Will surgeries on pre-existing scar be covered?
November 8th, 2009 | TriCare Help | Posted by Military Times
Q. My young daughter was burned two years ago. She has had surgery two times for scar revision as she has grown, and will need at least two more operations as she gets older.
My family and I will get Tricare later this year when I am 60. Will my daughter’s subsequent surgeries be covered by Tricare, or will coverage be denied or limited because the scar is a pre-existing condition?
Tricare is not an insurance company; it is a federal health benefits program, similar in that respect to Medicare. Unlike many commercial health insurance plans, Tricare has no restrictions or limitations on the coverage of pre-existing conditions.
A potential problem, easily overcome, could be with the continuity of care if you want the later surgeries performed by the same surgeon who did the previous operations.
For Tricare to cover the surgery, the surgeon must be or become a Tricare-authorized provider. That is, he must apply to Tricare and submit the information required to establish that he is a properly trained and licensed physician in the state where he practices.
When Tricare approves his application, he will be authorized to receive payment for services rendered to Tricare beneficiaries. All insurance plans and companies require some form of provider authorization.
Apart from certain medical emergencies, Tricare may not pay for any services received from an unauthorized provider.
Tags: doctor, pre-existing condition
Comments are closed.