Tricare Standard Maternity **updated**
Can someone help me understand why I keep getting bills after every
appointment? My doctor is a network provider, so that's not in
question.
I was told by the Tricare office on base that if I switched to Standard that there would be no deductible and no-copays. They said maternity is 100% covered under global maternity. I did some checking before I switched and everything I read agreed with this. I've seen lots of posts on here where folks say they didn't pay a dime other than for L&D.
For example: My doctor billed Tricare $145 for an office visit. Tricare paid $137.14. They billed $268 for an ultrasound. Tricare paid $251.66. The bill states that I owe $24.20 and that it represents the co-insurance amount due. I thought if a doctor agreed to accept Tricare as a network provider, they agreed to accept the negotiated amount as payment and not bill the remainder to the patient. Am I wrong?
I also have a bill from my first appointment that says I owe $163 as my deductible. I believe the billing company is saying it is because an ultrasound was unable to confirm pregnancy on that date. Therefore nothing about the appointment was considered "maternity". I don't think that is fair since a urine and blood test did confirm at that appointment, but I think I'm pretty much screwed on that point and will have to pay.
I have a few other bills that also say it's "co-insurance". When I add everything up, I already owe close to $500 out of pocket.
Also, I received an authorization letter from Tricare stating that I have been approved for: 16 office visits, 1 L&D, 12 Fetal non-stress tests and 12 echo exams. So it seems that "global maternity" has been activated. My doctor isn't doing any tests or procedures that are out of the ordinary.
I've called Tricare several times. I've called the billing company that works for my doctor. They keep blaming each other. Help, please!
Re: Tricare Standard Maternity **updated**
I have no clue about Standard, I was/am on Prime during my last preganacy. But as for them blaming each other, have they said whats going on? Is the doctor using the wrong code? Do they have you down as Standard?
We had a problem from DS's NICU stay and bills not getting paid and I called Tricare with the bill date and they were able to pull it up and tell me why it wasn't fully paid. I then had to call the doctor and tell them to re-submit with a different code or what happened to us was his name was down wrong.
Did you go to the doctor before getting your authorization letter/before getting on Standard?
I have some questions.
1) Which region are you in?
2) What exactly does TRICARE say is the provider's fault?
3) And are you sure that you are in the system as Standard? I never once got an authorization for visits, since Standard does not need auths...Tricare just wont pay for what is not considered standard practice (ie 2 U/S unless there is a medical necessity) or something that is not prenatal (ie GERD even though it is caused by being pregnant, it is not actually part of the pregnancy - I know this one).
Are you sure you are recieving bills in the mail, or are they just "explanation of benefits"?
I know with united concordia (military dental insurance provider) I get explanations of benefits after every visit, and it will say how much the office charged and how much united concordia paid...
Usually there is adifference in the amounts, but the office basically agrees to accept the amount that the insurance will pay if they accept united concordia. It states that on the explanation itself. I'm assuming its the same for tricare.
Also, my understanding of standard was that you are expected to pay a deductable once a year, the amount was in the hundred dollar range so yours soudns about right. But thats the max you will pay as long as the kind of care you are getting is covered by tricare.
I hope this helps!!
That is true except for maternity. It's called Global Maternity and there are no deductibles or co-pays.
Unfortunately, they are definitely bills. I know I have a deductible for anything other than maternity, but maternity is treated differently. No deductibles, no co-pays as long as services fall under Global Maternity.
41 weeks pregnant!! How are you feeling?
Thats a bummer then... I recently had some billing issues with my stepkid's doctors office vs. tricare- it was a big mess caused my coding, and I was on the right track to straightening it out and said the magic word "stepdaughter" and they cut me off right there, so now its all up in the air and up to their mom to figure it out (dh is away right now)..
Its all so frustrating, especially when its just because of a clerical error or oversight- I feel your pain on this one!!
41 weeks is interesting... it doesn't feel real anymore lol. Like I feel like my body is playing a big joke on me, I think I'll be surprised when I go into real labor!
You do have to pay the deductible though.
No, really, the deductible does not apply to global maternity. I have verified this with Tricare.
That info is also found on this page, if you click on the Maternity Outpatient Costs link.
https://www.hnfs.net/bene/benefits/TRICARE+Maternity+Care.htm
I went through this twice. I had to pay for the first visit, because that is where the pregnancy was established. I didn't agree with that, but that is how it is.
Other than that, I paid less than $40 for my hospital stay, and nothing else.
And this is on standard.
I've posted on here a few times before, but I'm mostly just a lurker. I'm on Prime and I keep getting a bill for my first appoint (back in the beginning of June) for almost $600! I have gone back and forth between Tricare and the Dr office and both have said it's been "fixed" a few times, but Tricare also said that it was a coding problem. This is my 3rd bill that I've gotten for the same appointment. I hope everything gets fixed for you soon because I know how annoying it is to keep having to get on the phone and deal with this. It might be easier to go to a local office and talk to someone in person. GL!
I went to the Tricare office yesterday and I'm SOL for the first (and most expensive) bill. As PP said, any appointment that includes "pregnancy determination" is not covered. The woman I spoke to said this is one of the biggest complaints they receive and they have been trying to get Tricare to communicate this more effectively for awhile now. In the handbook and on the website it states that global maternity starts with the "first obstetric appointment". It does not mention anything about pregnancy determination. I had to dig around to find that on HealthNet's website.
So if I had just had a urine or blood test as my first appointment, my bill would have been either ~$3 or written off by the doctor. They then should have put me in the system as pregnant and I could have gone back as soon as the following day for a follow up. Instead, since my urine test came back positive, my doctor went ahead and did a pelvic exam, STD's, dating ultrasound -- pretty much the works on the same day. So nothing is covered. Lesson learned.
As for the bills that came after that date, the Tricare office is trying to help me out, but it doesn't look good. My pregnancy did not seem viable at first and apparently Tricare waited to start the global maternity coverage until after my third appointment which I happen to think is incredibly callous.
That is horrible!! So if you had lost the baby, then you would be responsible for the bill? That's just wrong!!
I did get one bill from my OB after I gave birth for the whole L&D and all the appointments and Tricare sent me a check directly, which I deposited and then wrote a check to my OB. Maybe they will do something like that for you?