Question:
Tri-Care Standard

K I had my surgery. I have tri care.. live in Ill. so my question is... when tri care sends in what money they will pay and its excepted by the docs, etc..doesnt that mean that I'm clear of oweing anything else? I'm new to the tri care so I was just wondering if anyone knows more about it? I paid some money out of pocket for surgery. and now they are sending me a massive bill saying I owe them more. any input would be great thanks.    — Stacie2 (posted on January 27, 2009)

January 27, 2009
Pull out your EOB and it will state what you owe in dollars amounts. Any question call or go into your nearest Tri-Care office, most military bases have a tri-care rep. You may also check the Tri-Care online site.
   — dc10pilotswife

January 27, 2009
Some things Tricare will not pay for ...such as some tests that surgeons require...and will charge you if they are not pre-approved...But the surgeon and tricare usually have it all worked out test by test. And ALL surgery costs are negociated between them. You will have to ask specifically about your bill. Sometimes, the surgeon will send you a bill automatically...because Tricare payments are often late...You might just need to wait and see if the payments are just not caught up...
   — .Anita R.

January 27, 2009
Because you have Tri-care Standard you will have co-pays and other deductibles. I have Tri-care Prime and as far as I can tell my out of pocket expenses will close to nothing.
   — moondancer2000

January 27, 2009
I have TriCare Prime...and from my understanding the surgeon etc and hospital are apart of the network. They accept what Tricare pays them...even if its a lower amount. No matter what. You wouldn't be responsible for the difference...they accept what tricare give them for being apart of the network...However. If you sign statements at the hospital and/or doctor's office that says you are financially responsible for anything the insurance doesn't pay, you would have to pay it...I had to sign those forms at the hospital. Of course I do have prime and not standard, so standard may be different. Your best bet is to call Tricare and ask if you would be financially responsible for any difference they don't pay. They will tell you.
   — Carrie S.

January 28, 2009
I have tricare standard...and I paid about 1000 out of pocket for my surgery. They paid for everything else - with an allowable amount..on the eob it states the charge and what tricare allows ...you pay the number listed further down ..after the deductible is met. Also, if you signed a paper at your dr's office saying that you would pay the costs the insurance won't pay, then you owe them what tricare will not cover. example..dr charges 150 for this and tricare allows 60 you owe your 20% or 25% if retiree, and then possibly the 90$ more if you signed this paper saying you will pay the difference. Good luck to you! You can always call tricare and ask questions too. I had a dr's office-not surgery related-- who overcharged me for years and then when I found out..they went into a panic. Not every tricare ricipient knows the laws around tricare. Tricare was very helpful in my situation and I ended up going to this dr for 6 years with no payments..every month mind you..for allergy shots and testing etc...hugs, kim
   — gpcmist

January 28, 2009
Go to your Tricare representative at your base, they are usually located in the med clinic. If you are not near a base call the 800 number. It is my understanding that as a Tricare standard beneficiary you will have co-pays for most everything. I am Tricare Prime and I have not paid one cent of my own money for any procedure. As far as all the pre-op tests and stuff I was fully covered. We are reimbursed for all travel expenses since the surgeon is over 100 miles away. I really like Tricare Prime since we usually have to go to a medical facility over 100 miles for any major/specialty stuff. This happens a lot because we are in the middle of nowhere. I have never had any procedure or referral request denied.
   — im3d2