Question:
Has anyone ever been able to co-ordinate benefits using TriCare?

My primary insurance is through Manatee Health Network, and my husband is a retired Marine, so we have TriCare as well. My primary insurance refuses to consider full coverage to an out-of-network surgeon that I want to go to. They will pay 100% for an in network surgeon, but he doesn't do distal RNY, which would be the best procedure for me (BMI greater than 50). If I want to use the out-of-network surgeon I would have to pay a $500.00 deductible plus 60% of the total bill. I am wondering if anyone has ever been successful coordinating benefits from their primary carrier and TriCare to cover WLS with an out-of-network surgeon? Thanks!    — victoriandove (posted on February 28, 2003)

February 28, 2003
Commercial insurance does not coordinate with Champus/Tricare coverage.
   — RebeccaP

February 28, 2003
The best thing to do would be to call the 1-800 # on the back of your card and speak to a Tricare rep about this or go to your nearest Tricare Service Center and speak to someone face-to-face about it. Tricare does coordinate with other commercial insurances however Tricare is always secondary to everything but Medicaid or supplemental insurance. You have to follow the rules of your primary insurance. Also remember that Tricare has an allowable as established by the DOD and will not pay more than that amount so if your primary pays more than the Tricare allows, they will not pay anymore towards the cost. Again, it would be best to call and talk to a rep at the 1-800#. (Make sure you get names of who you speak to) Good luck.
   — karen B.