I am trying desperately to jump through Tricare's hoops but keep getting knocked down at every turn.
I am on Tricare-Prime Remote. I am in an area (SF bay area) where there are a lot of CNMs in my network. However none of them do HBs. So I found an CNM that is out-of network that does HB and got a referral to her from my PCM. Tricare denied it saying that she wasn't found in their system as certified. I had her send in her info, tax id #, cert # the works. They said they aren't showing this info but that I am okay to see her for my care but as a POS (point of service) care provider. This would mean paying 300.00 deductible and then 50% of remaining.
So my CNM charges 4700.00 so if they allow this then I would pay around 2500.00 out of pocket. I am wondering if it would be cheaper to switch to Standard and continue to see her? Its my understanding that I would pay a copay and then only 20% of allowable charges. This is where it gets sketchy...whats allowable? Will they tell me this amount if I call and ask? I have seen on older threads that they will pay 1500.00 for standard which would mean I would be left with 3200.00.
Has anyone else had problems with this? Should I keep fighting to get it covered under Prime-remote?
I am super frustrated here. I was hoping they would cover around 3000.00 but its looking less and less like that will be the case. Any help or insight would be greatly appreciated.