Tricare Prime Secondary

Wildcat Diva · Dec 9, 2016

^^^ about lawyer needed. I was just thinking that, and had just mentioned in an email to my boss that our company's attorneys on retainer might want to take a look at this. I found the 1999 Texas Legislative signed act that says that the new hours requirement applies ONLY to those who apply after the amended act, it specifies that someone in my circumstances is to follow the law prior as I applied before the Act was enacted.

I got woke up too early for something stupid, so I did some grumpily inspired relentless research to find the specific bill (House Bill 923, 1999 session). It was challenging for me to find, but I feel satisfied now that I did. Thanks y'all for letting me vent. A state funded community mental health service center ought to be able to provide services to kids of military families who need treatment (we are a not for profit who gets some state funding, but we still have to file with insurance too to stay afloat).

Wildcat Diva · Dec 9, 2016

Updated: I called Tricare, and it seems they don't adhere to any state law about the requirements for a counselor practicing in a state, they have their own standards that they set overall. So me being state licensed and well within that law, it doesn't matter. Even though I have 20 years experience. (It's lacking 1000 hours experience that I would have needed to have paid a supervisor to meet with me for an hour a week and discuss cases during that half year back in 1997.)
Feeling defeated.

shooterfpga · Dec 14, 2016

Wildcat Diva said:
Updated: I called Tricare, and it seems they don't adhere to any state law about the requirements for a counselor practicing in a state, they have their own standards that they set overall. So me being state licensed and well within that law, it doesn't matter. Even though I have 20 years experience. (It's lacking 1000 hours experience that I would have needed to have paid a supervisor to meet with me for an hour a week and discuss cases during that half year back in 1997.)
Feeling defeated.

I had a similar discussion recently with a doctor about how hard it is to find prime providers vs standard providers and it fell along the same lines as what you had mentioned earlier.

TexasBrandon · Dec 30, 2016

My situation escalated as I thought it would with Tricare and a third party doctor that they referred me to with authorization to see. Now I get a bill from the third party after they told me it was some issue between them and Tricare or Triwest as they call it. So, authorized, get surgery, get billed despite the VA authorizing everything? Yep, lawyer time. I am just going to suffer from here on out, if the VA doesn't do the work themselves I am going to refuse treatment. Getting things done outside of the VA is full of red tape.

ussoldier1984 · Jan 19, 2017

Bozz10mm said:
Once I turned 65, Tricare became my secondary insurance. Medicare is the primary. So far I haven't had to pay anything out of pocket for annual check ups.

Same here. Its awesome never having anything out of pocket. But I am not 65 I have SS disability so I was put on medicare.

ussoldier1984 · Jan 19, 2017

tmd11111 said:
I've been retired for 15 years and have never taken employee insurance. Have used Tricare prime only. I also fortunate enough to have a local military base that see's retirees. When I need a referral for a specialist it's only a $12 copay. In fact earlier this year I broke 7 ribs in a motocross accident and the er visit bill was over 13k and only cost me $12. Shortly after my back finally gave out and had a spinal fusion done total bill was well over 100k and only paid a little over $200 for the office visits

If you do not mind I have a quick question and sorry to change topic. I am on Tricare for life (medically retired) what is the benefit to pay for the prime? I have SS disability so I have medicare but would it benefit my wife and son?

oohrah · Jan 19, 2017

You didn't say your age. If you are over 65, you have no choice. You must take Medicare and Tricare for Life as the supplement (I'm assuming you do not have an employer health you could optionally use).

If you are under 65, you will probably need to talk to Tricare. Prime is advantageous for families, and usually cheaper than employer health. Your disability requiring you to take Medicare may impact that.

Texas42 · Jan 20, 2017

If he's born in 1984, he's 32.

Bobk · Jul 23, 2017

Got another question for you smart guys. TRICARE no longer uses CVS to fill prescriptions, however my primary insurance requires that I use CVS.

Have any of you guys tried to have Tricare reimburse for what you paid?
https://tricare.mil/CoveredServices/Pharmacy/Claims/OHI

TexasBrandon · Jul 23, 2017

You can't get your prescriptions mailed to you from the VA? That's what I do.

oohrah · Jul 24, 2017

Can't you use Express Scripts through Tricare?

Bozz10mm · Jul 24, 2017

I take all my prescriptions to HEB. Usually involves a co-pay of about 9 bucks for 30 day supply. I believe you can get most generic drugs through Express Scripts without any co-pay. I just don't have that much faith in the mail.

oohrah · Jul 24, 2017

My wife and I get all our regular meds from Express Scripts. They even contact our Drs when refills are up without our asking. Never had a mail problem.

Bobk · Jul 24, 2017

I don't know as I had been previously told that I first had to use my primary insurance prescription which is CVS. This is when I had talked with Tricare about losing my regular doctor.

TxStetson · Jul 24, 2017

oohrah said:
My wife and I get all our regular meds from Express Scripts. They even contact our Drs when refills are up without our asking. Never had a mail problem.

When I first got the notification about having to use the mail service, I imagined all kinds of things going wrong. The mail service has been absolutely flawless. My wife has 1 prescription that was costing me $20/month at CVS, now costs me $6/qtr. all others prescriptions are completely free.

Bozz10mm · Jul 25, 2017

TxStetson said:
When I first got the notification about having to use the mail service, I imagined all kinds of things going wrong.

Wait, what? We have to use the mail service?

TxStetson · Jul 25, 2017

Bozz10mm said:
Wait, what? We have to use the mail service?

On Tricare you have to use the mail service for long term/maintenance prescriptions. Anything short term is still handled the other way.

Bozz10mm · Jul 25, 2017

TxStetson said:
On Tricare you have to use the mail service for long term/maintenance prescriptions. Anything short term is still handled the other way.

Well, darn it, I didn't get the memo. I'm still getting my long term meds at HEB. The wife too.

TxStetson · Jul 25, 2017

Bozz10mm said:
Well, darn it, I didn't get the memo. I'm still getting my long term meds at HEB. The wife too.

They sent me letters, emails, and even called to force me into using express scripts. They even threatened to not cover any prescriptions if we didn't use it.

Bozz10mm · Jul 26, 2017

Okay, I see why now. From the military.com web site:

New TRICARE Pharmacy Rule
You must refill select maintenance drugs through home delivery via TRICARE's home-delivery pharmacy, Express Scripts. You can also refill maintenance drugs at military pharmacies. This doesn't apply to active duty service members.

When you get a prescription for a drug on the select maintenance drug list you can fill it up to twice at a network pharmacy, after that, you need to switch it to home delivery or to a military pharmacy. If you continue to fill your prescription at a network pharmacy, you'll pay the full cost.

Exceptions to the Rule
If you use generic maintenance drugs you are exempt from this rule, you can continue to fill your prescriptions at a network pharmacy.

All our maintenance drugs are generic.

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