Tricare copay more expensive? — The Bump
Military Families

Tricare copay more expensive?

I have been on tricare standard since 2010. I gave birth to my first child in 2011. I am pregnant with my second child now. I received my first bill from my OB office, new state and new OB, and it is more than any bill I received during my last pregnancy routine visits. I am using an in network provider like I did before. I am planning on contacting Tricare to get more answers but wanted to see if anyone else had similar experiences or might know why it is so different.
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Re: Tricare copay more expensive?

  • IlumineIlumine member

    TRICARE Standard has a cost share, not a premium/co-pay.  Your cost share as an active duty family member, is 15% (in network) or 20% out of network - as long as the provider accepts TRICARE.

    You also have an annual individual deductible of $50 for under E5 or $150 E5+ and a family deductible of $100 or $150.  That must be met before any TRICARE coverage begins, to include Global Maternity. 

    FInally, the first OB visit where your OB officially diagnosis your pregnancy is not covered under the Global Maternity coverage.  

    So if this was your first visit for this pregnancy and you have not met your annual deductible, you would have to pay a lot.  This happened to me.  

    file:///Users/Ilumine/Desktop/Family%20Portrait%20for%20gift.jpg
  • I switched to standard in January because I wanted to deliver at a civilian hospital, with a better Dr. I have yet to pay anything for my visits, and tests. I was told that I will have to pay $25 a day for hospital stay- that included my husband's meals and his stay too, if he chooses to stay with me. That's it though.

    **knock on wood that I don't get a bill before then!**

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  • The first replay is correct that is is a cost share and you have to meet the deductibles first.  However the other catch is that it is Tricare Standard/Extra.  Just because your doctor will accept Tricare insurance doesn't mean they are in the network.  So if the doctor is in fact out of network the office is billing Tricare through the Standard option making your out of pocket costs higher.  To be in network the doctor should be billing through Tricare Extra.  I have also found over the years that if the doctor's office doesn't code the visit properly it will result in higher costs or Tricare not pay at all.  Perfect example the doctor's office can't bill Tricare for a "physical exam" they must bill for each service performed under the physical umbrella for Tricare to pay for the services.

    Good luck. Hope you are able to get to the bottom of this.

      

  • Thank you for the replies. I'll update when I find out more in case anyone else has this issue.
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  • imageIlumine:

    TRICARE Standard has a cost share, not a premium/co-pay.  Your cost share as an active duty family member, is 15% (in network) or 20% out of network - as long as the provider accepts TRICARE.

    You also have an annual individual deductible of $50 for under E5 or $150 E5+ and a family deductible of $100 or $150.  That must be met before any TRICARE coverage begins, to include Global Maternity. 

    The family deductible is $300 yearly if you're E5+, so that could make a difference too.   

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  • Just wanted to update...I've been given the run around and don't really have any new answers. But the next time I went to my OB there was a credit on my account so I guess somebody figured out the coding. Thanks for the replies.
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