Tricare Help: Can my girlfriend’s baby be covered before birth? - Getting out, military health issues - Navy Times

Tricare Help: Can my girlfriend’s baby be covered before birth?

Answering your questions on Tricare.

Q. My girlfriend is pregnant. How do I get the baby covered by Tricare until it is born?

A. Your girlfriend cannot be eligible for Tricare unless she is married to you. Similarly, the baby cannot be eligible for Tricare until it is born. For official confirmation, call the Defense Enrollment Eligibility Reporting Service at 800-538-9552.

If you and your girlfriend marry, she will become eligible for Tricare immediately. All of her maternity care will be covered starting on the day you are married. If you do not marry, the baby will be covered by Tricare from the moment of birth.

Q. I am a retired Air Force officer and have Medicare Parts A and B and Tricare for Life. Recently, my wife’s doctor ordered a set of lab tests that included a thyroid function test. Neither Medicare nor TFL would pay for this test, leaving us to pay out of pocket. How can Medicare and Tricare deny that tests ordered by a physician are “necessary”? And why was our $100 out-of-pocket payment not credited against our deductible?

A. Because a test for thyroid function is a covered service under both Medicare and Tricare, there may have been an error in how you got the medical service or in the way the doctor filed the claim. Was the doctor who ordered the tests a Medicare provider? If you have TFL and get care from a non-Medicare provider, neither Medicare nor Tricare may pay the claim. Whenever a Medicare or a Tricare claim is denied, the reason for the denial is reported on the explanation of benefits.

It also has a toll-free number you can call for a full explanation and, if possible, what you need to do to make the claim payable.

The EOB also describes how to file an appeal. An appeal requires the plan to reconsider the way it processed the claim to ensure that all rules for payment were considered correctly.

Unless the EOB indicates that the amount Medicare or Tricare would have paid was credited to your deductible, the denial was not related to the deductible.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or email us. In email, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice anytime on our blog.