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Thread: Am I understanding TriCare Coverage right?

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    #1

    Am I understanding TriCare Coverage right?

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    Hello all! I am new here and new to being a Military SO. We are going to be getting married this summer and looking at Tricare vs my insurance with my work and I am hoping you can all help me understand a few things. My BF is in the Army Reserves and we are looking at the reserve Select Plan. Looking at the cost shares it would see that once you pay the annual outpatient deductible that things like office visits are covered you would just pay for lab work etc if needed. Is that correct? Also for those who have had Tricare for a while, does it often change year to year what they cover or does it stay pretty stable?

    Also if anyone who reads this happens to be in Utah-any personal experience with it in this state?

    Thank you all!!! Any pros/cons or advice you have please share!!
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    Personally, I think TriCare can be very difficult to understand, no matter how much experience you have with them!

    I would call their customer service center for wherever you are stationed--if it is Utah, I believe they are covered by TriCare West. Your SO should have the customer care number. They will be the best people to answer your questions because they can answer your specific questions and you won't be getting guesses/experiential answers from an online forum. Overall, TriCare tends to be rather stable with what they cover.

    Visit Home to see what is covered/find the appropriate TriCare customer service line
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    Personally, if you have your own insurance I would continue to use that. I would forgo tricare at all costs if possible.
  4. "If you don't like my attitude, quit talking to me"
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    I am under the understanding that reserve tricare is only 'active' when they are on orders.
    I would use your employer as primary and tricare as secondary.

    I would also surely call Tricare to get the specifics on reserve select because there may be stipulations as to when it can be used.

    As far as coverage, it is normally pretty consistent. The copays and coverages haven't changed since I can remember.

    There are 10 types of people in the world, those that understand binary and those that don't
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    Why would you forgo it Southern-queen?
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    #6
    Dont. Get. Tricare.
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    Quote Originally Posted by Dr.VinoVet View Post
    Dont. Get. Tricare.
    Why? BF thinks its great so I need some good reason to make as to why we should not if that is the case. I guess he had it in the past but it was just him.
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    Quote Originally Posted by LizaLou View Post
    Why would you forgo it Southern-queen?
    Because imo, it is crap medical care. I dislike that in general, you have to ask your pcm (primary care manager) for a referral to see any other doctor in the hospital. Want to see a dermatologist, ask your pcm. Pregnant and want to see an ob/gyn than go ask your PCM (if you are seen in family med) for a referral.

    And yes, I realize that to some extent you need permission to see other doctors on outside health insurance. But dang. Permission to see a military doctor at a military hospital as a dependent or even active duty?

    Than add to the fact that many hospitals offer substandard care (imo) or only part time care. I mean I have plenty of reason for not liking tri-care. I won't get into all of them as many are personal but yeah....
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    Quote Originally Posted by Southern-queen View Post
    Because imo, it is crap medical care. I dislike that in general, you have to ask your pcm (primary care manager) for a referral to see any other doctor in the hospital. Want to see a dermatologist, ask your pcm. Pregnant and want to see an ob/gyn than go ask your PCM (if you are seen in family med) for a referral.

    And yes, I realize that to some extent you need permission to see other doctors on outside health insurance. But dang. Permission to see a military doctor at a military hospital as a dependent or even active duty?

    Than add to the fact that many hospitals offer substandard care (imo) or only part time care. I mean I have plenty of reason for not liking tri-care. I won't get into all of them as many are personal but yeah....
    I'm not sure what your experience has been with TriCare, but I've never had a problem getting a referral from my PCM, even over the phone. I've had dermatology issues my entire life and as soon as I ask to go see one they give me a referral right away to see almost any doctor I want. Also, you can go to another doctor besides your PCM if your PCM doesn't have availability within the next 24 hours, you just need to call the appointment hotline.

    this isn't too different from what it is like in the civilian sector for medical care--you need a referral to see most specialists. For a brief 3 years of my life I was not covered by TriCare, but rather by a private insurance company and I had to jump through more hoops in order to see a dermatologist and a gynecologist. And then they didn't cover most of my treatment even though I had the referral.

    A lot of this also depends on whether you are on TriCare Prime, TriCare Standard or TriCare Remote. Like many other things related to the military, you need to be on top of things and know your rights/benefits in order to receive them. That's why I recommend talking with a customer service agent/exploring their website. Most of their agents are knowledgable about what you need to do in order to get something done.
  10. "If you don't like my attitude, quit talking to me"
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    #10
    Quote Originally Posted by emtuck90 View Post
    I'm not sure what your experience has been with TriCare, but I've never had a problem getting a referral from my PCM, even over the phone. I've had dermatology issues my entire life and as soon as I ask to go see one they give me a referral right away to see almost any doctor I want. Also, you can go to another doctor besides your PCM if your PCM doesn't have availability within the next 24 hours, you just need to call the appointment hotline.

    this isn't too different from what it is like in the civilian sector for medical care--you need a referral to see most specialists. For a brief 3 years of my life I was not covered by TriCare, but rather by a private insurance company and I had to jump through more hoops in order to see a dermatologist and a gynecologist. And then they didn't cover most of my treatment even though I had the referral.

    A lot of this also depends on whether you are on TriCare Prime, TriCare Standard or TriCare Remote. Like many other things related to the military, you need to be on top of things and know your rights/benefits in order to receive them. That's why I recommend talking with a customer service agent/exploring their website. Most of their agents are knowledgable about what you need to do in order to get something done.
    Agree.

    I haven't ever had any issues with Tricare or the clinic or my PCM. Maybe its because we are AF and until we moved here we were always seen at civilian doctors due to the clinic having minimal staffing.

    I've never had to see my PCM before making an appt with OB/Gyn, I have always directly called OB or just called Appt line and made an appt with OB.

    The only referrals I have ever needed were specialists for a specific things, and 90% of the time you have to see the PCM first anyway because you don't really know what the issue is. We can't self-diagnose, so a PCM would need to be sure whatever specialist is needed.

    I have found the care to be better than civilian doctors. The doctors are fine, Tricare customer service can be difficult at times, but the care at a clinic/hospital has been just fine and (in my case) better than civilian.

    There are 10 types of people in the world, those that understand binary and those that don't
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