Do you use TriCare?

SleepDaddy mentioned that he wished there were more Tricare members on the forum. Since we all know how difficult Tricare (and most insurance carriers) can be, perhaps we can identify ourselves and benefit from the experiences of others.

I will start it off. My husband and I use Tricare Standard, pay 25% of costs after deductible is met, and are retired military. At least he is, I'm just along for the ride. Also, we have a Tricare Supplement that picks up our 25%. Tricare Standard is our primary.

Anyone else care to share if you are Tricare?

I plan to keep of list of the Tricare members, and perhaps PM them if I have an insurance problem or question.

Linda

Linda3032:

Thanks for starting this thread (wish I had thought of it). I am Tricare Prime (both Wife and I are retired AF). I am just starting this journey--I have my first meeting with my DME tomorrow!

I think Tricare Prime will pick-up 80% of cost of xPAP rental and I have to pick-up the rest. Per Linda's suggestion, I am going to call Tricare to talk to the DME department to see if I can convince them to let me buy all my supplies online so I can get the set up I really want. I keep you posted on how I make out.

Just FYI Lincare (other part of the US from you) will be billing my insurance around $2300 for the purchase of a CPAP and heated humidifier which is more than the RT told me it would be.

Get the price at the DME and the determine what you need to do. I didn't have to spring for 20 % myself so that entered into my decision but I was pretty appalled at the mark ups.

I am also using TriCare standard. Hubby is retired Navy. Got myp xPap (a Remstar Pro 2)(cpap, xpap, or auto??? does have CFlex) the day before Thanksgiving. The DME told me it retailed for around $2500. I do know he said Tricare would only rent it and not buy it outright. Haven't received a statement from Tricare yet. My DME actually admitted he didn't know what to charge. That he was just throwing out numbers to see what Tricare would pay. Said if they allow what he put, my part (25%) should be around $117 a month. Sounds awfully high to me, but what can ya do??
Am still sorting thru all the medical stuff, as I was diagnosed with sleep apnea while in the hospital for congestive heart failure, COPD, pulmonary hypertension, etc.

Joyce

I retired out of the military 10 years ago and have used Tricare Prime for the past 2.5 years as our sole insurance.

Tricare, Northern Region, managed by Healthnet has been very helpful in dealing with my DME (Apria, and I won't say any more about them.)

I've asked Tricare a couple of times to simply buy my APAP Remstar w/C-flex but they continue to rent. Apria bills them $461 monthly. Tricare approves $83.27 and my copay is $16.65.

Tricare will pay anyone 100% or less of the 80% of an approved charge.That means if (example) cpap.com sells a mask for $80 and Tricare approves at $100 then there will be no copay because it cost no more than their approved price.... in or out of net work..

Comfort classic mask, the cheap one, billing was $148. Approved at $118.40. My copay was $23.68. This is the reason I will buy all future masked from cpap.com. I will end up with no out of pocket expenses.

The above makes you begin to realize just how much someone who is not insured pays and how much an insurance company could save if they let us, the consumer, shop around.

Hope this info helps.

Just in case I get "guested", this is Craig

I'm another Tri-Care Prime guy. I retired from USAF about 12 years ago. My wife is 100% disabled and on SSDI. A while back, they changed the rules, so now she gets to go to anyone who accepts Medi-Care and Tri-Care picks up the rest. Plus, she doesn't have to pay the premium. She recently had a pacemaker/defibrillator put in. Total bill was around $150K, out of pocket was $25!

Anyhow, I went through various trials with my MTF primary care doc. After 18 months or so of tests, she finally sent me for a sleep study. Surprise, I've got OSA. They set me up with a nice Remstar C-Flex and some generic mask. I ended up with three masks, none really worked well. After 12 months on CPAP, another sleep study at another clinic. Their choice was to go with BiPAP. So, the DME brings out this old clunker and says my permanent machine is on order. Finally, much later, I get a Remstar Bi-Flex. This time they gave me a ComfortGel mask. On the old clunker machine it worked quite well, but after about 8 months started to have a lot of leakage issues. They got me a replacement cushion set, but I still have leakage problems. The new Remstar is very different. It is at a much higher pressure than I was using before. It is set for 17/15. I have to put the mask on first, before starting the machine. But this thing has an autostart, so once the mask is on, about three breaths and the machine fires up. After a few seconds, it starts the air flow. Sounds like a small jet engine winding up, then POW, it hits you.

Well, about Tri-Care. For the first CPAP, then for the BiPAP, they sent me a letter each time about DME. They authorized X amount for the machine. They said they would pay rent for the first three months. If I still needed the machine, then it was my choice to buy or continue to rent. However, they would only pay the allowed purchase price. Once that was paid, I was on my own. It worked out to about 12 rent payments to equal the purchase price, then the machine was/is mine. Since the DME is a network provider, they must accept whatever Tri-Care pays them, and I am liable for my 20% co-pay. It came out to about $40 per month. I have heard several stories about what Tri-Care covers in the way of masks and tubing. When I called them on the phone, they told me that replacements were covered, that I just need to get it and send in a claim. They preferred I simply called my supplier who provided the machine and let them take care of it. That really doesn't suit me well. Of the two DMEs I worked with here, I wouldn't give you a nickle for either one. I need a new mask, but don't know what to try yet. I hear a lot of talk about the Swift nasal thing. Weird part is, it's much smaller and less parts than a mask, but more expensive. Go figure.

Anyway, I am surprised at how well Tri-Care is working for us now. The old CHAMPUS system was pretty much a waste of time.

Michael

I don't have tricare, but it is amazing how much they charge to rent a machine out with insurance and how much they bill the insurance companies. In all reality, look how much less a machine is on this site and it costs less than what they are chargin for rentals in a two month period if I am looking at this right.
I talked to my DME company to the guy that does ordering about eventually buying a CPAP. He told me I was better off ordering offline or through EBAY (even though I know ebay no longer sells them because of prescription needs).
It is amazing how the costs differ. One more reason to buy my own if I get the money.

God bless
Chelle

For my masks, Tricare standard will let me get one every six months, plus I need a new prescription for them every year.

I still get all of my equipment online at a CPAP store, (I've not used CPAP.com yet because I didn't know about them). After I get my equipment, usually mask and supplies, I submit my claim to Tricare. No problems.

By supplies, I mean filters, hose covers, new hoses, and I got an extra power cord. I leave one power cord hooked up by my bed (under the bed, around the leg, under the night stand, into the night stand middle drawer which has a hole drilled into it for the cord to feed through, etc. ). Now you see why I wanted an extra one to put in my travel bag.

Again, I've never had a problem with buying and paying for all my own equipment online, and submitting the claims to Tricare. I have never used a DME.

Linda
Hubby = USMC who retired with 21 years in 1979

Another thing. My Tricare benefits representative in DME dept told me that I can replace my APAP as needed. So I'm going to get a new prescription for one in March and get a newer RemStar Auto. Mine (one and only unit) quit on me last Sept at it was hell for my hubby until I got a loaner and mine repaired.

An again, for whoever missed a previous post I made, Respironics repaired my 2 1/2 yr old unit free of charge, even though it was no longer in warranty. I was so impressed and surprised as it was my fault and I fully expected to pay. It don't get no better than that, IMO.

Linda

I am a Tricare Prime person. Retire AF (7 years ago). I am just getting into the CPAP world. Like most of the other prime it looks like I am stuck with the "approved vendors", but was encouraged by sleepdaddy's comments in another thread that looked like they might be reasonable and might be able to get what I want instead of what they want. I already "own" the heated humidifier in my rental.

Barry (also in Arkansas)

Great thread!

I work in Medicare customer service. Many Medicare beneficiaries have TriCare coverage as secondary. Just for my education, what is the difference between TriCare standard, TriCare for Life and any other level of TriCare? Can a former military person have some type of TriCare coverage if they did NOT retire from the military?

Thanks in advance for your comments and advice.

Joe

My husband is also retired military and we use Tri-care also

Tricare Prime and Tricare Standard are similar. Prime is normally used in areas near a military installation. You are supposed to use only providers within the "network" you are assigned to. Tricare Standard allows you to go to any doctor which accepts Tricare. When you reach 65 and start using Medicare, you are automatically enrolled in Tricare For Life. This acts as Medicare supplement, and picks up what Medicare doesn't. It only covers what Medicare covers. It also provides the Part D coverage as required my Medicare.

Someone again commenting on a 9 year old post.

LSAT wrote:Someone again commenting on a 9 year old post.

At least it's getting closer to the weekend! I don't have to worry as much about my computer clock failure, I hope the orgional in this old post are still using their machines. Jim