TRICARE Denies Coverage for Non-Invasive Prenatal Tests

Pregnant woman at the doctor's office

TRICARE Denies Coverage for Non-Invasive Prenatal Tests: Are you aware TRICARE no longer covers non-invasive prenatal testing (NIPT)?  With NIPT, your blood is drawn and tested for indications that your baby might have a genetic disorder.  It can be done as early as 9 weeks into your pregnancy and reduces the need for more invasive prenatal testing such as amniocentesis.

Here’s the problem with TRICARE and NIPT: If you are seen at a Military Treatment Facility, the Department of Defense (DoD) will pay for the NIPT your doctor recommends.  If you receive your prenatal care from a civilian provider in the TRICARE network, TRICARE will not reimburse for NIPT. 

Approximately 125 TRICARE beneficiaries per month receive NIPTs. Currently, commercial laboratories continue to process NIPTs for military families even though TRICARE isn’t paying for the tests. We are concerned  private labs will eventually turn off the spigot of free testing and TRICARE beneficiaries seen by civilian providers will have to pay out-of-pocket or forego recommended NIPTs. We believe ALL military families should have coverage for medical innovations, including NIPT, regardless of where they receive their care.

Please help us educate Congress on the importance of NIPT coverage for military families by sharing your stories via our brief online survey. Please note all responses will remain confidential. Thank you in advance for your help!

Posted April 20, 2016


From: Erin on: May 1, 2016
My husband and I chose to pay for this test out of pocket since it was not covered. I wish more than anything we had done more research about the SCREEN. It is not regulated by any governing body including the FDA. Therefore the labs can claim whatever they want as far as accuracy. They are only accurate as most people tested are negative. I however received a call that my screen was positive for a disorder that I came to find out the SCREEN was only correct 38% of the time!!!! I was rushed in for CVS sampling the next morning and then forced to wait for two more weeks for NOTHING. I tell my friends and family and all that will listen it is NOT WORTH IT. I WOULD NOT HAVE THIS TEST EVER AGIN. it does not take into account so many factors and is truly only a screen. Only benefit maybe getting to know the sex of your child much earlier, however this can also be wrong. Stress is much worse for a new born than simply undergoing traditional screening as for my first pregnancy. Tricare good for you for not throwing money at these bogus companies until their science is more accurate and they advertise as such!
From: Jennifer DeFrates on: April 20, 2016
This is absolutely disgusting. A simple blood test that could improve the lives (AND COSTS) of these future military children, these tests should be absolutely covered. It doesn't even make financial sense to not cover it if it leads to more invasive (dangerous) tests that might also delay diagnosis and treatment of genetic conditions.
From: Alissa on: April 20, 2016
I am 21 weeks pregnant and chose to pay out of pocket for the Cell Free Fetal DNA Test due to a horrible experience with my last pregnancy. In 2011, while pregnant, I had the Quad Test and received a false positive. It was a life changing moment for my family. Everything stopped. Not only did the result add unnecessary stress to my pregnancy and unborn child but it cause stressed within my entire family. We chose to received further testing with a specialist and had a late term Amniocentesis because the high visual ultrasound didn't result into conclusive results. Again putting my unborn child at risk. With all that in mind we chose to pay the +$900 for the blood test but it has definitely been a hardship on our family. Babies are quite expensive without the added expense of peace of mind.
From: Joy on: April 20, 2016
I did my research and called Tricare with the coding numbers for the prenatal testing k wanted done. I would have liked very much to go through with the genetic screening because our first child has a genetic deletion. I chose to cancel my genetic screening appointment for the fear of having to pay out of pocket. Now an acquaintance is dealing with this same issue and she opted to have the test. I feel sorry for anyone who gets the testing, thinking it will be covered by insurance.
From: CC on: April 20, 2016
Unfortunately, abuse and neglect is nothing new for the military and their families; this is becoming the norm.
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