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Any cordination of benefits gurus our there willing to try and answer a question? (Tricare w commercial insurance)

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DD19 got married this spring.  Her husband is active duty Air Force.  She has Tricare Standard/Select due to the marriage. 

She also has BCBS from my employer.  We plan to keep her on my plan because she has extensive health issues and it gives us more freedom for making healthcare decisions.  I don't pay extra for her to be on my plan so she may as well have the extra coverage.

Which is primary? Secondary?  Does it matter if it is medical or dental?

The complicating factor is that usually it goes:

1. Patient's own health insurance. (She has none)

2. Spouse health insurance. (He has Tricare)

3. Parents health insurance. (I have BCBS and she is on the plan)

BUT.....Tricare isn't actually "insurance" and always gets billed after private/commercial plans.  So, is Tricare primary or secondary to BCBS?

I don't think it matters but, For birthdays... His is before mine

For length of benefits....Mine was in effect before his

No court order to complicate things like in divorces etc.

 

When we called Tricare today, they said bill BCBS then Tricare

When we called United Concordia Tricare Dental, they said bill Tricare Dental then BCBS.

(Is Tricare dental actual insurance? )

It seems odd that one would answer one way and the other would say the opposite.  I guess it is possible, but confusing unless dental is actual insurance and so other rules apply maybe?

 

Any ideas?

Edited by Tap

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Tricare dental is a separate animal from Tricare prime. You sign up for it separately.  It appears on the LES as a (small) deduction, because it is subcontracted out as a separate benefit program and the government changes the contract every few years. 

I would trust Tricare's advice over the other, because they have less profit motive... Probably. The folks from Tricare that have helped me seem focused on doing things by the book, and if I can get them all the right pieces, they can work things out. Is she talking to the office on base? If she's trying to get answers over the phone, she might have better luck with going in. 

 

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Dental is separate from Tricare.  It’s a military-specific plan, but you enroll in it and it is debited off of the LES (pay stub) every month.  Her husband doesn’t have to sign up for dental.  He is signing up for a family plan for her.  (This is my understanding, anyway.)

For medical — everything I have ever heard is that Tricare is the second payer.  

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I will add about the dental.... my husband who is active duty has all his dental done on post for free.  

But for me and my kids, we cannot get dental on post, so my husband signs up for the family plan and we see a civilian provider off post, and we’re just like anybody else going to the dentist with insurance.  Some things are covered and some things are a fee. 

For medical we just go on post.  Sometimes we get a referral off post.  

For vision, I have no idea if my husband is paying extra or not, but we see off-post vision providers.  I believe their exams are free and then we pay for glasses.  

For my husband that is all done on post.  

I would expect your SIL to be able to ask anyone married, and especially with kids, that he works with about things like this.  

Since my husband does everything on post, he may not know, but he will call and ask me sometimes about dental insurance when someone at his work has just gotten married.  

Edit:  also if she lives in a place where a lot of people are using military insurance, ime the receptionists at the civilian provider will know, too, because they are the ones to submit claims.  If she lives in a place where not many people have that insurance, then probably they won’t know.  

Edited by Lecka

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Also if she hasn’t had a flu shot yet, ime it’s been very easy to have done at any of the places that advertise walk-in flu shots.  

Also, if she ever wants a prescription filled at a pharmacy off-post, that is also very easy ime.  

If she gets a prescription from a civilian dentist, ime they will ask her what pharmacy she want them to send it to, and she can tell them any pharmacy she wants.  

She will give her insurance information at the pharmacy also.  

If she’s having work done, she also may have options to have the prescription filled ahead of time so she already has it.  

If this is just a routine cleaning, I think it will be completely covered by her husband’s insurance.  

 

Edited by Lecka

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Also a lot of people do have additional insurance coverage, because many spouses work and have insurance coverage or some kind.  It’s not unusual.  

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One of the questions that you are usually asked when going to an appointment in a military facility is “Do you have other insurance?” If so, TRICARE is always the secondary payer. Hubby is a soon to be retired Navy and I’ve dealt with TRICARE for 30 years. Your daughter may also call TRICARE to get a direct answer:)

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I thought of two other things.

One, United Concordia (dental) May have mailed a glossy booklet to your SIL.  You can tell him (or them if they are living together) to hold on to those.  

Another thing is that when they PCS, part of in-processing briefs may be relevant to people with extra medical needs.  Your daughter may want to go to those briefs with your SIL.  That can be a good time to ask questions and knowledgeable people usually give those briefs.  

Also, if she ever gets a referral to someone she doesn’t want to see, she is free to ask for a list of providers and call and see what their availability is.  She is also free to seek out a provider who isn’t on the list and ask them to do paperwork to accept Tricare.  

Also she may be able to see any provider in her Tricare region and not just state.  Sometimes people can go to a specialist clinic or get a shorter wait time for an appointment, this way.  

She may also be able to have reimbursement for mileage and expenses if she ever needs to drive somewhere and stay in a hotel.  

There are a lot of things like this that might come up.  

There is also probably an office where she could ask questions, the EFMP.  They may know a lot locally about different hospitals and insurance and referrals etc.  

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On medical, Tricare is always secondary.   Also, Tricare certainly is insurance-- compared to almost all plans, the best insurance.  Now Tricare medical comes in two versions that your daughter can be under--- Tricare Prime- which is where you see base physicians or in some cases, outside primary care or Tricare Select- where you can see any Tricare or Medicare physician or actually anybody that has been authorized provider by the gov't.  Tricare medical for active duty families has a 1000 dollar catastrophic after which there are no costs at all for the calendar year.  He will have to always be Tricare Prime but she does not need to be and really shouldn't be because of the extra insurance.  I have included a sheet here for all the different costs for everything Tricare including the Dental.

Costs_Sheet (2).pdf

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6 hours ago, elroisees said:

Tricare dental is a separate animal from Tricare prime. You sign up for it separately.  It appears on the LES as a (small) deduction, because it is subcontracted out as a separate benefit program and the government changes the contract every few years. 

I would trust Tricare's advice over the other, because they have less profit motive... Probably. The folks from Tricare that have helped me seem focused on doing things by the book, and if I can get them all the right pieces, they can work things out. Is she talking to the office on base? If she's trying to get answers over the phone, she might have better luck with going in. 

 

DD's husband is at technical school right now. She is home with me and we don't have a military base in our area, so offices are less familiar with Tricare.  Everyone I talk to first says "Tricare is always secondary" but then when they think about the fact that insurance from a parent is always behind that of a spouse, that is where it gets complicated. She is getting Invisalign (braces) and is scheduled for impressions on Thursday.. Her mother-in-law is the ortho coordinator for the office, and is going to call Tricare also to see what they tell her as a provider.  

She is also starting up physical therapy this week.  Again...the office has no idea which will be primary. LOL  

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32 minutes ago, Tap said:

DD's husband is at technical school right now. She is home with me and we don't have a military base in our area, so offices are less familiar with Tricare.  Everyone I talk to first says "Tricare is always secondary" but then when they think about the fact that insurance from a parent is always behind that of a spouse, that is where it gets complicated. She is getting Invisalign (braces) and is scheduled for impressions on Thursday.. Her mother-in-law is the ortho coordinator for the office, and is going to call Tricare also to see what they tell her as a provider.  

She is also starting up physical therapy this week.  Again...the office has no idea which will be primary. LOL  

Tricare is always the last payer by law for medical. I don't think it matters that it's spouse vs parents' coverage. They will claw back any money they spent if they find they weren't the last payer. It doesn't follow the normal rules for who pays like other insurance companies.

I'm not sure how the dental coverage works. 

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12 minutes ago, Paige said:

Tricare is always the last payer by law for medical. I don't think it matters that it's spouse vs parents' coverage. They will claw back any money they spent if they find they weren't the last payer. It doesn't follow the normal rules for who pays like other insurance companies.

I'm not sure how the dental coverage works. 

Yep, this is how I always understood it.  There are a few rare exceptions to this rule, but I don't think her situation is one of them. 

The odd thing is that dental told us the opposite.  If both medical and dental said Tricare is secondary, I wouldn't be in conflict. Dental being different can make sense, since it is a different type of benefit. It is just not congruous with typical billing standards....but it is the military, soooo.... LOL

 

Edited by Tap

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I could see Dental being different because it is available to military dependents but the active duty member has to pay for the premiums and he does not get to use it if active.  The company that is handling the Dental is United Concordia Companies, Inc. 1-844-653-4061. I would call them directly and find out if they are secondary or primary.

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Tricare is ALWAYS last payor insurance, per federal law. 

Dental is a whole other ball of wax. 

Edited by Kinsa
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If it helps you to understand, they change insurance companies every few years (through a bid) in different Tricare regions (from what I understand).

So it’s NOT the same insurance company doing medical and dental.  Dental is United Concordia right now, as far as I know it’s United Concordia everywhere.  

Whatever vendor (?) does the medical insurance (which comes up with referrals off post, etc), it’s not necessarily United Concordia, unless they just happen to hold the contract for that vendor right now.

So — they’re really separate.  

Tricare, when somebody says it, is usually not referring to dental At All, just medical.  

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I was just going to google quickly to see... okay, from a quick google it looks like Tricare East has Humana right now.  But dental (I assume) is United Concordia.  

 

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http://www.apta.org/PTinMotion/News/2016/7/27/TricareReorganization/

This is from 2016, and talks about the medical insurance.

https://tricare.mil/CoveredServices/Dental/TDP

And this is saying that now dental is United Concordia, but it used to be Met Life.  

They aren’t the same companies for medical and dental.  

I would think of it this way:  dental is similar to non-military dental insurance, it’s a typical kind of insurance plan.  Medical is different.  It’s more like Medicaid.

Sometimes with Medicaid, the government requires that they be second payer.  So Tricare medical is like Medicaid, in that way.  

Dental for family members is more like any other insurance.  

It is decided by Congress as far as I know.  It’s how they decided to do it for “reasons.”  Sometimes they want military insurance to work more like private insurance, and then — they decide to do dental the way it’s done.  

This is what is normal to me, though, so to me I think it’s normal for Tricare medical to be second payer, and United Concordia dental to be first payer.  

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I think what happens is — sometimes it’s popular to want to “privatize” things.  At some point dental for family members got privatized.  So — it’s like regular insurance.

Tricare (ie medical, not dental) is still the same way it’s always been, and similar to Medicaid, it’s more of a government program and they think it’s proper to say Tricare will always be second payer.

Edited by Lecka

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My understanding is military dental will not pay for braces after 18 unless it is medically necessary. Military One Source May also be a good resource for her. Also, she may want to start researching EFMP, exceptional family member program. From what you have shared on various posts about her health issues, they may have no choice but to do the paperwork and see if she qualifies.

 

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I just saw the more recent post.  

Has her husband definitely enrolled in dental insurance? 

From my understanding — Tricare (aka medical) will cover “dental” only if it’s something like an injury.  Like — there is some overlap with what they can do if you are hit in the face and have damage to your mouth.  

You can ask him, or check his LES and see if it’s on there.  

You can also see what is covered with United Concordia.  

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I think it’s a lot harder living away from a military base.  They do have to look into the coverage.  Around a base it will be one of the most common insurance plans and all the office staff will know about it.  

Edit:  but I think the MIL will get good information from calling!  That sounds great!  

Edited by Lecka

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Also, it would be really understandable if her husband either hasn’t had the chance to enroll in the family dental plan, or if he didn’t understand what it was and hasn’t enrolled yet.  It is not very easy to understand when someone is just getting started!  

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Also — I’m assuming she is enrolled in DEERS and enrolled in Tricare.  

That doesn’t mean she is enrolled in dental.  

This is how it has worked for me:  my husband signs up for the family dental plan at work, and then when I show my military ID they can see that we are enrolled when we’re at the dentist office. 

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https://tricare.mil/CoveredServices/Dental/TDP/Enrollment.aspx

It looks like there is enrollment information here and a link to the benefit booklet.  My husband has only done it at work, but the internet access stuff is fairly new.  It looks convenient. 

I’m not sure if someone has linked this already!

Edited by Lecka
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TDP_HB.ashx?la=en&hash=A1FFCD2AE93EA34DB

So — the benefits booklet — orthodontics starts on page 29.  Just so you know — CONUS basically means in the continental US, and OCONUD basically means overseas (and maybe Alaska and Hawaii, I’m not sure).  

Don’t be misled by it saying “Tricare.”  It’s basically not Tricare.  It’s basically “dental” or “United Concordia.”  They do use the same benefits number from the military ID, but it’s basically not Tricare.  

Edit:  the entire page 33 looks like it only applies to OCONUS (overseas).  

Also I think calling is still necessary, because it doesn’t say anything about Invisalign that I saw.  Also they may tell additional details for you if you talk to them (or her MIL talks to them).  

I have had people in a therapy office get on the phone and call with questions, too, it is how they can find things out and make sure they are submitting things in a good way. 

Edited by Lecka

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