No surgeons in Network within 50 miles - what next?

Tricare Standard help please!! I am so confused about this insurance. I am new to it and I don't know what to do. I have been told (by a TriCare Representative) that since I live in a remote area and there are no surgeons within a 50 miles radius, that I can go to any surgeon within my Region (which includes five states). She went on to state that TriCare will pay 80% of the total charges (not just allowable charges). Does this sound kosher? I am also confused about the their catastrophic cap. I understand that I do not pay any additional co-payments or deductibles for allowable services received during the remainder of the enrollment or fiscal year, whichever applies, after I have reached my cap. But they state that the cap is for only annual deductibles and co-payments based on CHAMPUS allowable charges, not non-allowable charges. So if I understand this right, If I am charged $45,000 for RNY and TriCare pays 80%, then I get stuck with a bill for $9,000. The cap doesn't count, cause the $9,000 is for non-allowable charges. Please help!!

We greatly appreciate your interest in helping us build our Q&A database. To discourage vandals from posting garbage, however, we require people to register before posting.

You must be logged in to post an answer. Click here to log in.

×