Why am I getting billed from my ER visit ?

2022-02-12T00:02:09-05:00

I'm active duty army . I got hit by a car and I went to the hospital (off base) and had to go to the ER. I got a bill from the hospital for 13,000 thousand dollars ! I thought Tricare paid for my medical bills . Please , any help would be wonderful. I'm stressed out.

Response by SFC Private RallyPoint Member made Feb 12 at 2022 4:03 AM

2022-02-12T04:03:26-05:00

Tricare is an HMO it's not magic, it doesn't know who to pay if you don't give that information. It's only automatically covered on post and with network providers, and even that isn't unlimited.

You've learned a valuable lesson about health insurance and why people join the Reserves after active duty for health insurance. You're very lucky, this could have been a much more expensive lesson.

You need to get into the Tricare website to see what they do and don't cover, especially while traveling (like when you're on leave). You're required to contact Tricare and inform them when you seek emergency care off post within a day or two of being released. You need to do that now so that Tricare can cover your ER visit. Be aware that Tricare has caps on certain expenses and you might still be liable for some of the charges.

Response by SGT Private RallyPoint Member made Feb 12 at 2022 8:34 AM

2022-02-12T08:34:54-05:00

Whether or not You end up paying all or part is going to depend somewhat on the Line-of-Duty investigation of Your accident. Did You try to get the ambulance to go to Womack? JAG should be one of your upcoming appointments.

Response by MSgt Steven Holt, NRP, CCEMT-P made Feb 12 at 2022 11:06 AM

2022-02-12T11:06:54-05:00

Unless you needed a Level 1 Trauma Center, most EMS agencies would have taken you to the local base/post if you had asked. Secondly, most medical policies (including Tricare) won't pay a dime until after the vehicle policy has paid. As this was a vehicle crash, in most jurisdictions, the vehicle insurer is on the hook for any expense up to the amount of the policy. Worst case, you will have to retain a competent attorney and sue for any unpaid claims assuming you were not at fault.

Response by SSG Private RallyPoint Member made Feb 12 at 2022 1:29 PM

2022-02-12T13:29:55-05:00

Call tricare you are covered. The info can be found on the tricare website.

Response by SFC Private RallyPoint Member made Feb 12 at 2022 9:28 PM

2022-02-12T21:28:33-05:00

Did you tell them you were active duty when you were able to? I've had more experience using TRICARE with my daughter than myself off base - and the first time I go to any medical facility, I tell them I have TRICARE and give them the information they need so they can bill TRICARE. Things fall through the cracks though - when I had to take her to the ER that ended up with her being Life Flighted at 6 weeks old, I did get a bill for an Xray she had there. But I just ignored it since I had gotten the bill for the Life Flight but TRICARE covered it after I had looked into it. Then I got a "final notice" letter on the $100 bill. So I got ahold of the POC in the letter and they said "oh we didn't know you have TRICARE" and then they filed the claim with TRICARE after that.

So if I was you, I'd get a hold of billing at the hospital and see if they know that you have TRICARE. Then you can go online to whatever region you're in (TRICARE West or East) and contact them via contacts listed there if the hospital did send in claims.

TRICARE only covers claims that get filed. They don't know when someone gets medical care unless they get a claim.

Response by MSG Private RallyPoint Member made Feb 13 at 2022 1:42 AM

2022-02-13T01:42:42-05:00

Ouch. That is a very expensive lesson to learn.

Response by SSgt Christophe Murphy made Feb 13 at 2022 11:50 AM

2022-02-13T11:50:22-05:00

You did to contact the hospital payment folks and your local Tricare office to help figure it out.

ER visits are covered and you should be in the clear but nothing is automatic. You need to contact them to figure it all out.

Response by SFC Ralph E Kelley made Feb 13 at 2022 10:11 PM

2022-02-13T22:11:50-05:00

Go talk to a Tricare representative. They can most likely reduce the majority of that debt since you were incapacitated when they took you to the civilian hospital. They did with my wife when that happened to her when I was away on contract. You're not expected to know the niggling rules of HMO when you've suffered a traumatic accident.

Response by SSG Jack Scott made Feb 14 at 2022 8:20 PM

2022-02-14T20:20:21-05:00

Simple fix call the hospitals billing department and remind them you are Active Duty and to pound sand, don’t pay it! The Hospital has to bill Tricare and they KNOW it! The Billing Department is just being lazy! Go pound sand!

Response by 1SG Private RallyPoint Member made Feb 15 at 2022 6:44 PM

2022-02-15T18:44:00-05:00

Go to this link. It will give you the information you need. BLUF: you should not be paying that bill unless there is a different circumstance.

https://tricare.mil/CoveredServices/IsItCovered/EmergencyCare

Emergency Care | TRICARE

Discusses TRICARE's coverage of emergency care

Response by SMSgt Bob Wilson made Feb 16 at 2022 1:17 PM

2022-02-16T13:17:09-05:00

ALSO, talk to legal office. Should you sue and get a settlement, Uncle Sam's medical program wants to be reimbursed for the cost of the treatment.

Response by SFC Private RallyPoint Member made Feb 24 at 2022 10:44 AM

2022-02-24T10:44:04-05:00

I would recommend submitting a medical claim to Tricare. You fill out a DD Form 2642 along with a copy of the bill to Tricare. The instructions are on the tricare website here:

https://tricare.mil/formsclaims/claims/medicalclaims

Medical Claims | TRICARE

Provides information on filing medical claims and checking the status of filed claims