LABOR AND BIRTH
Once you are admitted for labor and delivery, you or someone acting on your behalf should contact your TOP Regional Call Center to notify International SOS of your admission. This allows us to monitor your care and your baby's care and make any necessary adjustments to the inpatient authorization e.g. Cesarean Section or NICU admission. We will also ensure that the authorization will cover any additional required hospitalization time that is recommended by your treating doctor. Your TOP Regional Call Center is available 24/7 to answer any questions you may have and provide support with authorizations.
HOW WILL I RECEIVE AUTHORIZATION FOR THE LABOR AND DELIVERY CARE FOR MY PREGNANCY?
| Authorization Issued For Care | For TRICARE Prime Remote, once you have informed International SOS of your pregnancy, an authorization will be sent to your nominated email address as well as the provider detailing what medical care is authorized for cashless/claimless service. This authorization is valid for one (1) year. For TRICARE Prime, your PCM will have submitted a referral to support the issuing of the authorization. |
| Recommendations Provided by Internationals SOS on Standards and Safety of Care in Your Location | International SOS makes recommendations on the standards and safety of local prenatal and delivery providers. For care endorsed by International SOS in your geographical location, you will be able to receive all prenatal care and deliver in a local hospital. Please note recommendations may change based on your medical status throughout the course of the pregnancy. In some country locations, you may need to travel to access appropriate care. Find out more about "Traveling to Appropriate Care" in the . |
| Can I change providers? | As your pregnancy progresses, it might be necessary to alter the provider (hospital) initially identified for your labor and delivery. You can also choose to change providers. If you have any questions or concerns about your provider, please contact your TOP Regional Call Center to seek a change of provider and/or speak to a member of the TOP Team. |
| MyCare Overseas™ Beneficiary App |
You can check the status of your referral or authorization via the . In the following country locations, Bahrain, Benelux (Belgium, Netherlands, Luxembourg), Germany, Greece, Italy, Japan, Poland, Romania, South Korea and Spain, the provides support through the MyCare Overseas™ Beneficiary App chat. |
| Near Patient Program Team |
In Bahrain, Benelux (Belgium, Netherlands, Luxembourg), Germany, Greece, Italy, Japan, Poland, Romania, South Korea and Spain,
you can reach out for language/cultural and visit support during your admission from the . The medical teams in these locations will support you and your baby with any health care needs throughout your admission. |
For more information about labor and delivery services covered under TRICARE Policy, please visit or download the
IF I GO INTO LABOR EARLIER THAN MY DUE DATE, AM I COVERED UNDER TRICARE?
Yes, when your treating doctor advises you that an inpatient admission is required for pre-term labor. Care is also covered should you experience other complications in your pregnancy that necessitate inpatient care. In these situations, authorizations are issued depending on diagnosis and treatment plan recommendations on a case-by-case basis. If you are unsure of your coverage for inpatient care, please contact your TOP Regional Call Center as the TOP Medical Team is available 24/7 to support your inpatient admission.
Please Note: Admissions are authorized only if medically necessary.
AFTER GIVING BIRTH, HOW MANY DAYS CAN I REMAIN IN HOSPITAL TO RECOVER?
An authorization for inpatient care for labor and delivery and the number of days covered will vary depending on whether you have a vaginal or C-Section delivery and your post-partum progress. If further information is needed for the number of days identified on the received authorization, please contact your TOP Regional Call Center.
TRICARE Policy states "The mother and child length of stay may not be restricted to less than 48hrs following a normal vaginal delivery and 96hrs following a Cesarean Section." Any decision to discharge prior to the set minimum is made by the attending Physician / Obstetrician in consultation with the mother. For more information visit .
IS A PRIVATE ROOM COVERED BY TRICARE?
No, you are entitled to a semi-private room for care after labor and delivery. For more information on room entitlements visit .
IS A CESAREAN SECTION ALWAYS COVERED?
TRICARE covers Cesarean Sections (C-Section) when they are medically necessary (). TRICARE's coverage of elective C-Sections (those done at the request or convenience of the beneficiary) is limited to what would have been provided for a vaginal delivery, and the beneficiary is responsible for the difference in cost (TRICARE Policy requirements: ). For more information you can call your TOP Regional Call Center.
IS A VAGINAL BIRTH AFTER PREVIOUS CESAREAN SECTION (VBAC) COVERED OR ALLOWED?
A vaginal birth after a previous Cesarean Section is something to discuss with your treating medical team. TRICARE covers labor and delivery services that are medically necessary (i.e., it is appropriate, reasonable, and suitable for your medical situation) and recommended by your treating medical team. There are no policy exclusions for a VBAC.
IS AN EPIDURAL ANESTHESIA COVERED BY TRICARE?
TRICARE covers epidural anesthesia services and supplies as part of your labor and delivery authorized care. In some country locations prior to labor and delivery, it is recommended that the subject of epidural is discussed with your treating obstetrician to ensure the service is available when you are admitted.
IF MY BABY IS ADMITTED TO THE NICU, CAN I REMAIN AN INPATIENT?
If your baby requires continued inpatient hospital admission either to a Neonatal Intensive Care Unit (NICU), Special Care Baby Unit (SCBU) or other ward, TRICARE does not cover the additional inpatient days for the mother unless the treating doctor has determined that the continued inpatient admission is medically necessary for the mother. Therefore, the non-medically necessary continued inpatient stay is not a TRICARE benefit and will not be authorized and you will incur additional out-of-pocket expenses if you choose to stay in the hospital.
Please contact your TOP Regional Call Center immediately if your newborn needs to be admitted to the NICU to request an authorization for emergency inpatient admission. The NICU is a critical care unit, so admission is almost always a medical emergency. If the admission is planned and you are enrolled in TRICARE Prime Overseas, your Primary Care Manager (PCM) at the Military Treatment Facility (MTF) must submit a new referral. Hospitalization and medically necessary diagnostic tests performed during the NICU stay will be covered by TRICARE. In the NICU, neonates commonly undergo various tests and examinations to monitor their health status and detect any potential issues or conditions early on. Some of these tests will require a parent or both parents to sign a consent form.
| TRANSLATION SUPPORT DURING YOUR MEDICAL APPOINTMENT OVERSEAS | |
|---|---|
In my location the hospital where I receive my pregnancy care and evaluations does not have English speaking staff. I am worried this will cause a problem when I am admitted for delivery. Where can I get translation support?
|
INTERNATIONAL SOS HAS RECOMMENDED THAT I TRAVEL FOR THE BIRTH OF MY BABY; WHAT HAPPENS IF I CHOOSE TO REMAIN IN MY CURRENT LOCATION?
As an Active Duty Family Member (ADFM) making an informed choice to deliver locally against the recommendations of International SOS, the medical team will make contact and talk you through the risks and the recommendations for traveling to an endorsed care location.
If your decision is unchanged and you choose to remain in a non-endorsed location, International SOS is unable to issue an authorization for labor and delivery care. This is due to the location not being recognized as meeting international quality standards. As a TRICARE beneficiary, this will mean a requirement to self-pay and submit a claim for the inpatient labor and delivery services received to the TOP Claims Processor.
During the claims process, as the inpatient care is unauthorized for the location, the claim when submitted is processed with a point of service requirement, which may mean up to 50% of the inpatient care costs will not be reimbursed. For more details about . º£½ÇÂÒÂ×ÉçÇø who give birth in a non-endorsed location are not eligible for doula services or breastfeeding support services from a lactation consultant or counselor under the CBSD.
To learn more about traveling for appropriate care, please download the .
