Tricare Coverage for CF Dietician?

[rhcnurse]

Hello,

I would greatly appreciate if any one has any recommendations or information about Tricare coverage for specialized CF dieticians. Currently, we have several pediatric patients that are referred outside of our military clinic and receive their CF care at specialized pediatric hospitals for their routine Pulmonology visits. However, these children have been unable to receive specialized dietician consults along with their CF team visits because Tricare will not cover the services stating that the children can receive dietary consults with the dieticians on-post. However, as I am sure you all agree, CF dietician are very specialized and knowledgeable of this disease and can provide additional services and education perhaps outside the scope of a regular dietician.

Therefore, has any one been able to receive CF dietician services under Tricare, and if so, do you know which CPT or ICD-9 codes and verbage was used in order to get the referral approved?

Thank you very much.

 

[Liza]

Hi, I don't have any advice on how you go about getting it approved but my daughters CF dietitian care was always covered as part of their CF clinic visit care. Usually, I believe, your CF visit is a all inclusive cost with the exception of lab work and pft's. Now, some clinics, at least adult clinics, have also included in their visits, GI and CFrD visits when needed. For example, my daughter's adult clinic has a Gastroenterologist and a Endocrinologist that would also see her during her CF appt., if needed. BUT it is a separate cost as they require their own referrals. We never ever got referrals for the dietitian (either while active duty or retired) that was part of the team visit just like the social worker. Who is staying that it's not covered? Are you going to an accredited CF center? Are you a parent, patient or someone from a MTF trying to help figure it out? (just curious).

 

[lauryn.tubes]

Hi. I'm not 100% certain of the answer for you, but are you on Tricare Prime or Standard? I was active duty when we got my daughter's DX and switched her over to Standard. There's a small deductible ($200/year) but you do not have to see on-base doctors. You're free to go off base and choose the doctors that you'd like to see and probably could find a doctor to get your a referral for a dietitian.

HTh

 

[Liza]

Hth, I'm not the original poster but I've a question for you about switching to standard. You say there's a $200 deductable, is that it? No out of pocket expenses past the $200? They once suggested that to my daughter when she was trying to get her care back to an out of network CF doc. She was also told that she'd have to pay any difference above the allowable (the part tricare will pay) How about hospital stays etc? She declined changing from Prime, we know it covers transplant at 100% and that's the direction she's headed. Thanks for sharing your experience with switching to standard.

 

[Aboveallislove]

Hey Liza,
just wanted to make sure you understand what it means to pay above allowable because it is s confusing....if she has to pay above allowable and the doctor bills 1200.00 and allowable is 400 and she has a 20% copay, she would pay 20% of 400 so 80, but then shed have to pay the entire remaining 800 which is what isn't allowable. And the difference is often that large...between what the doctor charges and what an insurance compan says is allowable...just want to make sure you understand this if you think of changing because it could be huge.

 

[Liza]

Aboveallislove, That's exactly what I thought! Well, not the 20% but that she was responsible for the remainder of the bill after the allowable amount. Which is why she turned down the actual suggestion that she change over to standard from prime. Her husband is a senior airman, they can't even afford all her co-pays for meds and her OTC vitamins and other supplements. Heck, her magnesium supplement is $144/ month alone. Thanks for the example, sometimes I really just need the cost example to get it. Seriously think her casemanager that suggested it was a tad bit crazy in the head.

 

[RobinB29]

I've had tricare prime for 13 years now, always been treated at an off post cf center, never needed an additional referral to see a dietician. They always come in as part of my CF appointment. Now, if you aren't going to a true CF center and they don't have a cf dietician on staff then I'm not sure. I know tricare covered 750k for me one year and I never paid anything. Tricare Prime is something I wouldn't give up.