Tricare Standard out of Region / Network?

Greg112 · 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?

BigTexRex · 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.

remoandiris · November 12, 2016

Whatever happened to the West/South merger??? Or do I have my regional mergers mixed up?

BigTexRex · November 12, 2016

Tricare went from four to three regions:

http://www.tricare.mil/About/Regions?sc_database=web

remoandiris · November 13, 2016

Thanks for that.

Scion Gypsy · 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.

nana25k · 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.

remoandiris · November 17, 2016

And yes they are transitioning to 2 regions as we speak.

Should make it easier on travelers, yes?

nana25k · November 20, 2016

Should make it easier on travelers, yes?

For your sake one can only hope

skp51443 · 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?

remoandiris · 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.

nana25k · 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

skp51443 · 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.

RV_ · 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.)