Greg112 Posted November 12, 2016 Report Share Posted November 12, 2016 We've got Tricare Standard with a Livingston address so we're serviced by the South Region. Seems like lately getting medical care in the West Region we're getting charged a 25% out of network copay even when the provider shows on the West website as in-network. I've checked some of the past EOBs from West providers and they show a 20% copay. Talking to Tricare we're told if the provider is not in the South Region network database they're out of network. Is this something recent? New interpretation of regs? Did we get away with something previously? Is this right? A provider that is network for a West Region beneficiary is out-of-network for a South Region beneficiary? Wouldn't this interpretation make Standard like Prime? What do nonmobile people that live near regional boundries do? Link to comment Share on other sites More sharing options...
BigTexRex Posted November 12, 2016 Report Share Posted November 12, 2016 There are three regions of Tricare and each is covered by different insurance companies. North is Health Net, South is Humana, and West is UnitedHealthcare. So, if you use the West region and are assigned to the South region you're outside of the network because the doctor accepting Tricare is actually accepting a different insurance company for assignment fees. Rex & Karen Libre y pobre en La Casa Rodante Link to comment Share on other sites More sharing options...
remoandiris Posted November 12, 2016 Report Share Posted November 12, 2016 Whatever happened to the West/South merger??? Or do I have my regional mergers mixed up? Link to comment Share on other sites More sharing options...
BigTexRex Posted November 12, 2016 Report Share Posted November 12, 2016 Tricare went from four to three regions: http://www.tricare.mil/About/Regions?sc_database=web Rex & Karen Libre y pobre en La Casa Rodante Link to comment Share on other sites More sharing options...
remoandiris Posted November 13, 2016 Report Share Posted November 13, 2016 Thanks for that. Link to comment Share on other sites More sharing options...
Scion Gypsy Posted November 16, 2016 Report Share Posted November 16, 2016 TriCare is going to 2 Regions soon, North and South. Not sure on effective date but the new contract was let about a month ago. Don Kostyal CMSgt, ret USAF A Veteran - whether active duty, retired, national guard or reserve - is someone who, at one point in their life, wrote a check made payable to "The United States of America", for an amount of "up to and including my life."Author Unknown Link to comment Share on other sites More sharing options...
nana25k Posted November 17, 2016 Report Share Posted November 17, 2016 We used standard until hitting the TFL age and never had an issue. Didn't matter where we were. And yes they are transitioning to 2 regions as we speak. Ron & LindaClass of 20072000 Monaco Diplomat 2005 Honda Element"Do what you can, with what you have, where you are" Theodore Roosevelt"We can't control the wind, but we can adjust our sail""When man gave up his freedom to roam the earth, he gave up his soul for a conditioned ego that is bound by time and the fear of losing its attachments." Link to comment Share on other sites More sharing options...
remoandiris Posted November 17, 2016 Report Share Posted November 17, 2016 And yes they are transitioning to 2 regions as we speak. Should make it easier on travelers, yes? Link to comment Share on other sites More sharing options...
nana25k Posted November 20, 2016 Report Share Posted November 20, 2016 Should make it easier on travelers, yes? For your sake one can only hope Ron & LindaClass of 20072000 Monaco Diplomat 2005 Honda Element"Do what you can, with what you have, where you are" Theodore Roosevelt"We can't control the wind, but we can adjust our sail""When man gave up his freedom to roam the earth, he gave up his soul for a conditioned ego that is bound by time and the fear of losing its attachments." Link to comment Share on other sites More sharing options...
skp51443 Posted November 20, 2016 Report Share Posted November 20, 2016 As long as I called for authorization first I never had a problem with being out of my home area, is that a problem today? First rule of computer consulting: Sell a customer a Linux computer and you'll eat for a day. Sell a customer a Windows computer and you'll eat for a lifetime. Link to comment Share on other sites More sharing options...
remoandiris Posted November 20, 2016 Report Share Posted November 20, 2016 As long as I called for authorization first I never had a problem with being out of my home area, Same here. Wife and I are on Prime. Link to comment Share on other sites More sharing options...
nana25k Posted November 23, 2016 Report Share Posted November 23, 2016 As long as I called for authorization first I never had a problem with being out of my home area, is that a problem today? Are you on Prime? We never needed any authorization for anything in standard and never ever made a phone call Ron & LindaClass of 20072000 Monaco Diplomat 2005 Honda Element"Do what you can, with what you have, where you are" Theodore Roosevelt"We can't control the wind, but we can adjust our sail""When man gave up his freedom to roam the earth, he gave up his soul for a conditioned ego that is bound by time and the fear of losing its attachments." Link to comment Share on other sites More sharing options...
skp51443 Posted November 23, 2016 Report Share Posted November 23, 2016 No, I'm on Tricare Standard. It was years back now but I got stuck for a couple short-term, expensive prescriptions when I didn't get authorization to pick them up out of my home area. Called first after that and never had another issue. First rule of computer consulting: Sell a customer a Linux computer and you'll eat for a day. Sell a customer a Windows computer and you'll eat for a lifetime. Link to comment Share on other sites More sharing options...
RV_ Posted November 25, 2016 Report Share Posted November 25, 2016 I traveled with Standard too, 1997-2003. We actually stopped at bases a lot and always had a VA nearby. The active duty clinics and hospitals like Travis back then were the only places that gave me a hassle. I had to register all over again with the Medford OR VA hospital when I fell off my ladder onto the cinder covered spaces at Sutherlin and broke some ribs. I used the Madigan Army Medical Center for a follow up as we moved to McChord AFB next that year. So for Tricare standard like me I always made a mental note of the VA and Military facilities nearby. I would rather go to a base clinic than an unknown civilian doc. I just had cervical and lumbar surgery at Laser Spine Institute in Tampa. They had to get my surgery approved which cost me an extra thousand out of pocket for the exam trip and then back for the surgeries. NO issues and yes, we still are on Tricare Standard. Despite living next to an Barksdale AFB, where we do fill prescriptions from our civilian doc, I do not like the lack of selection locally here for the Prime docs. We can afford our Catastrophic cap and this fiscal year may hit it with my neurosurgeries and up next before Christmas or mid January 2017 we will get my laser cataract and lenses replaced for no glasses vision. That alone is $3000 out of pocket, $1500.00 each eye over and above what Tricare covers. We can afford it. Our decision was based on our excellent health save my back issues. There are other options as I discovered since the VA was not even on my Radar until we were full time. Many years we did not need a doc and did not have to pay for coverage. If we did it was $150.00 not the $600 plus for family Prime. (I did not look up the cost of Prime but it was in that ballpark. Standard still is the same I believe,but I keep hearing about increases coming.) RV/Derekhttp://www.rvroadie.com Email on the bottom of my website page.Retired AF 1971-1998 When you see a worthy man, endeavor to emulate him. When you see an unworthy man, look inside yourself. - Confucius “Those who can make you believe absurdities, can make you commit atrocities.” ... Voltaire Link to comment Share on other sites More sharing options...
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