Anyone with TRICARE PRIME??

I will start with Tricare Prime on Jan. 1. After having a PPO for years, this HMO stuff is really concerning me.  I talked to someone today and they say my Primary Care Dr. will submit the info to them and they will refer me to a general surgeon of their choosing. Well... The dr. that I so want to have as my surgeon is NOT a tricare prime surgeon!  Is it possible to still go to him and they will pay a portion of it as Tricare Standard? I really don't want a huge expensive bill so I'm very confused at this point. I am so missing my old insurance co where I could go where I wanted. But hubby is retiring in Jan. and will have Medicare and Tricare for Life, which leaves me stuck with only Tricare. I would appreciate any advice!

Sorry..I cannot help you specifically with Tricare, but my surgeon and the hospital were out of network for my insurance BCBS of Alabama and they did cover the charges at 70%.  Also my surgeon and the hospital both agreed to take the "in-network" reimbursement amount as the total payment.  Bummer that you have to have an HMO...being a nurse...I do not like being told what MD I will go to or not.  I know who's good and who's not....and I wouldn't want to have to go to a bad doctor just to be covered for visits.  I would have paid out of pocket if necessary, but hey..70% with a write off for the rest wasn't bad.  Also talk to your surgeon's office...they deal with these insurance companies so much they might know a way around it. Good luck,

Thanks for your reply!  I too do not like being told what dr. to go to but the cost of keeping our Mail Handlers insurance was just too much and that was just for my coverage.  I found out that if I go out of network, I have to pay $300 and 50% of costs.           Take care,                  Cindy

i am tricare prime, I had my surgery, they did pick my surgeon, but i didnt mind as I had not been in contact with any surgeon as of yet.  A word to the wise, if you are prime, do not switch to standard.  It is a decision your whole family will regret!  I work at a military treatment facility and make medical appts and I can tell you that prime is much better than standard!  I recommend calling your tricare regional office (mine is triwest) and asking them.  Have your doctors name ready with all contact info just incase they ask for it.  My surgeon is awesome!  Good luck to you!

Thanks for replying! Tricare Standard was fine when I was using it as my secondary. They usually picked up the difference that my primary didn't cover. BUT I know what you mean about only using it as your only insurance. I could not believe how little they would pay so that's why I went with Prime.  I have an appt. with my primary care manager on Tuesday so we'll see what he has to say. I did learn from calling humana that they won't pay for the Lap Band but that's okay.          Take care,                Cindy

Hi!  I have tricare prime and i was assigned a doctor but I looked him up and the hospital that he uses and both had very poor reviews so i got scared! I used this site for the research. SO,... i called tricare and they told me that if i could look on their website and find a doctor that I liked as long as he was in my network area .. i think that is 200 miles or less away from you.... they would change the doctor I was refered to by my PCM to the doctor that i wanted.  The only thing is 1. the PCP has to refer you to a surgeon first.  2. If you are going to change the surgeon he has to be within network 3. You must not have visited the surgeon you were originaly refered to. So there is some choseing you can do. Hope I helped. Cristy