How about I went to a senimar at Palm Bay Hospital in August and waited til Sept 29th for a Doctor consult and then waited 2 weeks for them to obtain insurance (tricare) approval only to be told that they want me to pay the difference between the docs charge and what tricare will pay. That means out of pocket for me $4008.00. Keep in mind, I was APPROVED by my insurance. Sounds like a scam to me and a very disappointing roller coaster ride for me:frown:

Do you have Tricare Prime or Tricare Standard? Are the Docs in Network or out of network?

I have Tricare Standard and the docs are not in Network so I am paying about what you have quoted.

Mimi

I don't have Tricare but I was approved for surgery and that is about what I had to pay out of pocket too. My surgeon required $3,000 down and after all the other bills came in it post-surgery, it all added up to a little over $4,000

Tricare standard has a catastrophic cap of $3000 per family per year so if her doc is covered that's the MAX out of pocket she'd pay even if she had no other bills (yet) against tricare.

Her doctor supposedly IS an in network doctor with tricare. She confirmed that. She is supposed to pay, if Standard, only 20% of the fee tricare approves, on each service, after paying a $150 deductible. Once she reaches the cap, tricare covers at 100%. So you can see even if tricare standard, since he IS in network, he's at the least trying to overbill her.

I am Tricare Prime so that means I should only be responsible for my $30.00 co pay

Don't give up just go to a different surgeon. I too was put through a bunch of loops. I'm just now in the process of getting scheduled again for my surgery. Some surgeons just want to make sure they get paid the most they possibly can. But here's the kicker if they actually require additional money like you've said what are their real priorities their patients or money. Things happen for a reason and you just need to move on and not give up. You can do it!

Humana hs informed this doctors office that it is ILLEGAL to do what they are trying.

When choosing a physician;contact your insurance company prior to the appointment to make sure they are a participating provider.It is helpful if you have their tax id number when calling. If they do not participate with your plan you have to pay the difference between what insurance pays/allows and physician charges. This is not a scam, it is simply how it works.

It was a scam because this doc is a tricare network provider period. Cannot balance bill patients. Lesson learned.

How about I went to a senimar at Palm Bay Hospital in August and waited til Sept 29th for a Doctor consult and then waited 2 weeks for them to obtain insurance (tricare) approval only to be told that they want me to pay the difference between the docs charge and what tricare will pay. That means out of pocket for me $4008.00. Keep in mind, I was APPROVED by my insurance. Sounds like a scam to me and a very disappointing roller coaster ride for me:frown:

MLJAWAYS: I am the insurance diva at my house. Don't ask my husband anything he just goes to the doctor.

Right now we have 'open enrollment' at my school district. Insurance options are like an ala carte menu, you gotta read those fine details, example; If I take the PPO, I have an out of pocket of $2000 before insurance kicks in, same with my husband but his is $3000 as he is considered family not employee.

Per incident at hospital is $1000 before insurance kicks in, then it is 80/20%.

I don't have Tricare, I have BCBSFL. I am sticking with the BCBSFL even though they don't cover LapBand (yet).

Best of luck to you! Call your insurance and ask for a breakdown of what is covered. Sounds like you are good to go just get clarification on the what of it all.

Glad to help you if need be, I'm the insurance diva!!