." That's only partly true. How can that be true when
I know PLENTY of people who are seen at off-post infertility clinics?!
They will cover EVERYTHING except the actual IUI or IVF procedures.
The clinic in Olympia says they bill Tricare all the time and that I
just need a referral. My RE's office on post is refusing to give me one. This is so
incredibly frustrating. I don't want to burn any bridges with the
clinic on post, especially with my laparascopy scheduled for the 25th of
August. It's a Catch 22 because I'd have no problem getting a referral
to a civilian infertility clinic if we were at a duty station without
one on post.
First, the IF clinic jerks me around for months because they can't see me when I need to be seen and now we have to wait an effing year for IVF. It's especially ridiculous because there's a perfectly good RE who is ready and willing to see me NOW and who charges less for IVF than the cost on post, but I need that damned referral. So I'm stuck and right now I'm waiting to hear from the Patient Advocacy office. I really, really hope that they are able to help us.
I am looking for any and all suggests as to where to go from here. If we switch to Tricare Standard would we will need a referral since we'd be going to a "specialty" clinic?
I gave you life, then you gave me mine.
TTC February 2008 to October 2008 One year forced break due to OIF deployment #2
Resumed TTC in October 2009 HSG, Hysteroscopy, S/A all clear
Five total medicated cycles and IUI #1-3 = BFN and all while we were still "unexplained IF"
25 August Lap revealed Endo, adhesions and blocked left tube
September 2011: Femara + IUI #4 (IUI #1 post endo removal) =BFFN
November: IVF #1: Stims started 11/16 ER 11/25 (7R, 5F) ET 11/30 Transferred 2 beautiful expanding blastocysts +HPT 12/6/11
Beta #1 at 9dp5dt=153! Beta #2 at 16dp5dt= 4009!
Ultrasound 12/30 showed one beautiful heartbeat! EDD 17 August, 2012
Hazel Evelyn arrived 10 August, 2012!
Re: Patient Advocacy, Infertility and Referrals
Actually, I don't think you need referrals at all with Standard.
Your first step is to speak with the patient advocate however. Also, you should probably see someone at the tricare office and go over exactly what is and what isn't covered by Tricare. It's possible there has been a change to the rules or that the people you know are mistaken by what is covered or whether they were actually referred or simply switched or were switched to standard.
Good luck
Click me, click me!
It seems like every IF patient has a different experience with Tricare. I don't see why they won't pay for ANYTHING for some patients and others get their meds and monitoring for IVF covered 100% and only have to pay for the retrieval and transfer. It's so frustrating and talking to Tricare doesn't help. Some idiot there tried to tel lme that if I get pg by A.R.T. then Tricare will not cover my pregnancy.
I gave you life, then you gave me mine.
TTC February 2008 to October 2008 One year forced break due to OIF deployment #2
Resumed TTC in October 2009 HSG, Hysteroscopy, S/A all clear
Five total medicated cycles and IUI #1-3 = BFN and all while we were still "unexplained IF"
25 August Lap revealed Endo, adhesions and blocked left tube
September 2011: Femara + IUI #4 (IUI #1 post endo removal) =BFFN
November: IVF #1: Stims started 11/16 ER 11/25 (7R, 5F) ET 11/30 Transferred 2 beautiful expanding blastocysts +HPT 12/6/11
Beta #1 at 9dp5dt=153! Beta #2 at 16dp5dt= 4009!
Ultrasound 12/30 showed one beautiful heartbeat! EDD 17 August, 2012
Hazel Evelyn arrived 10 August, 2012!
Blog: This Space for Rent
When DH and I got married I was on standard for awhile before switching to prime. No referrals necessary up until July of last year(last month I was on standard). As far as I know, it is still the same. I have been considering switching back to standard for quite some time now.
On another note, Tricare and all military treatment facilities STINK! I am counting down the seconds to get out of this terrible, stupid system. The referral system is even worse for service members, believe it or not. I'm considering working on a lawsuit because DH came home from deployment with major physical issues and has been on lite duty for over a year and can't get help from any doctors here......the whole military health care system really really needs to be improved! I hope things get better for you, I'd definitely be switching to standard!! GL
Click me, click me!
Click me, click me!
Yup. I tried to get referred off post because I'd have to go to the other post an hour away for most of my appointments, any sonograms, and the delivery. They put the referral though but assigned me to a doctor 45 minutes in the other direction. So I called to change the referral and ended up on the phone for nearly an hour while tricare called around to find a doctor in town that had an opening before last September.
The amusing/frustrating thing is that I live five minutes down the road from a shiiton of doctors who take tricare, all of them across the street from two hospitals that take tricare.
Can we say special?
Click me, click me!
Oh I forgot about that part. I was on prime when I started the appointment process and referral process. However, by the time the referral went through and I called to have it changed, I was rolled back off onto Standard, where I don't even need a referral.
Nice to know after being on the phone for an hour, right?
As a bonus, we are prime eligible and H could go get the paperwork done to add us back. However, I'd have to go through the entire referral process again, including being referred to a random and then asking to be changed back to the person down the street.
::headdesk::
I'll just be staying on standard, tyvm.
Click me, click me!