Should we take Tricare?

[Jarhead Daddy]

Our practice is considering taking TriCare. At first glance, it appears that the 92004 and 92014 rates are reasonable, and that members are eligible either every 12 months (active duty), or every 24 months (retired and other). Looks like there is no benefit for materials under TriCare.

How are they for claims, on-time payments, etc.? Would you recommend going in network?

Thanks in advance for any advice.

[jpways]

Tricare is a fairly easy plan to deal with, in our area (local conditions may vary) the reimbursement is 60% of U&C or the listed rate whichever is less. As long as the patient is Tricare prime the exam rules you listed for routine vision exams are correct with no coinsurance when they standard it becomes a little harder active duty is generally every year there may or may not be coinsurance depending on the sponsor's (member's) rank, retirees there is generally no exam benefit. With all plan you can also submit medically similar to Medicare rules though with coinsurance for some Tricare Standard patients. Now in most cases as long as you can submit the claim to Tricare's website same day you can print what they call a patient receipt which is an EOB preview that will show your reimbursement and the patient's responsibility. Payments are fairly quick generally 1-2 weeks, though some medical claims may take longer if additional documentation is required.

You are correct there are generally no material benefits in an off base situation, the exception being cases where Medicare would pay for materials (post-cat glasses, medically necessary CL).

If you go in network a word of warning for the active duty member (not family but the service member themselves), call on each and every patient. On certain service members where there are minimum vision requirements, they are generally required to go to the on base doctor for service unless the doctor cannot see them in a reasonable time, then the service member has to fill out some form with a department that I cannot remember the name of to request an off base exam exception. I've had that happen once and the paperwork took about 4 or 5 months to get straightened out we ended up having to get permission to charge the patient while the paperwork was in process, and then later refund them when Tricare finally received the approval to pay.

Even with that exception, I would still say that Tricare is a good insurance to be in network with, though make sure you know upfront what the reimbursement is just in case you have to accept 60% of your U&C.

[Jarhead Daddy]

Thanks jpways. The Tri-Care in my region is administered by United Health Care. Is that the case with you? Also, how long between submission and payment typically? Thanks.

[jpways]

No we're Health Net Federal Services, I never dealt with Tricare West claims, I've also dealt with Tricare South, when the sponsor was based in TX, generally payments are 1-3 weeks on routine vision claims, 3-5 weeks on medical claims from both East and South. And one other thing I forgot to mention because it came into play for the Tricare South claim, when the patient is Tricare Prime and you need to do a medical claim you need to get a preauthorization from the PCP, Tricare Standard never requires preauthorizations.

[Jarhead Daddy]

Cool. Thanks.

Anybody out there have any experience with Tri-Care West?

[optilady1]

My daughter was seen by my office, and both times we were paid within three weeks time from date of service. We are Tricare prime. I most of the Tricare regions have a specific department dedicated to the military version (health net, united health care...) and they are maybe a step above the average person you deal with on the phone, meaning maybe 30% really know what they are talking about. They never pay hardware, so you'll never have to deal with billing that. Anything medically billed will require a referral from their primary care dr.

[Jarhead Daddy]

Thanks for the great information everybody.

[Dustin.B]

As for material benefits Tricare doesn't cover anything as you already know, But if you work with the VA as well Every retiree receives a voucher for $200+ toward eyeglass materials. There's of course more paperwork but it can definitely add to your sales in a large way. Top that off its through the Prosthetics department so most of the time you wont be dealing with the admittedly slow main office and get a much faster response for it.