Anyone Use Tricare?

My primary (Anthem BCBS) doesn't do ANY weight loss surgery due to the lack of rider.  My secondary is tricare prime and they do allow the RNY and some others.   I have gotten everything I need for tricare prime but on March 1st my husband is officially retired from the military and we will go to Tricare Standard.  According to my doctor that actually means I don't need the preauthorization.  Tricare Standard needs all the same documentation but they dont need to send it in ahead just have it if the insurance questions later.   Here is my question.  Tricare Standard is an 80/20 split I think.  While prime is just a deductible.  How do I figure out how much I will owe at the end.  With Prime they said about 1500.00 when its all said and done.  If its truly 80/20 with standard I am sure that is A LOT MORE.   Just confused.  especially since its the secondary then is the 80/20 still valid. 

I know this is a small problem to have considering many are not covered at all, let alone have two insurances. 

 

Thanks

My husband is retired, and he kept tricare prime.  My total bill for everything was my copay for the psyc eval (12.00), and a copay to the hospital of 25.00.  I don't know if there are regional differences, or if changes were made to the payout after my surgery too or not (the supervised diet changed right after my surgery...I didn't have to have one, and now patient do).  Good luck!

I have zero experience with tricare, but to give you an idea of final bill for my civilian surgeon, it was $66,000+.

Just had my RNY. I have Prime North. It makes a huge difference as to what region you are in and if you are using base facilities or not. I went out of state for my surgeon, just got the referral, and with Prime there is no co-pay at all.
A friend of mine had it done last year, she is on Standard, and just had to pay her deductible, $1500 as they hadn't used any of it that year. She did not get a referral.
Again we are in North region, HealthNet Federal Services is our contractor. It never hurts to call your contractor and find out what is what (or if you are close to a Tricare Service Center, they can get you the information as well).
Good luck!
Jenn

First, although your provider is technically correct that STANDARD doesn't require a preauth you will still want to get on.  Per Federal Code, whenever you have a primary insurance EVERYTHING must run through that insurance first.  You want to work those kinks out (because there are provisions for non-covered benefits of the primary insurance) BEFORE you are handed a $66,000 bill. 

Now with TRICARE Standard there is an annual deductible for retirees of $150/per indiv/year with a max. deductible of $300/per family.

Once that has been met, you are then responsible for 20% in network, 25% out of network of the ALLOWABLE charges.  That is key to keep an eye on all of your EOBs to ensure you are being charged allowable charges, not billed amount (i.e. billed amount for anesthesia at a local facility here was $5200, TRICARE allowed $516--all cost shares and deductibles are based off of ALLOWABLE.

Catastrophic Cap is $3,000--the max out of pocket cost per fiscal year per family. 

If you have problem contact your local BCAC for further assistance (www.tricare.mil/bcacdcao)

 

THANKS EVERYONE!     I am in the North Region.  We were going to keep prime but then decided not too as we would be paying when I already have insurance and its a secondary.    The problem I have right now about calling them is that I am not technically ON Tricare Standard Yet SOOO I have no one to call.  I will be sure to talk to the Dr's office as well about being sure they send it through the primary before we proceed with sending it to tricare

 

 

you may want to elect to continue Prime just until you are completed with your RNY and then disenroll (you'd be locked out of re-enrolling for 12 months, but that's it)...that way you can have the much greater less expense under Prime and save big $$ in the long run...You can even chose to keep just YOU on Prime and allow the rest of the family to go STANDARD.  I assumed Prime wasn't an option in your area.

I think this is the way we are going to go!

Thanks