Skylark

Has anyone had surprise charges with Tricare Prime? I was approved a few months back and am scheduled for surgery next week. Because there were no Tricare Prime participating surgeons within 150 miles of me, Tricare approved a great surgeon in my city, who is not a Tricare participant. Triwest keeps telling me that my only charges are $20 a day for the hospital copay. The hospital where the surgery will be performed is not a Tricare Prime participating hospital, and the surgeon and hospital bill seperately. Triwest will not give me anything in writing except the approval letter for the surgery with the surgeon's name on the approval. Triwest says that they would need an itemized list to tell me what is covered, yet he hospital is being evasive, saying that there is no way to know exactly what my surgery will entail. Just wondering if anyone else has had this experience.

hexx2003

I have done other things not RNY with tricare prime. Including inpatient care and being hospitalized for 4 days too. They stated for the inpatient i had to pay 25 or something like that and i never got billed. Sometimes things come from the hospital (like when i as hospitalized for 4 days). They billed me $250 more than tricare was paying. That was because tricare penalized them for not filing it within time. I would say wait it out, but the information is available through the tricare prime website. Now, you should have an online chat option for help. I know that healthnet (tricare north) does. And that way you can print out the conversation and have that as proof. Also, if you visit your MTF Tricare office they should provide you a list. I wouldn't expect to pay anything honestly, but it will take months to have the info make the circle back to you. You dont like it, fight it!

__________________
Heather

Surgery date 01/13/2009
VA People.. JOIN VIRGINIA IS FOR LOSERS GROUP!!http://www.thinnertimesforum.com/gro...ia-losers.html

Highest Weight 346 lbs 55.5 BMI
Day of Surgery:342.5 lbs 55.5 BMI
Current: 208 lbs 33.6 BMI (omg.. finally below 40!)
1st Goal: 250 lbs (The weight on my id's!! LOL) CHECK!!!!!!
2nd Goal: 1-- I want to see a 1!!
Surgeons goal:150 lbs (appearently i am big boned

Down 135 lbs since 1/13!
Expecting our first Kid 6/19/2010 thanks to WLS!

SueRN

Here's the problem, and not just with tricare, when you use a non-participating provider. if they don't have a contract with your insurance, they can balance bill over and above what your insurance pays. The insurance may pay at the higher in network rate because they were did not have a local in network provider, but insurance is not going to pay a non-network more than what they contract for an in network provider. so when you choose to use an out of network provider, they are not under any obligations to accept only what the insurance pays and they will bill you for the balance. it's not something you can fight the insurance on because it's an issue with the provider. sue