Question:
I have tri care champus...we are retired can you help w/ eobs?

im getting large eobs from the hosp. after champus said i was approved..they are paying but a lot is saying more than allowable amount like some charges are 110,000 and champus is only paying 2000, i have a 2nd insurance too but will i be billed for anything ? im getting nervous...jacki    — Jackiis (posted on January 28, 2002)

January 28, 2002
The EOB should show how much of that is your responsibility. It's unlikely that the hospital would have gone ahead with your surgery if your insurance wasn't going to pay most of what the insurance allows. It may also be that the hospital will write off a substantial amount of the bill, but that should also show on the EOB. This is assuming that the hospital is in network for your plan. Your second insurance will also pick up what the first doesn't, although again it may or may not cover all of it. I would worry too much about getting a really high bill. The way things work these days, if the hospital thought you were going to be responsible for a really substantial amount, they would probably have asked for a desposit up front.
   — garw

January 28, 2002
Sorry, that one sentence above should say 'I wouldn't worry' not 'I would worry'.
   — garw

January 28, 2002
Hi from a fellow military retiree! As far as I know, once a Dr. or hospital agrees to accept you as a tri-care patient, they are also agreeing to accept the amount tri-care pays. They are not allowed to bill you beyond your co-pay. I would definitly call the tri-care help line to be sure, however. I had my RNY 4 months ago, it would have cost @ $25,000, Champus paid @ $13,000 and we paid a $25 co-pay. Pretty good "bonus"!
   — Bobbie B.

January 29, 2002
Hi Jackie, I am going through this right now and have an EXACT answer for you. I am a military retiree and have TriCare Standard. If your surgeon and hospital are in TriCare's network then you will only have to pay 25% of ALLOWABLE charges up to your yearly out-of-pocket max which is $3,000. as of 10/1/01...Congress just changed it from $7,000. IF, your surgeon and hospital are TriCare "authorized" but not "in-network", they MAY, by law charge you an additional 15% above the ALLOWABLE amount. Many surgeons, like mine, write that amount off. In the end, you can expect to pay no more than $3,000 for your surgery and pre-op tests if you had your sugery after 10/1/01 and I believe, if my memory serves correctly, you did! I had no idea of the new law until I received an EOB stating I had met X dollars toward my yearly max of $3,000. I had to call and make sure because I thought it would be $7,500. We are saving more than half from last year! Isn't that great! Take care, Karen
   — Karen B.

January 29, 2002
That was supposed to be "Congress just changed it from $7,500." Sorry...typo.
   — Karen B.