Tricare Help: Can I be sure fiancée will keep same doctors? - Getting out, military health issues - Navy Times

Tricare Help: Can I be sure fiancée will keep same doctors?

Q. I am an active-duty sailor who is getting married this month. My fiancée has bipolar disorder. She’s concerned about being able to keep her same doctors and therapist when we are married. How can I help her ensure she keeps her current doctors once she’s under Tricare?

A. Tricare is a federal program, but it has a rule in common with most commercial health insurance companies and policies: For Tricare to help pay for medical services, the provider of care must be registered with Tricare and be authorized to be paid by Tricare for covered services rendered to Tricare beneficiaries.

Tricare has no limits or restrictions on its coverage of pre-existing conditions. Mental health care, including pharmacy services, is a Tricare benefit, subject to existing rules regarding the medical necessity and appropriateness of care for the particular patient’s diagnosis, symptoms and medical history.

Once you are married, seamless continuity with your wife’s same providers may be a problem for two reasons:

• The perennial element of military service: You are subject to periodic transfer to a new location, perhaps across the world. You have little or no control over that element of military service.

• Whether your wife’s providers are, or are willing to become, Tricare-authorized providers. Your wife should talk to her doctors about becoming Tricare providers if they are not already, and direct them here to learn more. That decision is voluntary and entirely in their hands.

Q. I am 66 and have Tricare for Life. Medicare covers only one prostate-specific antigen test a year. I just had a PSA test and it was high. The biopsy showed cancer. They are going to remove the prostate. After three months I am going to need another PSA to see if they got it all. Will Tricare cover the test?

A. Under Tricare for Life, Medicare has become your primary health insurance. All claims must be filed with Medicare first. Tricare is second payer on all claims. When a medical service is covered by both Medicare and by Tricare, Tricare will act as your free Medicare supplement and will pay whatever Medicare did not pay.

Regardless of whether Medicare will cover the second test, all claims for it must be submitted to Medicare first. That’s true even if Medicare will deny payment on that claim.

If you diagnosis is made a part of your Medicare claim, I feel certain it will be paid. Regardless of whether Medicare covers the second PSA, Tricare will cover it if the claim, including your diagnosis, is submitted properly to Medicare first. Even if Medicare denies payment, it will forward the claim to Tricare just as it always does.

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