Vets, what did Tricare pay?

[wolfpacker]

Request some info from our vets/military retirees on Tricare: I understand with the Tricare billing system, if you get a referral to a surgeon who Tricare "approves" from your PCM then the surgery will be totally covered by Tricare. However, I was told by the Tricare rep on the phone (humana military contractor) that if I choose to go to another "in-network" Dr of my choice who is outside of my local area (in my case I want to see Dr Eid, but I'm sure Tricare won't approve a referral to him since he's several states away) that this is called Tricare "point of service billing" and I will be responsible for splitting the bill 50/50 with Tricare.

My question is: those who had the surgery paid for with Tricare, how much did Tricare pay in total? I need this info to have an idea of how much I will be responsible for paying before I commit to going down this route.

Many thanks brothers

[Txagq8]

Tricare Select, which used to be Tricare Standard.

Hospital/surgeon/anesthesia/labs billed a total of $53K.

Tricare allowed just shy of $18K and everyone accepted it as payment in full.

How much each got varied. Doc billed $1800 and got nearly $1400. Anesthesiologists (two) billed a lot and got $190 to split between them. The hospital itself got around $12K but that included the AMS device.

Had I not hit my cap I would have paid about $3600. Since I was almost there, I ended up paying $2.84 out of pocket.

This was done 31Dec2019.

[wolfpacker]

Excellent breakdown, thank you for providing that data!

[Lost Sheep]

Thanks for serving, wolfpacker.

Having or not having service-connected disability may make a difference. (I am, and the VA picked up the whole tab in a USAF Base hospital.)

Enrolling in the VA Healthcare system where your chosen surgeon practices will make a difference (if you are eligible for VA-covered healthcare).

Bureaucracies have hidden pathways and back-door ways of getting things done.

Ask questions (be polite and take notes assiduously) and thank EVERYONE (even those who are not helpful - they gave you their time and may remember you kindly) by name (people love to be remembered).