By Kate Horrell, Military.com
With Tricare, there’s always something that isn’t quite clear. And there is plenty of confusion about Tricare and fertility treatments. What’s covered, what isn’t covered – how do you know?
First, you need to know that there are big differences between the fertility services available at Military Treatment Facilities (MTF) and the fertility services covered by Tricare.
Military Treatment Facilities
There are six major MTFs that, in conjunction with civilian partners, handle the full range of fertility treatments:
- Walter Reed National Military Medical Center (WRNMMC) – Bethesda, Maryland
- Tripler Army Medical Center (TAMC) – Honolulu, Hawaii
- Womack Army Medical Center (WAMC) – Fayetteville, North Carolina
- Madigan Army Medical Center (MAMC) – Tacoma, Washington
- San Antonio Military Medical Center (SAMMC) – San Antonio, Texas
- Naval Medical Center San Diego (NMCSD) – San Diego, California
The portion of the civilian partner care not covered by Tricare is billable to the patient, but because so much of the care is handled by the MTF, the cost is much lower than civilian procedures. For example, per the Report To Congress Efforts to Treat Infertility of Military Families, the estimated cost is $5,000 per couple per In Vitro Fertilization cycle. There are, however, waiting lists for these programs.
Smaller MTFs may be able to provide more limited fertility care, depending on the staff and facility capabilities.
If you are considering fertility treatment, it is definitely worth looking into the programs at these major medical hospitals. Sarah, an Army spouse, told me, “I think more people should be aware of the services Walter Reed offers. It ends up being half the cost.”
Tricare will cover medically necessary care that could lead to a natural conception. This includes diagnostics and treatments. Things that may be included are laboratory work, corrective surgery, or prescriptions.
Tricare benefits do not cover assisted reproductive technology such as intrauterine insemination or in vitro fertilization.
Getting Tricare To Pay
As with all insurance issues, the procedure or medication must be coded properly when submitted to Tricare. As we all know, stuff is coded incorrectly all the time. Usually, it is still covered and so it gets paid, but this is a situation where correct coding is essential.
In addition to ensuring that your claims are submitted correctly, it is worth appealing items that are denied. Many previously denied items are subsequently paid after appeal or fixing of the claim.
The Tricare website is actually really good about explaining covered fertility services, especially at this page. It’s important that you understand the coverage, because you can’t always count on the Tricare employees to know the nitty-gritty details.
Important note: There are entirely different rules for active duty members who have impaired or lost fertility due to a serious injury or illness sustained while serving.
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