Flyinhigh

I don't know what types of health care Delta has but we are using a high deductible policy through FedEx with Tricare Standard as a supplement and it works great. It may cost you a little more than Prime but the better service and convenience may well be worth it.

MikeF16

After 20 years of AD I've been insulated against this and wanted some outside input. I switched to standard about 6 months ago, and have noticed that quite often somebody sees the doctor (or dentist on our private insurance), we get a bill up front then several months later I get a 2nd bill for some additional money because "insurance didn't pay what we thought they would". The amount is usually trivial but the principle of the matter drives me through the ceiling.

My questions:
1. Is this common?
2. Is this legal?
3. Is this just some doc/insurance scam to get more money out of me since they know I won't spend a lot of time over these "small" additional fees?

$30 isn't a big deal, but if every office manager charges every patient an extra $30 for every visit for the entire year it adds up. Shouldn't these guys know what insurance is going to pay and give me an accurate payment amount up front?

Jughead135

The key is to look at the EOB that TRICARE (and, in my limited experience, other insurances) send out.

If the doc's office is charging more than the agreed amount, then you do NOT owe the money (though they'll happily accept it if you send it)--that's the deal they signed on to when accepting TRICARE.

Lurking

!. May be common where you is not common here is SA? With Standard you do have a co pay which is often paid upfront and can be the norm (say a wellness visit) when I have had this happen it was because we went in for say a twisted ankle and I mention a sore throat and we wind up with a strep test after the fact, which they did not count in the co pay

2. It depends (every lawyers favorite answer). There are many issues that can bring this up the scenario above, in network/out of network providers etc....

3. Always a chance but I doubt it

If I remember from previous posts you used to be in a huge military area but are now in an area without an MTF within 50 miles if so I would go back to prime all of the private doctor privileges none of the Std costs.

blastoff

Welcome to civilian healthcare (not limited to Tricare Std). Still better than getting poked at by Capt Snuffy at the base Hobby Shop.

MikeF16

Good memory. I will consider your recommendation since as you mentioned, I am no longer bound by an MTF which was it's own special flavor of hell.

The entire thing feels like a big bait and switch. Used car dealers can't do it, why can my doctor?

I was fairly happy with the squadron flight docs. It's not the total cost that I care so much about (even though that's really all that matters). I just feel like they are taking advantage of me, and they hold all the cards. The tag me for another $30 which I have to pay. It's not enough to spend 5 hours researching and fighting, but if I just refuse to pay it, I get a hit on my credit for 7 years. Complete BS.

Flying Boxes

Not retired, but when activated we use Tricare Standard for the family. We used to get doctor bills after Tricare paid. When we called Tricare and asked, they told us that the doctor agreed to what Tricare paid and that we were NOT required to pay anything over that amount. So we just make sure the amount paid is accurate and let the doctor know.

We stopped getting those bills for little amounts after that.

YMMV!!!

ugleeual

I never pay up front at the doctor when using standard... I get a bill from the doctors office normally a couple weeks after treatment that shows the Tricare payments... I pay the difference.

Flyinhigh

Mike;
The whole medical insurance business (civilian and military) is extremely complicated and just when you think you have it figured out, you find out that you really don't have a clue. One of the things that may be impacting your billing is the Tricare Deductible. It is $150 per individual and $300 per family. The deductible starts with the fiscal year; i.e 1 October.
Lets set up a scenario for your family. Your wife has a bad cold and goes to the family doctor. Doctor charges $100 but Tricare only allows $80. So, she has $80 towards her deductible and you have $80 towards the family deductible. You owe the doctor $80 (assuming they accept Tricare.) Your wife doesn't get any better so she goes back. Same bill of $100, $80 allowed. She has now met the individual deductible with $10 to spare. The family deductible is now at $160. Tricare will pay the doctor $8 and you owe $72 ($70 deductible plus 20% cost share on the $10). A few days later your child has the same cold and off they go to the doctor. Same drill; $100 billed/$80 allowed. You owe the doctor $80 since your child's $150 individual deductible has not been met and you only have $240 towards the family deductible. Finally you come home off a trip and you get the same cold. You go to the doctor and again it is the same $100 billed/$80 allowed. You have $80 towards your individual deductible but the family deductible now totals $320. Tricare will pay the doctor $16 and your share of the bill will be $64 ($60 of the family deductible and 20% of the $20 over the family deductible.) You have now met the deductible for the year so from now on any covered family member will only owe the 20% cost share on the allowed amount. Of course in the real world the allowed amount is never an even dollar amount and depending on the diagnosis code filed by the doctor's office, the allowed amount can be different between family members with the same symptoms.
Also follow ugleeual's advice, don't pay upfront. Wait until you get the Tricare Explanation Of Benefits and the doctor's bill before paying and, even then, you may want to wait for another billing cycle before you pay. Tricare has 30 days from the date the bill was FILED to complete the processing. Occasionally the billing office will be a little slow in filing and the doctor's offices tend to bill every 30 days and sometimes these things cross in the mail. This may also be impacting your bill. Just because they send you a bill, doesn't mean you really owe them anything. I am on a first name basis with the three billing clerks in my wife's allergy office. They will tell me the day it was filed and I can see if the Tricare payment is still pending and then figure out if I owe them anything. Most of the time I don't owe them anything even though the bill says I do. The next billing cycle will usually be correct.
Tricare South (I assume that is your region) has a great web site and you can track all of this online. The only thing the website doesn't show is the date the claim was filed. Good luck getting a handle on all of this.
The days of walking into the Flight Surgeons office and walking out with your medications and no bills are a thing of the past!!

MikeF16

Thanks.

I tried the web page but since I hadn't touched it in a year I had to reregister, now it's a 10 day wait for them to snail mail me my new login code. I think they're trying to compete with the VA for worst service known to man .

I did get one funny anecdote out of the entire thing. I called the doctor's office who I thought had overcharged me and told the office manager so. She was incredulous and asked 'what do you mean we overcharged you?' to which I had to answer 'that's when the amount you billed me is more than what I'm supposed to pay'. It was funny at the time but reading it now it just looks like I just wasted 5 seconds of your life you can't get back.