Navigating Tricare: How to Find an Alternative/Holistic Health Practitioner
So after doing your research, you have decided that making the switch from Tricare Prime to Tricare Standard fits your healthcare needs. So what's next?
The first step is selecting a doctor. On Tricare Prime, we're used to being assigned a doctor, or at least a military treatment facility. But with Standard, the flood gates have swung open, and it can feel overwhelming. Being able to find not only a doctor, but one that will meet your needs, is no easy task. Luckily there are a few resources that can help.
The following resources have listings based on zip code and specialty that can help you narrow your search:
Keep in mind that certain health care practices are not covered by Tricare, even if they are administered by a licensed doctor. Examples of some of the types of treatment not covered by Tricare are acupuncture, chiropractic, and naturopathic. A full list of services not covered by Tricare can be found here. You can still pursue having these treatments, but know Tricare will not reimburse any portion of the cost associated with them.
When you've found one or more physicians that may fit your needs, make sure to call the physician and ask them the following questions before setting up an appointment:
- What is your medical philosophy? It's nice to know what your physician considers optimal health. Do they consider it a patient with limited- to no prescription needs? If so, how do they usually try to achieve that? Do they address diet? If so, what do they generally recommend?
- Describe the initial visit? Initial visits can last from 15 minutes to an hour and half. It's important to know what will happen during the visit, and what paperwork you will need in advance.
- Are you familiar with Tricare? If so, are you familiar with network or out-of-network? If non-network, are they participating or non-participating? If non-participating, will the correct codes be given to file a claim on your own? If the practitioner is non-participating/out of network, you will most likely be responsible up front for the full cost of the appointments, so you will need to know going in what the cost will be so you can prepare financially in advance.
- What are your fees? Don't be afraid to ask this question. When working with a non-participating practitioner, you will most likely have to pay out of pocket, and then you will be reimbursed, in part, by Tricare after you submit your claim. Most practitioners, if they are non-participating, will give you in advance the CPT (Current Procedural Terminology) codes for your visit. These codes are what insurance uses to bill and determine costs. You can then take those codes to find out if Tricare will cover the cost of the procedure.
- Are you familiar with _______ issue / disease /etc.? If you are suffering from a specific set of symptoms or an issue, you should make sure the physician you see is familiar with it. After all, this is part of the reason you are searching for an out of network doctor!
- Do they do blood tests and lab work? If so, are the tests done in- or out-of-office? You may not have this information until your first visit. However, it is important to ask at least during your appointment, as insurance may or may not cover blood tests prescribed by alternative doctors as they can be more unique than typical prescribed tests. Also, it is important to know if the laboratory where the tests will be done is in-or-out of network. If your doctor is out-of-network and does lab work on site, it may be best to request for the lab work to be done at an off-site, Tricare-approved laboratory. You can find one here. The reasoning is that some lab tests cost thousands of dollars, and many are negotiated down by Tricare. The remaining cost is then covered at least partially by insurance, even Standard (post-deductable). If the tests aren't done at an in-network, participating laboratory, you might be responsible for the full, non-insurance negotiated price. You can check to see if the test is covered by first finding a test's CPT code - ask for this from your doctor. Once you have the CPT code, you can plug it into Tricare's Prior Authorization; Benefit Tool. It will tell you whether or not the test is covered by Tricare. Use the image below as a guide.
With this knowledge, go out and find the doctor that best suits your needs. And stay tuned for the next installment of our Navigating Tricare series where we break down how to submit a claim.
What do you think is trickiest part about navigating Tricare?