Tricare, I Have Questions

November 29, 2011 | Kate Horrell

Just when I think I’ve figured out this whole Tricare thing, something new happens.  And it is usually incomprehensible.

Last month, the family was out of our usual Tricare area and got sick.  We got authorization to go to a local urgent care center (I’ll let you know when the bills start arriving…) and we were given some prescriptions.  I took them to the nearest Tricare pharmacy to be filled.  Of course, nothing worked out as I planned.

First, there was the cough syrup with codeine in it.  According to the submission system, Tricare will not pay for this because it is an over-the-counter medication.  Um, yeah, I don’t think so.  The pharmacist said that it made no sense but that there was nothing she could do.

Then there was my inhaler.  That seemed to go through the system just fine, even though I did get stuck with the new, higher $12 co-pay because apparently it was a name brand medication.  (Note to self:  next time, ask the doctor to be sure to prescribe generics.)

Then came the real mystery.  My daughters were prescribed a generic steroid, and the bill came to $2.02 each.  I knew that wasn’t one of the co-pay amounts, but I didn’t think too carefully until the Explanation of Benefits arrived.  Apparently, the drugstore only charges 95 cents for that prescription as part of their generic prescription promotion.  However, because Tricare allows $2.02, that was how much I had to pay.  If I had not told them that I had insurance, or if I had asked the pharmacy not to process the prescription through my insurance, I would have paid 95 cents each.  Now, $1.07 isn’t a lot of money, but why should I be paying more because I have insurance?  What is the point of that?

I tried to check with the Tricare representative at my local Military Treatment Facility, but I’ve been having difficulty catching her in the office.  I’ll try again tomorrow when I am over that way.

Please do not think that I am complaining.  I only paid about $65 for all of the prescriptions, which is significantly less than the full retail value.  As sick as we were, I would have gladly paid many times more in order to make everyone well.  However, I do find it all very confusing.

I try to be the person who understands all this stuff so that I can help my friends and my readers when they have questions.  Tricare has stumped me this time.  I’ll report back when I have some answers.

 

Comments

  1. Navet says:

    I will gladly put up with Tricare benefits than having to pay deductibles and copays to other insurance companies. Wait until you have to deal with Medicare.

    • Joe Simmons says:

      If you have Tricare for Life, why do you a problem with Medicare?

      • JJJ says:

        Because, when you meet the magic retirement age of 65. YOU MUST sign up for Medicare part A and B in order to maintain your Tricare services. If you don't TRICARE goes BYE BYE.

  2. Tom says:

    Yes JJJ, and then one will have to pay for Part B which in my case is over 100 dollars monthly and I don’t even use it because I live outside the US.

    So I am in fact paying for something I do not use. So much for “free” medical care for life which I was promised afte 20 years service.

    If one is thinking of career, better rethink.I would not do it over again.

  3. A person says:

    As per your real question, why did you have to pay more than the pharmacy charges is because that was the pharmacy’s choice and should not have happened. The people you want to call is not your local TRICARE office who can do nothing about it, but call express scripts directly: 877-363-1303. It is my understanding that a pharmacy/clinic should only charge upto the allowable charge or amount billed wich ever is less. Likily 99.99% of the time it’s the allowable charge…but you shouldn’t be given a higher amount than the lesser of the two.

  4. Tony says:

    Does Tricare For Life (I will be eligible for starting 1 Sep) cover my spouse as well? Or do we pay premiums for her to stay on Tricare. Can prescriptions for her be filled at local pharmacy?