Tricare Help
 

Since 08-01-05

From: Waspscpo@aol.com [mailto:Waspscpo@aol.com]
Sent: Monday, August 01, 2005 3:17 AM
To: undisclosed-recipients
Subject: Tricare Help

 
This is a classic example of military retirees not being fully informed and aware  about the advantages of Tricare for Life(TFL)  and are still waiting around to get into a Military Treatment Facility (MTF) for their care and their dependent's.  If you are a military retiree, have reached age 65 and enrolled in Medicare Part A and paying the premiums of Medicare Part B and  enrolled in DEERS, you should be getting your healthcare from
the most successful healthcare program in the U.S for military retirees, Tricare for Life.

http://www.navytimes.com/story.php?f=0-NAVYPAPER-985016.php

Tricare Help

You may have to wait for care at military hospital

By James E. Hamby Jr.
Special to Navy Times
1 August 2005

Q. When I turned 65 and got Tricare for Life, my military hospital told me I wouldn’t be able to get care there anymore. I always thought retirees had a lifetime guarantee of free medical care at military hospitals. What went wrong?

A. As far as I know, you still have a legal right to free care at military hospitals, depending on the availability of space, personnel and technical capacity to care for you. What changed things is a directive from the Office of the Assistant Secretary of Defense for Health Affairs that relates to Tricare Prime. The directive established a priority list for people to receive care in military treatment facilities. The mission of military treatment facilities, by law, is to provide health care for active-duty members, so they are first in line. Second in line are family members of active-duty personnel enrolled in Tricare Prime.

Third in line are retirees and their family members enrolled in Tricare Prime, and after that comes “everybody else” — active-duty family members and retirees and their family members not enrolled in Prime. Tricare Prime is not an option for Tricare for Life members. Their Tricare coverage is under Tricare Standard, plus Medicare, of course.

So, the question for you to consider is whether you would want to wait, and wait some more, to get into an MTF for care when you could go to the Medicare provider of your choice, get care more quickly and still get it free — or almost free — because of the combination of Medicare and Tricare payments.
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Different subject:

Q. I got a notice from Tricare that it denied my wife’s claim. They said the surgery wasn’t medically necessary. I can’t afford to sue the government — it’s not worth it for an $800 bill. What can I do?

A. Anytime a Tricare claim, or even a single charge on a claim, is denied (Tricare allows $0.00 on the charge), the adult patient (18 or older), the custodial parent (if the patient is under age 18) or the patient’s legal guardian should file an appeal with the claims processing contractor. Instructions for filing an appeal are on the back of the Tricare explanation of benefits.

An appeal must be in writing, state the specific matter in dispute, include a copy of the Tricare EOB showing the denial and be signed by an appropriate party. Sponsors may not file appeals on behalf of adult patients unless they are appointed in writing to represent the patient in the appeal. An appeal must be filed within 90 days of the date the claim completed processing (the date of the EOB).

If the denial is upheld and if the amount in dispute is $50 or more, the report of the first-level appeal will advise the appellant of the right to file a second level of appeal within 60 days. Sometimes, all that is needed to turn a service determined to be “not medically necessary” into a payable procedure is a statement from the provider showing why the service was provided for that particular patient. But it all starts with an appeal.

James E. Hamby Jr. may be reached by writing to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or by sending e-mail to tricarehelp@atpco.com .