Tricare Help: Save money: See only participating providers - Getting out, military health issues - Navy Times

Tricare Help: Save money: See only participating providers

Answering your questions on Tricare.

Q. Before I change doctors, I need clarification. The new doctor says Tricare Standard pays him more if I file the claim myself. Is that true?

What he means is that he can collect more if he does not “participate” on your claim.

A provider who files claims for you usually participates in Tricare on those claims. A participating provider agrees to accept the amount Tricare allows as full payment. Tricare pays 75 percent of the amount allowed and the retiree pays 25 percent. By law, that is the maximum a participating provider can collect on that claim.

If the provider does not participate, you file the claim. That provider is allowed to charge you up to 15 percent more than the amount Tricare allows. Tricare pays its usual 75 percent of the amount allowed and the retiree pays his usual 25 percent.

Then the provider can tack an additional 15 percent onto the amount allowed onto the patient’s bill — and the patient, not Tricare, must pay it.

Whenever possible under Tricare Standard, use a participating provider for your care. You’ll save 15 percent.

Q. Why doesn’t Tricare for Life have a membership card that I can use to prove my insurance coverage? My doctor’s office has never heard of that insurance company or that policy. I finally used my Medicare card so I could see the doctor.

Tricare for Life is not an insurance company or policy. It’s a combination of two full-service, stand-alone health insurance plans. To use TFL, you must be a Tricare beneficiary who is entitled to Medicare and is enrolled in Medicare Part B. Medicare and Tricare become TFL only when they are used in combination.

The proof of insurance is your Medicare ID card for the Medicare portion of TFL, and your military ID card for the Tricare portion. Medicare is your primary health insurance; Tricare Standard acts as your free Medicare supplement.

You must seek all your civilian medical care from Medicare providers only. Your provider will file a Medicare claim; Medicare will pay its share, then forward the claim to Tricare Standard, which in most cases will pay whatever Medicare did not.

You can learn more by visiting the official Tricare website

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Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In e-mail, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice any time at our blog.