Tricare Standard

miissxangela · March 5, 2008

Hi everyone.. I currently have tricare prime, but was told there is a 6month waiting list at the MTF which I am assigned. I talked to tricare and they said the only way to get around it is to do Point Of Service just for the surgery..which I'm not clear on what that does... or completely unenroll from prime and switch to tricare standard. I understand I have to pay co-pays and what not, but i'm just wondering, after surgery, how much did you end up paying for hospital bills and everything?? I'm so confused and don't know if it's just best to wait 6mos. or if I should get the ball rolling and just get off my wallet. :thumbdown:

Tantrica · March 7, 2008

I'm not sure of the details but please research carefully! If you do indeed have to switch to Standard to have POS care for the surgery it may take a while to get back on Prime, depending on your Soldier's rank. I **THINK** that if they are E-5 (E-6?) or above you have to wait a full year before switching back to Prime!

Kari

mel_smiddy · March 7, 2008

If I were you I would wait and stay on Prime you will save thousands in copays and cost shares. If you do POS for the surgery Tricare will only pay for 50% and believe you me that is alot that you have to pay for out of pocket. It wasn't hard for me to switch from Tricare standard to Tricare Prime I was able to do it the 1st of the next calander month. My soldier is an E-5. I switched from Standard to Prime for the EXTREME savings to me. My surgery will be paid 100% I am only responsible for $500 vs at least $1150 with standard.

Hope this helps. Oh BTW I am not close enough to a MTF so I am able to go to an out of network Civilian surgeon. As long as Tricare approves my referals to my surgeon it is my understanding that they will pay 100%.

miissxangela · March 7, 2008

My husband is E-4 right now, he takes his test for E-5 next week though, but those results usually take a while.. I will have to research the amount of time it takes to get back on prime if he's E-4. I called tricare yesterday and was told the only thing I would have to pay for are, of course, the copayments and $14 to stay overnight in the hospital. There is a $750 program fee with the civilian surgeon that I am looking into, but no insurance covers that. I am going to a seminar next week for the civilian surgeon to make sure there aren't any other hidden fees to help better make my decision. I would like to save money, but in the same hand... I want last summer to be the last miserable summer of my life. It may sound stupid, but I'm sick of being the miserable fat girl that can't do anything/can't wear anything cute...and god forbid go to the beach or a pool.

Ohh yeah, and POS is out of the question now.. it is way too expensive!

Thanks to both of your responses!!!

BratKat · March 7, 2008

POS (point of service) only applies if you are Prime but go outside of the network/without referral to get care anyway. It is 50%, I believe. If you switch to Prime, your co-pay is 20%. There is no such thing as POS with Standard. Certain ranks (E6 and above, I think) have to wait a year to switch back to Prime if you go to Standard.

I don't have any experience with the Lapband area of Tricare as I was self pay but I am in the middle of the rest of switching back and forth between the two coverages otherwise.

mel_smiddy · March 7, 2008

I don't have any copay at all with prime. According to what I've been told by Tricare my surgery will be covered 100% if I was standard then I would have cost share of 20 to 20% depending on if I stay in network or go out of network.