Participating Non-Network Providers — The Bump
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Participating Non-Network Providers

heiringkheiringk
in Military Families
Yes, another Tricare question. Really wish they made it easier! Okay, so I'm on Tricare Standard and am not near a base at all. There are no pediatricians that are in-network providers but I talked to one who is a participating non-network provider who will submit a claim up each time I see him and he said he does accept the amount tricare offers for each appointment. So does that mean there won't be a cost share to pay, therefore being pretty much the same thing as an in-network provider? I need some help..I'm not an insurance guru in the first place. Embarrassed Thank you in advance!
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Re: Participating Non-Network Providers

  • bootsie08bootsie08
    You will have a 20% co-pay, vs. a 15% co-pay with network providers. 
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  • heiringkheiringk
    Then why haven't I received a bill at all for seeing my OB? He's not an in-network provider at all either? I'm just so confused! Trying to make sense of it all.
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  • seastar77seastar77
    My DD sees a participating non-network provider. I pay 20% copays. It doesn't much matter to me because the only participating providers are 45 min-1 hr away and I don't want to drive that far for every appt, plus we hit our max cap within a few months each year so what the actual copays are doesn't much matter. You probably haven't seen OB bills bc of the global maternity coverage - you shouldn't get billed for anything OB related except perhaps some extra tests or an u/s here and there, though I've had a bunch of extra stuff done this pregnancy and not seen a bill for any of it.
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  • bootsie08bootsie08

    imageheiringk:
    Then why haven't I received a bill at all for seeing my OB? He's not an in-network provider at all either? I'm just so confused! Trying to make sense of it all.

    Maternity care is exempt from deductibles and co-pays under the "global maternity" provision.  As long as everything is medically necessary and an allowable charge, it will be covered 100%.  You will have a room charge for delivery, which runs about $16/day.  If you go to your OB and he treats, say, a bladder infection, you will have a cost-share for that because it's not directly related to the pregnancy.  

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  • heiringkheiringk
    Okay thank you very much! I didn't know that was the reason why I got everything covered for my pregnancy. I thought maybe I didn't specify something to tricare or something got screwed up in the system. Like I said, I'm not the smartest when it comes to insurance. This helped a lot! THANK YOU very much!!!
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