Posted on May 27, 2015
Does anyone with Tricare Prime know if surgeries can be performed while outside of the country?
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Hitomi and I are covered by Tricare Prime and she is now in Japan. Does anyone know if Tricare Prime will allow surgeries performed by specialists in foreign countries? In the US, Tricare approved surgeons want to perform surgery that will destroy use of her thumb on her dominant hand. In Japan, the specialists laughed at what these surgeons proposed. We're caught between Tricare red tape and Japanese medical care that wonders what they should file with Tricare(if I am understanding this situation correctly). Bottom line, anyone know what happens with Tricare and surgeries in other countries? Not to be a drama queen, but we only have a few days before she flies home and I have to cancel flights, etc. I'm calling them in the am but the suspense is killing us.
Edited 9 y ago
Posted 9 y ago
Responses: 2
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Well i guess it's good that i came across this post. I work Tricare nad have for over the last year. According to the area your in there are 2 ways to do this. 1. go to your primary care get a civilian referal put into the system get it approved and go to your specialist (might have to pay up front but will be covered). 2. go to the specialist pay up front and file a claim with medical evidence supporting why said procedure needed to be done (not a 100% chance of success on claim though). 3. Switch to Tricare standard if possible see specialist pay no more than 1000$ out of pocket for everything as 1k is Catastrophic cap for Active Duty members. no money out of pocket for rest of fiscal year.
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SFC Mark Merino
Thanks, brother. $1000 for a good thumb is a blessing. I'm so glad and fortunate that you responded so quickly. I'm contacting her local doctor right now and left a message for her in Japan to accept any surgery date. Thanks HN (Join to see). Another RallyPoint success story! LTC Yinon Weiss CPT Aaron Kletzing Nick Petros CPT Laurie H. SSG Carlos Madden
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HN (Join to see)
Not a problem. What i'm here for. Make sure she switches to Tricare standard to avoid any problems if she can. Not 100% about the overseas program as different areas have different rules. Either way you won't pay more than 1k out of pocket. SFC Mark Merino
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Does Hitomi have insurance through her employer?
I know Tricare covered off base medical in Germany for my wife, but that was a command sponsored situation.
I know Tricare covered off base medical in Germany for my wife, but that was a command sponsored situation.
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SFC Mark Merino
We are retired. Japan is so confusing! Free medical, if you are Japanese and living there. She married a gaijin and I had to bring outside medical coverage into the works. She was authorized for all this thru Tricare in the US and that's what led us to surgery she can't have (unless she wants to lose her thumb). Japan is unsure if they can do this thru their public insurance system (again, if I'm understanding this correctly) and is willing to expedite. Personally, I'd pay for all of it so she can get use of her hand. In the US, they want to remove a bone in her wrist, making her thumb flop uselessly. In Japan, they want to take bone from somewhere and add it. WTF?!
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