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ericandmarie
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Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.
TriCare question
So I went to the Urgent Care a couple weeks ago because I fell and sprained my ankle pretty bad to where I thought (and the Dr. I work for thought) it might be fractured. I called and asked the quick care if they took TriCare Prime they said yes. When we got there I asked another 4 times if they took Prime.. not just standard and they said yes.
I was seen and told everything would be taken care of. Today I get a letter and EOB saying that I owe $105.
I was under the impression that ER and quick cares were completely covered. I know my last ER visit was. So quick cares aren't?
I'm really confused and kind of angry (i guess mostly at myself for not confirming it). Why would quick care said it would be completely covered?
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Re: TriCare question
I got an EOB from the ER (like the actual hospital) last time that was just an EOB. This one is a letter and EOB from TriCare.
It says:
Dear E&M
On March 5, 2012, you received services from [quick care] (and lists what I had done)
Your TRICARE benefits covers the service(s) listed above.
Tricare has applied the entire approved amount to your deductible. The amount you owe the provider for the service(s) is $104.05. You may have already paid this amount, and this is the maximum amount you owe provider for this claim.
Then tells me who to call and they're here to serve me and yada yada yada.
Hmm, I would just try calling the quick care place and explaining that they told you it was covered and see what they say.
I've had 3 urgent care visits 100% covered.
EOB is not a bill. There's a chance you won't be charged anything, but I'd still call and ask.
Did you have a referral? ER visits don't require them, but all others do. If you didn't call the MTF and have your provider put one in to submit to Tricare, that may be why you received a bill.
I would call or bring the EOB to your local Tricare office to confirm that you owe that balance. I have never paid anything out of pocket for urgent care visits.
This is right, with urgent care you pay a cost share of 20% if you do not get a referral first.
This is right, with urgent care you pay a cost share of 20% if you do not get a referral first.
When I worked in Referral Management we never did retro referrals. The system we used couldn't backdate and Triwest said they wouldn't either. Maybe they did this in the past, but changed their policy? Or it varies in different Tricare regions?
In my experience, no referrals are needed if the medical problem is potentially life-threatening. When I was rushed to a non-MTF ER without a referral for suspected appendicitis, that visit was covered 100%. Anything less serious needs a referral, though.
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Thanks guys, I guess I'll have to call.
I don't know where I heard it but I thought for sure Quick Care visits were covered just like the ER.
Did you bring your bill to Tricare? They probably filed a claim with Tricare to get the bill absolved if there is supporting documentation (i.e. the provider documented in AHLTA the test was being requested). Maybe that's what happened instead?
Also, It's possible the swallow test was specifically requested, but Tricare made an error in billing you and corrected it.
If your PCM did not specifically request the swallow test on the referral,the ENT specialist should have never done it. Most network providers review referrals before scheduling appointments. Even if they caught it the same day, the office could have contacted the MTF to process it as a STAT. Usually STAT referrals are reserved for emergency type issues (ie patient goes to the ER, and needs a follow-up with a specialist that same day), but if it was an error on the PCM's part, Tricare will process it right away per the PCMs request.
I brought my bill to Tricare to work it out. They said I needed a referral from my PCP. I needed write a letter stating why and what I had done. Then, the PCP would issue a retro referral and everything would be hunky dory. I had the swallowing test done. It was roughly a month and a half from the actual test that I got a retro referral. I am on Tri-South, if that matters.
I also had an ultrasound done that was ordered by the same doctor. Ultrasound was covered under my ENT but the swallowing test was not.