Please tell me...........

[mljalways 1]

Did you use Tricare and if you did, are you prime or standard and what was your bottom line cost out of pocket?

Thanks

[cobrien78 0]

I have tricare prime. My husband is active duty. I haven't had my surgery yet but I have not paid anything and it is my understanding that I won't pay anything either. Hope this helps!

[thatDEgirl 1]

I have Tricare Prime (south) and have paid nothing thus far and don't expect to pay anything.

[mljalways 1]

Thanks for the response........my doc is telling me he chares $5000.00 for surery and Tricare is payin $992.00 so he wants me to pay the balance and Tricare is telling me that is not right

[thatDEgirl 1]

Well, my surgery was $24,000 and Tricare only paid right under $9,000. Doctors that take Tricare though, are not allowed to bill you the difference as I understand. This though is why a lot of places won't take Tricare anymore, they way under pay.

[mljalways 1]

Yes, Tricare told me he cant bill me but he is. My issue with him is he accepted payment from Tricare for my eval so how can he NOT take it for the surgery?

[Cadets71 1]

If your Doctor accepts Tricare assignment, e.g. he files for your surgery with Tricare and he accepts payment from them, then he CANNOT bill you the balance.

However, if he requires you to pay, and to file with Tricare yourself, then he is not accepting ASSIGNMENT AND HE CAN BILL YOU FOR THE WHOLE BALANCE. Note that his bill is separate from the hospital, so the hospital bill should be covered by Tricare, if they are in the network (and most are).

I am standard Tricare. My surgeon billed $9,600; Tricare paid $1,640 and my gap insurance picked up the rest. So, I had no out of pocket costs. I think Prime patients are also covered 100%.

Just FYI for everyone reading this thread. Tricare reimbursement rates are based on Medicare rates - they are the same. You may have heard lately that the Congress was tryng to pass a bill to further lower Medicare reimbursements.. I wrote each of my Congressmen and Senators to tell them that when they do that - they are hurting military families as well as retirees 65 and older. When you see Medicare being adjusted...just remember it will affect us as well!

[karen_karen 0]

i have tricare prime and i live in dallas since i dont live in a miltary town things got alittle more complicated. alot of non military towns dont take tricare because they dont pay out like other insurance companies do. i called around dallas and the doctors wanted to charge me 1500 to 5k even with tricare. i ended up going to austin for surgery and i didnt cost me a thing. technically they cant charge you anything over because of tricare but they still try. all i can say is keep looking for a doctor that will do it without trying to make some money from you. there are doctors out there that wont charge you extra just have to find them. dont give up.

[mljalways 1]

I am going to try to not to give up but I just cant pay nor should I have to. I am just bummed that he was allowed to waste 2 months of my time.

[lindar172 1]

Not sure how to make a new thread, testing this

[dl2418 0]

If he is a Tricare Prime contracted provider, then he has agreed to accept the payment from Tricare. Did you have your referral to him through your PCM?

I'd be calling Tricare and letting them know he is still trying to bill you after accepting payment from them for services. If he does then it is fraud. Also you should have recieved your beneficiary statements from your visits that will show what your provider billed, what tricare paid and any amount owed by you. If that amount is $0.00 then he is being shady......

[mljalways 1]

yes he is a contracted provider with Tricare but he is telling me he is not contracted for "bariatric" with tricare however he did accept payment for my Bariatric eval from tricare. What a mess

[mljalways 1]

Anyone else?

[sunflwr78 0]

I am so sorry for all the craziness that you are having to go through. My husband is active duty and we have Tricare Prime(South). I have been told by everyone including Tricare that I will not have to pay anything out-of-pocket. Someone mentioned a $12 fee for the Psych Eval. $12 is pennies for a surgery that is going to change my life forever.

It sounds to me like your surgeon's office needs to be audited by Medicare. He can not bill you for the amount that Tricare does not pay. He has to accept their payment. If he is audited, then he will have to repay every single dime that he has collected from overcharging his patients.

Hang in there! Hopefully, you will get things figured.

[mljalways 1]

His office girl told me that they have had 3 or 4 Tricare cases come back that way so I know they have collected money from tricare and the patient. So unfair!!