Stumbling Block

[getitgirl 0]

Okay, I am doing my checklist for surgery.

Seminar check

Nutritionist check

sleep Study check

Psych eval on Friday

Lab at Hospital NO GO THEY ARE NOT IN MY INSURANCE'S NETWORK wtf.

Physician In network

I have Tricare Prime which means no copay. Everything is covered 100%. If I go out of network then I have to pay 15% of the total hospital bill?????!!!! Then why do I have insurance?????

I left a message with my coordinator about this. I can't afford 15% of anything. Boy I tell you if it isn't one thing it is another.

[Fifimcbandster 0]

I had to start with my primary care physician and he referred me to a bariatric surgeon in network and a hospital that is covered as well as all testing its all covered except the minimal co-pays

[getitgirl 0]

Yes, I got my referral from the PCM and the surgeon is in network but the hospitals that he is affiliated with are not in my insurance network not really understanding this one. My insurance has approved all of my appts thus far. I am just getting concerned about the hospital part I don't want them to bill me back the 15%.

[GipsyGirl 6]

at least you have 15% - I have 30% to ay and I haven't even acnowledged the bill that came in the mail the other day. I am scared to even open it.

I am also able to wiev my bill online and it does say that my minimum monthly payment is $60

My surgery cost 26,000

so if you do have to pay some out of pocket money then maybe you could arrange a payment plan with them that you can afford. I wouldn't let the money stop my surgery and a way of living longer and happier.

[getitgirl 0]

I know but with everything else going on right now this is not a bill that I can afford. I am not sure about the hospital's policy right now. It is up to the hospital if they will take the 85% and call it a day or will they try and bill me for the 15% it just never occurred to me that the hospital would not take Tricare. My daughter has cancer and the hospital that she goes to is in our network. Go figure.

I just don't know right now.

Thank you for the encouraging words.

[Melissannde 41]

Call the billing dept at the hospital and talk to a supervisor there. Even if they make you pay the 15% ( I doubt that they will make you pay the whole 15%), a payment plan can be worked out.

I know after my cancer surgery (and we had to prepay a whopping big amount because we had not met our deductible yet.. the surgery took care of that!!!) there was a little bit left over after insurance kicked in, which we arranged to pay out over some months.

At least call them so you'll have an idea what the numbers will be.

[ape087 1]

Okay, I hope that I can be of some help on this subject, because I just got banded last week and TriCare paid for it all except for my nutritionalist consultation (which was $60). What area are you in? Im with Triwest, and they sent me to a group (UCSD) and everything in that group was covered. I would double check with your dr to see if there is a hospital that he/she is affiliated with that you can do it at. Tri Care wont assign you to a dr that doesnt use facilities that they dont cover. Otherwise, I would grab your records and call tricare and ask for a different dr. Once you get your PCM referral, you can change all you want. I know it sucks, but sometimes it hasta be done.

If you have any questions, feel free to PM me. Ive been dealing with Tri Care (insert smiley shaking fist) for 4 years now, and I know how stubborn they can be, and sometimes it takes a good bitch fit to get stuff done.

[getitgirl 0]

Thanks I will PM and tell you what is going on. But I have Tricare North Region I live in North Carolina. I hate being so close but yet still so far.