Kjata

Now in GA, present day.....

Now that we are in GA and are ready to start TTC again I
call and make my the appointment to see an OB. There is a kooky
way for doing things in the military, anyway, I get the
referral, BUT, when I call to get authorization I find out
it has been denied. WHAT!

I was seeing a specialist in NC, why not in GA too. It's
all the same military, right?!? Well, I have come to find
out that anyone who is seeking infertility treatment to
include IUI will have all claims denied.

I start to research this and call back to NC where we were seen
before.

I talked to Jessica at UNC (where we had
the treatments done in NC) and I asked her if this "no
coverage for treatment if it leads to IUI" is true and she
said yes, technically no services should be covered if you
do IUI. But because tests and treatments are covered they
only bill for that. So, if Tricare ever calls and asks what
the treatment plan is and if it includes IUI and the
insurance person at UNC says "they are doing IUI' Tricare
will deny all claims. But because UNC doesn't claim IUI,
ever, to Tricare they never know unless they ask. And
apparently they never ask.

Plus Jessica said that most people go in not truly
expecting to do IUI and when it happens she said they don't
have time to change the plan of treatment so Tricare only
knows about the tests and treatment and nothing of the IUI.

For all Tricare knows conception is by intercourse (which
is covered). But Tricare has never covered infertility
treatment that leads to IUI or IVF, unless you go to WRAMC,
so the benefits we got were because the UNC insurance
filers didn't bill for the IUI and never informed Tricare
that IUI was done, so in truth what we did never should
have been covered.

So as far as "the because I did it once I can't do it
again" rule goes.....because we had IUI done and basically
got away with coverage, now when I ask for infertility
treatments they will deny everything. I basically got away
with it and now I am paying for it, in not being able to be
treated anymore. Its a sucky punishment for something I
didn't know about.

So now I am keeping my mouth shut, I don't want Tricare to
get wind of this and decide to try to get its money back.
But at least I know what happened and why we had coverage
when everyone is telling me I can't have it.

Word of advice, if you are a Tricare beneficiary DO NOT
EVER mention IUI to the provider who authorizes the
referral. If you have EVER done IUI in the past you will be
denied everything. When you need a new referral be very
careful what you ask for, Tricare will cover all tests and
treatments for infertility (office visits, meds, u/s and
blood work) as long as you have natural intercourse. If IUI
is mentioned you will be denied everything and all tests
and treatments you have had up to that point will be paid
for by YOU! Also be careful about the drugs you are on. Its
not just the infertility that they are watching....all
fertility drugs (Follistim, Gonal-F, Pregnal, etc) are
raising red flags and Tricare associates are calling REs
and asking for treatment plans and if in your plan it says
IUI or IVF...you will be denied.

So if anyone is receiving treatment and you are having IUIs
done and Tricare is paying for it , count your lucky stars
and hope that they don't call your RE and ask.

So that leaves us with a limited amount of options. The military
hospital does IUIs, but I have such a long history pregnancy loss the
Drs don't really want to touch me. I have a Dr looking into options
for me and I hope to hear back tomorrow. If we can't do IUI on post
we either don't do anything or we go to Walter Reed Army Hosp in DC.
They do everything there including IVF/ICSI, but its a 13 hour drive.