Posted on Sep 19, 2022
Any Mayo clinic tricare users receive notification about the pharmacy being dropped??
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Posted 2 y ago
Responses: 1
The Mayo clinic pharmacy still shows up as in-network according to the Tricare website.
https://militaryrx.express-scripts.com/find-pharmacy
(put in the zip of the Mayo clinic - 55902)
However, I didn't receive any notification recently (have used the Mayo clinic in the past, though not recently) and there doesn't appear to be any notification on the website either.
https://militaryrx.express-scripts.com/find-pharmacy
(put in the zip of the Mayo clinic - 55902)
However, I didn't receive any notification recently (have used the Mayo clinic in the past, though not recently) and there doesn't appear to be any notification on the website either.
Find a TRICARE Network Pharmacy | Express Scripts
Use our directory to find a TRICARE network pharmacy near you. Choose from retail pharmacies, military pharmacies, or home delivery for maintenance and specialty medications.
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LCDR Phil Griesbach
I got a letter on 8 sept stating the mayo pharmacy is out of network on 24 oct. my wife gets a monthly infusion so this may impact her care there. I forwarded a copy to mayo insurance for a read out. her use of the pharmacy is more complicated than just picking up a prescription...
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COL Randall C.
I'm out of my depth now. Would advise you to contact HNFS or Humana (depending if you're TRICARE East or West) to get an exact readout of the changes.
It MAY be one of those things where they are going from an "in-network" to "out-of-network but still accepting TRICARE" (which means possibly a bit higher costs and you'll have to submit the paperwork).
Not sure exactly which TRICARE plan you're on. The TRICARE/Mayo Clinic agreement is that the Mayo clinic bills full cost, but accepts the TRICARE reimbursement (which is what you normally see on your EOBs). If the reimbursement cost is the same, then you'll pick up a bit larger cost share on the front end (another 5% I believe on Select plans).
Again, contact the TRICARE agent to get a good read-out on what's what.
Keep in mind, as long as the Mayo Clinic has agreed to the TRICARE reimbursement rate, you should still be in good shape. Worst case as I see it - you might have to do paperwork in submitting the bills to be reimbursed (and might have to pay up front and then get the money back from TRICARE) and if you're on Select the co-pay changes from $32 for in-network to 25% cost share for out of network ... so you could be hitting your catastrophic cap (if you don't normally hit that during the year), which would be $3,706/year.
If for some reason TRICARE stopped covering the procedures .. then that is when you really start worrying about the costs.
It MAY be one of those things where they are going from an "in-network" to "out-of-network but still accepting TRICARE" (which means possibly a bit higher costs and you'll have to submit the paperwork).
Not sure exactly which TRICARE plan you're on. The TRICARE/Mayo Clinic agreement is that the Mayo clinic bills full cost, but accepts the TRICARE reimbursement (which is what you normally see on your EOBs). If the reimbursement cost is the same, then you'll pick up a bit larger cost share on the front end (another 5% I believe on Select plans).
Again, contact the TRICARE agent to get a good read-out on what's what.
Keep in mind, as long as the Mayo Clinic has agreed to the TRICARE reimbursement rate, you should still be in good shape. Worst case as I see it - you might have to do paperwork in submitting the bills to be reimbursed (and might have to pay up front and then get the money back from TRICARE) and if you're on Select the co-pay changes from $32 for in-network to 25% cost share for out of network ... so you could be hitting your catastrophic cap (if you don't normally hit that during the year), which would be $3,706/year.
If for some reason TRICARE stopped covering the procedures .. then that is when you really start worrying about the costs.
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COL Randall C.
By the way ... the disconnect between the 3rd and 5th paragraphs regarding cost share/co-pay difference. I forgot that for in-network they do a co-pay but for out-of-network they do a cost share (used to be a 20% cost share in-network and 25% out-of-network).
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