Medical treatment on the local economy

Medical treatment on the local economy

by Stripes Europe
Stripes Europe

When space-available health services at MTFs are not available for U.S. citizens living in Germany, patients may be referred to host-nation providers. The TRICARE Service Center will be able to assist you with information on providers.

Unlike billing procedures at an MTF, patients may have to pay the entire bill prior to care and are reimbursed through their private insurance company. Utilizing host-nation providers that are part of the TOP Contractors Network can help alleviate some of the billing issues and communication barrier concerns.

Non-Tricare Health Insurance Policies

Unlike billing procedures at an MTF, non-TRICARE health insurance patients may have to pay the entire bill prior to care and are reimbursed through their private insurance company. It’s important to know that employee health insurance policies for DoD civilians and contractors vary by organization. Review your policy carefully to determine deductibles, out-of-pocket maximums and scope of care (i.e. whether you have coverage when traveling beyond Germany). Depending on your carrier and the medical/dental facility, you may be required to pay a co-pay or the full price for treatment up front. Some facilities will file claims directly with your insurance carrier, while others leave that up to you. Your carrier may require that claims are filed online, by fax or by mail. Make sure you have an original itemized bill on hand if you will be submitting the claim. Except in the case of emergency care, imaging, surgeries and hospitalizations may need to be pre-approved by your carrier.

Also keep in mind that some care considered as standard practice in Germany may be “experimental” in the United States and will not be reimbursed.

Tricare Beneficiaries

TRICARE Network

The International SOS TRICARE Network consists of host-nation health care providers who agree to provide care to TRICARE Overseas Prime beneficiaries and assist them in filing TRICARE claims. In most cases, network providers will not require up-front payment from TRICARE Overseas Prime beneficiaries. At the end of your care, your results will be translated into English and added to your permanent electronic medical treatment record. Your local TSC staff will help you find a provider or hospital when you are referred for host-nation care. You can also use the provider search tool on the International SOS website, www.tricareoverseas.com/ProviderSearch/SearchContent.aspx.

International SOS Website

International SOS’ website (www.tricare-overseas.com/Beneficiaries.htm) offers a wealth of information for beneficiaries, including beneficiary forms and education products, network provider contact information and much more.

Beneficiaries are entitled to the following appointment standards:

Acute appointments are made within 24 hours

An urgent (acute) care appointment is reserved for non­emergent, urgent care that is typically delivered by an MTF or network provider. Acute care services for active duty and TRICARE Prime enrollees shall be scheduled no greater than 24 hours from the time the need for this appointment is determined.

Routine appointments are made within 7 calendar days

A routine primary care appointment is designated for patients who require a visit with their primary care manager for a new health care problem that is not considered urgent. Routine care for active duty and TRICARE Prime and TRICARE Plus enrollees shall be scheduled within seven calendar days from the time the need for this appointment is determined.

Wellness appointments are made within 28 calendar days

A wellness care appointment is designated for patients who require a visit for a wellness or preventive health concern, or with their primary care manager for an initial visit. This wellness care for active duty and TRICARE Prime enrollees shall be scheduled within 28 calendar days from the time the need for this appointment is determined.

Specialty appointments are made within 28 calendar days

A specialty care appointment is designated for patients who require an initial consult, referral or initial self-referral. Specialty care for active duty and TRICARE Prime enrollees shall be scheduled within 28 calendar days from the time the need for this appointment is determined. A specialty care appointment also includes procedures designated for patients in need of medical procedures. 

Source: Access to Care, Landstuhl Regional Medical Center Public Affairs Office

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