Question:
I have tricare

I was preaproved for my tummy tuck and hernia repair .. Tricare did my bill but it says patient amount is half of what they approved its called Cost share amount. Why do I have to pay this if I was approved from tricare and was apreapproved to have this surgery.. The amount is a little under 800 dollars which is nothing compared to the hospital bill but we are not supposed to have any copayments.. I am frustraited and of course this has to come on a weekend and cant do anything till monday..    — Catherine B (posted on March 12, 2005)

March 12, 2005
Do you have Tricare Prime or Standard? The other thing to consider is your surgeon a tricare provider? If not that is why you have to cost share. Hope that helps.
   — jenafwife

March 13, 2005
you got lucky then because for a tummy tuck and a arm lift i had to pay 4051.00 and i am tricare prime. i was also told that it was my co pay. i had my tt and arm lift at portsmouth naval hospital. so i wouldn't complain about 800. good luck it took me 2 years to raise that money.
   — Barbara M.

March 13, 2005
It depends what level of Tricare you are on, if the hospital and the medical staff (doctors, anestiologist, etc) accept Tricare, and how the hospital codes the procedure when they bill your insurence. So log into the tricare website and make sure there is not a percentage of each procedure that you might have had to pay. Some things are not covered 100%. Hernia repairs are usually covered 100%, is is stuff that can be considered "cosmetic" that they end up trying to charge you for. My advice, go to your local tricare office and talk to someone face to face.
   — MagickalMom

March 13, 2005
I have Tricare prime and my surgeon is a Tricare provider and so is the hospital.. The Tummy tuck was won on appeal and they deemed it medically necessary so it should be covered 100 percent.. I have used this surgeon for my breast reduction in May. I talked to a friend who does billing for tricare all the time and she said she sees this every day. What most likley happened is that The hospital probably didnt have the autherzation number on file and filed it without it and Tricare didnt look it up .. So I will be calling both places this morning...
   — Catherine B