Question
What is the name of your state? NC
I am Active Duty military and have TriCare Prime coverage. Recently I went to the ER for pregnancy complications. Later I received a bill in the mail stating I did not have insurance coverage from the on-call OB doctor who treated me. I called his office and explained there is a mistake because I am coverred by TriCare Prime. They in turn said they do not accept Tricare and that I am responsible for the payment. However, the hospital accepts TriCare without a problem. If the doctor would've informed me he did not accept my insurance, I would've refused his service. Now, I'm stuck with an over priced bill when free medical is supposed to be our #1 benefit. Can they do that??
Answer
What is the name of your state? NC
I am Active Duty military and have TriCare Prime coverage. Recently I went to the ER for pregnancy complications. Later I received a bill in the mail stating I did not have insurance coverage from the on-call OB doctor who treated me. I called his office and explained there is a mistake because I am coverred by TriCare Prime. They in turn said they do not accept Tricare and that I am responsible for the payment. However, the hospital accepts TriCare without a problem. If the doctor would've informed me he did not accept my insurance, I would've refused his service. Now, I'm stuck with an over priced bill when free medical is supposed to be our #1 benefit. Can they do that??
Have you called TriCare?
Answer
If it was a medical emergency, then the network status of the doctor on call shouldn't matter. But this is probably just a simple case of submitting the bill to Tricare and asking them to pay the doctor....worst case scenario, the doctor wants payment up front and you can expect full reimbursement from Tricare after you submit the claim to them. But I would try to get Tricare to pay the doctor for you. The doctor's office is probably only telling you that they won't submit the bill for you because they don't have a contract with Tricare.
Make sense?