Tricare Standard Insurance! - Page 2 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

hexx2003 · 03-18-2009, 01:21 PM

Rebecca, would it help if i posted my bill from tricare for the surgery?? On the billing it is how the hospital billed, what tricare paid, then what I have to pay. Not sure how it got so low, but if you want me to post it, i will

RebeccaNV · 03-18-2009, 04:20 PM

Quote:

Originally Posted by hexx2003

Rebecca, would it help if i posted my bill from tricare for the surgery?? On the billing it is how the hospital billed, what tricare paid, then what I have to pay. Not sure how it got so low, but if you want me to post it, i will

No Dearie, that isn't necessary. I was just posting so that other's who may come along with Tricare Standard can get an idea of what their costs may be. I am not surprised that the hospital wants to be paid in advance, since it is an elective surgery. The info from my weightloss center says that all out-of-pocket stuff must be paid for in advance.

hexx2003 · 03-18-2009, 04:30 PM

Oh, i wasnt looking at it being an elective surgery necessarily, its medically necessary. Does your weight loss center ask for an approval or do they just do the surgery and hope to be paid? Once Tricare approves the surgery it becomes medically necessary. Never knew anyone that had Tricare that had to put a deposit down on the hospital. As I said, doesnt seem quite right to me. I had standard for 4 years, prime 10 and now back to Standard and never had to do that through 5 surgeries.

RebeccaNV · 03-18-2009, 04:40 PM

My weightloss center gave me a packet when I went on my consult. After seeing the surgeon, I then had to see the person who handles all the insurance stuff. When I told her I had Tricare, then she told me what my cost share was (80/20) and said I needed to call the hospital where I was to have the surgery and the anesthesiologists and find out what their charges would be. When I called the contact at the hospital, she then called Tricare, then called me back, telling me that yes, I do have 80/20 cost share and that I would need to leave a deposit of 2k before the surgery. So, that I where I am getting these dollar amounts from.

shecee34 · 03-18-2009, 04:41 PM

I have Tricare Prime and my out of pocket was $500 to the surgeon's office for the nutritioinist and follow up care that Tricare didn't cover. Tricare did cover the entire hospital, dr and anthesiologist bill. I would make sure I have a Tricare approval in my hand before I have the surgery.

RebeccaNV · 03-18-2009, 04:52 PM

I don't know why I dont qualify for Tricare Prime. I am the retired one. I am the sponsor. I go to the website and plug in my info and it only says I qualify for Tricare Standard. In all of 24 years this is the first time I have used this for myself. I use the VA. I have used Tricare for my kids but they have never had to use it much. One of my kids had a tonsillectomy (outpatient surgery) and I think I ended up paying about $600 cost share on that.

shecee34 · 03-18-2009, 05:01 PM

If you do not have a military base within so many miles of you I don't think Prime is an option. My husband's daughter lives in a state without any bases and we have to have her on Standard while the rest of our family is on Prime

RebeccaNV · 03-18-2009, 05:12 PM

I don't live near a base.

Don't you Tricare Prime ppl pay a premium? I am gonna have to look into why it shows I only qualify for Standard. Now that I have looked into using Tricare for myself for this surgery, I think I might use it for a few other things.

hexx2003 · 03-18-2009, 06:29 PM

Yea retiries, are only VA or standard. Even my grandpa, is on VA or standard.. the va is 3 1/2 hours away so they do everything on standard. Yes, the cost share is 80/20 or 85/15 depending. Basically you expect to pay 15-20% or your catastrophic cap at most. We'll, thats what i paid, but the way they figure out the numbers isnt quite like that. You dont end up paying 15-20% of the whole amount its of a section. Mine was put in as a Copayment, not cost share. So maybe thats the difference. Not sure. But as i said others here and who have standard accross the us pay about the same. Now, how much will yours cost. No clue. But the hospital requiring a deposit doesnt seem right and I would talk to tricare about that. Tricare is a very well known insurance who pays the bills ya know. Most hospitals love working with them. The clinic informing you of the 20% rule is their responsibility. Thats all they know until it goes through your insurance. If they told you that you'd have to pay $100, then you got billed $3000, you could be very pissed and could even have legal action. Best thing I would suggest, is find some people in your area that may have used this clinic, the hospital who have the same insurance. Thats what I did in my area, and we've compared notes to the letter. Mine cost more cuz i was hospitalized 2 days longer, but only by a couple bucks. I know that even the hospital here for out of state insurances or self pay require a down payment, but not for national insurance like tricare. As I said, once you are approved for surgery through Tricare, your medical stuff should be all taken care of and you should just get a final bill, no deposits.

Good luck Rebecca, I hope you can get your surgery with very little upset! Maybe you should come to Virginia for it!!