Surprise! TRICARE Isn’t Covering Certain Lab Fees Anymore

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Next time you get a bill in the mail for your labwork, don’t throw it out and assume TRICARE will take care of it. Military families will soon have to pay out of pocket for certain diagnostic genetic tests ordered by their civilian doctors that the Defense Health Agency (DHA) no longer covers. In January 2013, TRICARE stopped reimbursing clinical laboratories for more than 100 different genetic tests—but they didn’t tell beneficiaries or healthcare providers about that decision. Labs have still been providing the tests that physicians order for TRICARE beneficiaries at no charge. In fact, according to the American Clinical Laboratory Association (ACLA), the labs have provided about $10 million in free tests to TRICARE users to date. But now military families will have to pay.

One of the tests TRICARE no longer covers is used to determine if a pregnant woman carries a marker for cystic fibrosis (CF). If she has the marker, the father is usually tested as well to determine the risk that the baby would be born with CF. The American Congress of Obstetricians and Gynecologists has recommended CF prenatal testing for more than a decade, and that test is is covered by Medicaid and other commercial health plans and is the standard of care under VA-DoD clinical practice guidelines for management of pregnancy.

The DHA has dismissed the significance of prenatal CF testing, saying the results don’t usually change the management of labor, delivery, and the neonatal period. They also emphasized that TRICARE can’t cover any lab tests that have not been approved by the FDA. Meanwhile, the ACLA argues that TRICARE does cover many other tests that aren’t FDA approved including pap smears, a routine test for cervical cancer.

Co-chairs of the Congressional Cystic Fibrosis Caucus, Representative Tom Marino (R-10th/PA) and Representative James P. McGovern (D-2nd/ MA), have urged TRICARE to reconsider their CF testing decision. And they aren’t the only ones calling to reverse TRICARE’s decision. The Military Coalition, an umbrella group of military associations and veterans organizations, isn’t happy about it either. Kathy Beasley, co-chair of the coalition’s health care subcommittee, pointed out that DHA has created two different standards: patients who use civilian providers will have to pay for these tests while patients at military clinics and hospitals won’t.

Why should military families be faced with deciding whether to forego a medical test their doctor ordered because they may not have the money to pay for it? Our Association has been working this issue for several months, and we’re meeting with several members of Congress this week to discuss the impact this could have on military families.


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