Military Significant Others and Spouse Support - MilitarySOS.com
Results 1 to 6 of 6

Thread: Help with cost-share info for Tricare Standard/Extra????

  1. Feelin' fly like a Cheesestick
    BethM's Avatar
    BethM is offline
    Feelin' fly like a Cheesestick
    Join Date
    Mar 2010
    Location
    Silverdale/Bremerton, WA
    Posts
    9,770
    #1

    Help with cost-share info for Tricare Standard/Extra????

    Advertisements
    I know there are people here who are or have been on Tricare Standard and I need help understanding.

    Ok, I know that there is a $150 deductible that must be met before Tricare starts cost-sharing. So will my provider (in-network) bill me for this or will they know what I need to pay when I go in (like a co-pay, paid before I see the doctor)??? Say that visit is $150... do I just pay $150 and then the next time I pay 15% because the cost-sharing starts?

    Does maternity care work any differently? And is it 15% each visit?

    I'm just confused about whether they bill me or if I pay my share up front or what?

    Also, I saw a psychiatrist yesterday (at the referral of my PCM) and they've already billed (wow!) and I see that it's $300... Oh. My. God. So if the next visit is $300, am I responsible for $45 of that (assuming I have already met my $150 deductible... otherwise I know I'd have to pay $150). Just sayin'... if I have to pay $45, I might not go back. I had NO idea it was that much LOL.

    Just curious so I know what to expect when I go for my next appointment.

    (I did see that my PCM's visits always seem to be $100... so I know my copay for that would be $15 after my $150 deductible is met.)
    Beth, Mama to Emmalee (12), Evan (9), and Ella (4 on May 7) (I really REALLY need to update my picture!)
  2. Moderator
    TheSisterWife's Avatar
    TheSisterWife is offline
    Moderator
    Join Date
    Jan 2010
    Posts
    20,567

    #2
    I think it's different for maternity care. I was on Standard for my last trimester with Damien, and I paid one copay ($15 or $20, I don't remember) and that covered the remainder of my maternity care. I never paid a deductible while I was on Standard, but I only received maternity care before I switched to Prime after D was born, so I'm not sure about the other providers.
  3. Together, Apart, Together, Apart .. its the Navy
    Pickels's Avatar
    Pickels is offline
    Together, Apart, Together, Apart .. its the Navy
    Join Date
    Feb 2008
    Location
    Ashland, OH
    Posts
    5,504
    #3
    Quote Originally Posted by BethM View Post
    I know there are people here who are or have been on Tricare Standard and I need help understanding.

    Ok, I know that there is a $150 deductible that must be met before Tricare starts cost-sharing. So will my provider (in-network) bill me for this or will they know what I need to pay when I go in (like a co-pay, paid before I see the doctor)??? Say that visit is $150... do I just pay $150 and then the next time I pay 15% because the cost-sharing starts?

    Does maternity care work any differently? And is it 15% each visit?

    I'm just confused about whether they bill me or if I pay my share up front or what?

    Also, I saw a psychiatrist yesterday (at the referral of my PCM) and they've already billed (wow!) and I see that it's $300... Oh. My. God. So if the next visit is $300, am I responsible for $45 of that (assuming I have already met my $150 deductible... otherwise I know I'd have to pay $150). Just sayin'... if I have to pay $45, I might not go back. I had NO idea it was that much LOL.

    Just curious so I know what to expect when I go for my next appointment.

    (I did see that my PCM's visits always seem to be $100... so I know my copay for that would be $15 after my $150 deductible is met.)
    lol I know from the Insurance Biller side of it (yeah I billed out for things on Tuesday that happened on Monday.) (I never worked OB/GYN, only ortho, nursing home, and PT/ST/OT) If I saw you had a copay in my system I would take it at time of check out, now with that said... I would enter it in my system, so next time you come in I'm going to know that with my system you have paid such and such towards your dedut. I won't know what someone else has you at. But there are diffrent deduts for things, ER, Specialty, PCM. Mine as a Specialty (ortho) had nothing to do with ER or PCM. Now if for somereason you are seeing more than one Specialist at a time there is only one dedut for you to meet. So When I bill Tricare, I'm going to show that I also billed you for such and such copay and that it was paid. If Tricare then hits me back with the full bill paid (including what you paid, so essen. I got say 10.00 from both of you) then I will note that in your account in my system. Which at the end of the month refund checks for overpayment would be cut. I would also know the next time you came in that you had a overage in your account, so I wouldn't take your copay. This is why billers bill out ASAP, if they don't, they have the poss. of being out that money untill the end of the month when bills go out to indiv. parties, where you may have to wait another month (if you are lucky) for payment.

    did any of that make sense? it is late lol
    Florida girl in a Snowy World
  4. Together, Apart, Together, Apart .. its the Navy
    Pickels's Avatar
    Pickels is offline
    Together, Apart, Together, Apart .. its the Navy
    Join Date
    Feb 2008
    Location
    Ashland, OH
    Posts
    5,504
    #4
    Oh I also read somewhere (might have been on here) that once you hit a certain appointment in your preggers.. everything after that falls under that 1 appointment, so if its like 2nd trimester appt. after you sono... everything after that would have to billed under that appt. sans the acctual birth.
    Florida girl in a Snowy World
  5. Senior Member
    *Stephanie*'s Avatar
    *Stephanie* is offline
    Senior Member
    Join Date
    Feb 2008
    Location
    JBER; Anchorage, AK
    Posts
    16,315
    #5
    I always got billed afterwards since its a cost share not co pay.

    Also if your getting billed for maternity care they probably aren't billing things right. Maternity is 100% covered on standard.
  6. Account Closed
    BeachBum's Avatar
    BeachBum is offline
    Account Closed
    Join Date
    Feb 2009
    Location
    Florida
    Posts
    184
    #6
    Quote Originally Posted by BubMunkeyBles View Post
    I always got billed afterwards since its a cost share not co pay.

    Also if your getting billed for maternity care they probably aren't billing things right. Maternity is 100% covered on standard.
    This was my experience. I paid my co-pay after one appointment with my PCM. After that I was billed for 15% of all other medical bills except maternity bills.

    The only time I had to pay for 15% of anything maternity related was when I had an additional test that was not considered medically necessary. I can't remember which test it was but it only cost me $40. All of my ultrasounds were covered, even the 20 week scan.

    Hope this helps!

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •