Tricare Prime Confusion?

Question

This might be a little long, but I appreciate any help given. I've been having trouble with Tricare Prime, but the main problem is right now is that they billed my husband and I $170 for an eye exam off base for my husband. In the Tricare Prime handbook it states that Active Duty and Active Duty family member can get 1 free eye exam a year. I got my exam and the place I went to off base, I asked them if my husband was allowed to get one free exam as well. And they told me yes. So my husband got an eye exam, and then a week later Tricare bills us for $170 stating that my husband is not allowed to be going off base. I did not kow this and I am new to all this military stuff, but in the handbook it doesn't say anywhere that an active duty service member cannot go off base. Well I just need some help and advice, I appreciate it. Thanks.

The reason we did not get an eye exam on base, is because it takes too long to get a appointment for him. It is obvious that I did not know this, unless they really think we would want to pay $170. The place I found off base is actually on Tricare's website, stating that the insurance will cover that place. The doctors there even told me that Tricare should cover it as well. In the handbook it says nothing about where an Active Duty member should be seen on base. Do they think we'd really want to pay $170?

Tricare only billed my husband, not myself. We were seen at the same place.

Answer 1

Active Duty can ONLY go through the military, he should have known that as it is drilled into them from day one.

You are responsible for the $170.

Answer 2

It totally sucks but be glad that the bill is only $170. It could be a lot worse. $170 is recoverable. I've heard of people going out in town with the same assumption and getting hit for upwards of $1000 for what ever they had done.

Look at this as a wake up call for you. You're Tricare Prime which is for dependents. He's some other form of Tricare for active duty. There are major differences in the billing and where you're allowed to go. In general, he *must* get his medical care through his base provider. As asinine as the system can sometimes be and as much of a pain as it can be to get an appointment, that's just the way it is. You'll always pay out of pocket if he goes outside that system and he can even get in major trouble if he does it too often.

The only recourse you have now is to work out a way to pay the bill. So find out who is actually billing you, Tricare or the eye doctor. Sometimes Tricare sends what looks like a bill but is actually a notification that they didn't pay this so you're responsible so make sure who you owe. Then go in and work out a payment plan with them.

Answer 3

The military member must go to have all of their medical attention on base. I know that Tricare can be confusing. To be honest, many times if you are near a base, they make the dependant utilize the medical facilities on post. You should definitely double check before you seek medical help off of post again, as they are likely to deny your claim. There are certain circumstances that they will allow the dependant to go off post, but not always. If you are ever in a situation again where you aren't sure- double check with Tricare first. They are quite helpful. Best of luck to you, be patient- you will start to get the hang of it!

Answer 4

I am sorry that happened to you Tricare can be hard to decifer at first but you will get the hang of it. The best addvice I can give is always call you PCM "primary care provider" before you go off base. There are some things they will ok off base but you have to get that permission first. For now I advise going to your MTF "military treatment facility/clinic" There will be a tri care specialist there that may be able to help you. If this 170$ is more than you can aford and you need finacial help go to you NMCR "navy marine corp relief society" or Red cross they can help get you fiancial help. They have intrest free loans for emergencies Good luck before you know it you will be a pro.

Answer 5

With Tricare Prime, Prime being the key word because there is another Tricare program.
In Tricare Prime no one covered under it can go off post unless, they have a referral from an on post doctor. You husband or yourself in order to been seen off post you need to get a referral.
make sure you double check because if they have an Eye doctor on post they, Tricare may only cover part of the cost if you go off post.
For instance if you and your husband get pregnant you will have to be seen on post, if they don't have an OBGYN, like where my husband and I are, they only have a gynecologist, I have to see her first and then get a referral.

Answer 6

Dependants are allowed to be seen by civilian doctors off base, but if you are, then you will end up footing the medical bill. Tricare will not cover any medical appoitments that are scheduled with civilian practitioners.

Military members are not allowed to be seen by anyone other than military care providers, unless they have been referred to by his or her PCM.

While your husband is in the military, take advantage of the free medical and dental care as much as possible. It's worth it in the long run.

Answer 7

Your husband can not use a cilivian medical or optometrist with out prior approval from his medical department at the command he stationed at unless it is a emergency. They do have eye care at the command he is at and if he had to wait that is way it goes. For him to do this with out approval was not the best thing he could have done, look I am sure that if he goes back and explains the situation with his command they will work sum thing out and also try explaining this to the eye doctor that you saw they should work with you and him. I know about using off base medical care because when I was a recruiter years back I was authorized to use the civilian dental due to my station being so far from our main head quarters. So unless you all live more than 50miles from his base or post or you on independent duty he pretty much has to use the base. Sorry hope this helped I am Ret Navy and I have Tri Care Prime now for me and my wife.

Answer 8

active duty must go on base unless they get a nonavailability statement or tricare or their PCM refers them. dependents may go off base to a doctor in the tricare list IF there is not care available for them on base. the base we are at right now alot of the med people are deployed etc and all the new people coming in are getting military docs but their families are getting sent to civilian docs by tricare. my children and i have civilian doctors and because of that we go off base for everything (because we have referrals from our civilian PCM)......a friend of mine has been here for over a year and both our children had to have a test done...she went to the onbase hospital (because her kids PCM is onbase) and had a horrible experience there....i went to a huge childrens hospital with technicians that do this particular test about 20 times a day. sometimes its luck of the draw really...but my husband always has to go on base no matter what.

Answer 9

with tri care prime you have to go to a military doctor in order to get free visits with prior aproval from tri care you must have that aproval or youll have to pay for your expensies im sure the book has that in there too you cant just assume with the military on anyting alwayse check before you act

tri care will pay for a vist if the military doctors office them selves sends him off post to get an eye exam however if you just took incentive because it was inconvient for you and your husband to see a doctor on post then you will get billed for it you have to go throught a process with tricare if they were over booked at the doctors office then you could have gotten permision to see a doctor off post for free but you didnt communicate that to them

some things you really need to communicate on especially with the military before you just assume that the military will pay for it or that you will benifit from it the military

normally before you get tri care you go throught a breifing about what you can and cant do if you would have gone to tricare first and explained that they are over booked at the clinic and you want to go to the economy first you may not have been billed but you took the incentive on your own with out warning hence they billed you for it the best thing you and your husband can do is go to the hospital and see what needs to be done or call the tricare hotline

Answer 10

If you fight it you might be able to not pay
However most times you are only allowed to go off base if there is no way to get the treatment on base. ie: If no Doc on base could do the eye exam then you can go to a civilan. But if the base hospitial can do eye exams you have to go there.