Military Families
TRICARE Coverage Question
Hi ladies, I have a TRICARE question. MH recently re-signed with the Army Reserves. I will have coverage as of 9/1/2010. Currently, I have no coverage and I ended up having to go to the ER this past week (with no coverage, the bill ended up being massive). My questions is: is there a chance that they will retrospectively cover me for the ER visit being as it was an emergency and the application had already been submitted? I am guessing that I am SOL but I was hoping that maybe someone had some insight on this subject. TIA.
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Re: TRICARE Coverage Question
DH and I were married June 12, 2004. I was enrolled in DEERS around the 21st of that month. I was told that I would not have coverage until August 1st of that year. I was told that if I needed any care, I would have to go to the MTF. If I went to a civilian hospital or doctor, I would be out of luck. The only place I could get my prescriptions covered until August 1 was the base.
Maybe things have changed since then. I don't know. I can tell you if things are the same though, you probably are SOL. It doesn't matter that the application is in. Your benefits don't start until 9/1/2010.
That's what I'm expecting to be the case. I guess that's just the way the cookie crumbles, right?
In my experience, if you were eligible for Tricare benefits at the time of your ER visit, the bills will be covered to the extent possible. If you weren't, though, you're SOL.
FWIW, DH and I were married in late June 2003 and a week later I landed in the ER with a serious infection. I hadn't been enrolled in DEERS yet, but when we called Tricare to ask them if I was covered they said yes. My coverage was retroactive to the day we signed the marriage license even though I hadn't been entered into the system yet.
Since your DH is Reserves, not Active Duty, you have TRICARE RESERVE SELECT, not Standard or Prime.
You are PAYING for your coverage, not being eligible for a entitlement/benefit. So the date of coverage is dependent upon the first payment.
You could try calling yourTriWest to confirm, but I think you are SOL.
Your huge ER bill is one of the truly unjust things about our current healthcare system. There is a multi-tier system of how much people are charged. If you have insurance coverage you get a big break in the bill. If you have no coverage your fees are much higher.
My "guess" is that you're going to have to pay the bill. But you should go IN PERSON to the hospital financial office with paperwork copies showing your DH's status. At the very least, they should reduce the charges to what Tricare would pay for - which is going to be considerably less than the original bill. It could save you hundreds of dollars.
Do call TriWest to determine your eligibility and find out what they authorize for the services you received. Tell the hospital that is what you can pay. Everything is negotiable nowadays.