UPDATE: Went to the website, found a doctor in my area who is enrolled...called them, verified Tricare Prime and my only initial cost is $12.00 for my son and set up appt. Called Tricare back, gave them the doc's fax number and new referral is being faxed to the Doc's office....whew! Tricare said they couldn't believe that the appt desk at CHKD was saying that and secondly, they are to set appts, not discuss payments etc....
So, it's not always Tricare....it's the place you are trying to set up appt's with...don't let them argue with you about it...you are only required to pay your co-pay (for me and my kids, that's $12.00 a visit per person). They file the paperwork and you will receive a bill for your share.
The main link for Tricare: http://www.tricare.mil/mybenefit/ProfileFilter.do;jsessionid=LKvp8hVpBRmj2GntpRp1p2hxHN0wdKLQGxhDbwkkyM0B2m52VJj4!1173450805?puri=%2Fhome%2Foverview%2FPlans%2FPrime
http://www.tricare.mil/mybenefit/home/Medical/FindingAProvider >>>Use this link for TRICARE to find a provider in your area.....don't just look for the military bases / hospitals.
Annmarie
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I am SO FUSTRATED.......Just talk to CHKD (Children's Hospital of the Kings Daughters) in Norfolk, and they are now telling me TRICARE PRIME WILL NOT pay for my son's hearing appt which has been approved for 5 visits. I have been on the phone with Tricare twice today and they tell me that IT IS COVERED and the doctor has received the paperwork regarding this. This referral was set up through my Primary Care Physician. This is NOT the fault of Tricare, but the Appt Desk at CHKD!!!! UGH!!!
They are arguing with me that my Tricare Prime will not pay for this and I am trying to tell them they will!! They are saying I have to pay 280 dollars before I can make an appt! WHAT THE $*@#($*($*((#()@)@)? This doctor is enrolled in Tricare Prime and I DO NOT pay anything, other than my $12.00 Copay at the visit until the claim has been filed by the doctor, in which I will get a bill for my share.
Tricare gave me another number for this doctor and it goes to the same appt desk I have been talking too all morning! So, now my son can not be seen until I pay this amount to CHKD first!!!! They are really ticking me off!!!!
So, I am in search for another doctor and Tricare said they would forward the paperwork to them for me to schedule the appt. If the doctor is ENROLLED, they are to accept Tricare Prime.... and the patient/sponsor is NOT required to pay anything but the copay and when the bill is sent in, they the patient/sponsor pays their share....that is how it works.
Thank God my Delta Dental Plan (retiree) works great!!! Never a problem and the dentist office does ALL the paperwork. We do, at the end of our appt, pay our percentage and sometimes we may pay a few dollars extra. Then when Delta Dental files the claims and gets all monies and benefits squared away...there have been some appts we did not have to pay a share...cause we have over paid, as per Delta Dental!


Ok...let's see if I can get another freakin' appt desk to come to their senses!!! Wish me luck!