tricare on TDRL

[shadow0289]

When i was placed on TDRL I was told that all my medical would be covered 100%. (An HSC told me this) Well I ended up paying for tricare because I was told that I would lose my medical and have to pay everything out of pocket. I went to a military facility that couldn't treat my condition so I was referred to an outside doctor. Now I keep getting bills for 20%. Is this true that I have to pay premiums every year and then pay the difference? Thanks for any input.

 

[AFPEBLO]

While you are on TDRL you are entitled to the same medical benefits as any retiree (length of service or disability) however, you must enroll in one of the three TRICARE plans (Prime, Extra or Standard).

When you say you ended up paying for TRICARE do you mean you enrolled in TRICARE Prime and paid the annual enrollment fee?

Retirees (under 65), Their Family Members, and Others:

TRICARE
Prime​

Annual Deductible​

None​

Annual Enrollment Fee​

$230/individual $460/family​

Civilian Copays ​

​

Outpatient
Emergency Care
Mental Health Visit​

$12
$30
$25
$17 (group visit)​

Civilian Inpatient
Cost Share​

$11/day
($25 minimum) Charge per admission​

Civilian Inpatient Skilled Nursing Facility Care​

$11/day
($25 minimum) charge per admission​

Civilian Inpatient Mental Health​

$40 per day​

 

[shadow0289]

Yes. I payed the family annual. The HS said that all my medical would be covered because I was still being treated for my injury. That is why I am confused. I was on the east coast, and when I got discharged, I transferred to Tricare west. I still need to see a military doctor every 18 months, but I was refered to an outside doctor by the military doctor to a specialist for my injury.

 

[AFPEBLO]

Are you getting explanation of benefits statements from TRICARE? They generate one every time they process a claim. You only pay the amount the statement shows you are responsible for, then the civilian provider is supposed to write off the difference between what they billed and what you and TRICARE paid.

Sometime civilian providers will get the TRICARE payment, the member’s co pay and then still bill the member for the rest, but when they signed their agreement with TRICARE they agreed to write off the difference. It’s generally because their billing clerks don’t know the differences in patient’s coverage.

If you are close to an installation go to the TRICARE service center and they should be able to explain further.

 

[shadow0289]

Yes I get the explanation of benefits and I get billed for the correct amount. I basically was under the impression that I wouldn't have to pay anything out of pocket.

 

[sfxer02]

I basically was under the impression that I wouldn't have to pay anything out of pocket.

I wish.....


I had my first civilian doctor visit through TDRL tricare and it was a $12 copay for the visit and I paid like $18 for the medications I am prescribed.....

 

[Chinook]

I'm on TDRL and I was given the choice to see an off base guy and pay the co-pay, or go on base-Peterson AFB and pay $0. So, I figured I'd mostly be referred off base and so I'd take my chances with the base docs. As far as the meds go-are you close to a military installation? I think you could get the script from your off base doc and get the scripts filled on the base for free. Just a thought. Hopefully I don't have to pay for anything regarding the referrals-I'll know on Dec 10th...my first referral to a spine doc. Well, my first spine doc since TDRL.

 

[jackgately]

Unfortunately, in the Coast Guard, there is quite a bad of bad information being passed along by well-intentioned individuals who are not part of the CGPC-adm-1 chain fo command and have not been trained in such matters.

For those from other services, the Coast Guard does not currently have a cadre of trained PEBLOs to provide information and materials to personnel who are begin placed on the PDRL, TDRL or medically separated.

However, when you were placed on the TDRL, it is customary for CGPC-adm-1 to send out an information packet regarding these matters. This package would make it clear what your options would be regarding the various Tricare plans, etc.

I am afraid that you were simply given bad advice by persons ill-qualified to offer it. However, as you have seen from the responses by other members ( particularly AFPEBLO), the information is out there.

Believe me, we all understand that it is sometimes preferable ( and less painful/aggravating) to poke yourself in the eye with an ice pick than to deal with Tricare on claims issues.

However, it is well worth it to pay the co-pays and receive decent treatment.

v/r

Jack Gately