Will Prime pay to reverse sterilization procedure?
February 15th, 2010 | TriCare Help | Posted by Military Times
Q. I have Tricare Prime, and I want to get my tubes untied so my husband and I can have a baby. Will Tricare pay for this?
No. Although Tricare may help with payment of the costs of surgical sterilization, it is not allowed to help pay for the reversal of a surgical sterilization procedure.
How can I get Prime for my wife?
February 13th, 2010 | TriCare Help | Posted by Military Times
Q. I have Tricare for Life, but my wife doesn’t have Medicare yet. How can I get Tricare Prime for her, what are the rates, and how do I pay?
Tricare Prime is not available everywhere, but it provides the best coverage if you can get it where you live. To learn whether it is available where you live, and for information about enrolling your wife in it, please contact your Regional Tricare Office. While talking with them, ask for a Tricare Prime Handbook if your wife is eligible for it. If not, ask for a Tricare Standard Handbook. If she can’t get Prime, she must take Tricare Standard. Standard is free.
Tricare Prime costs $230 annually and will send you a bill. I believe you can arrange for an allotment from your retired pay each month. Ask Tricare about that.
A supplement is not needed for Tricare Prime. But if only Tricare Standard is available where your wife lives, I suggest you look into buying one.
Most of the retired military associations sell a Tricare Standard supplement. If you decide to go that route, check out several before you buy. Read the fine print carefully, because Tricare supplements vary in price and the kinds of coverage they offer. Some have a deductible; some have limits on coverage for pre-existing conditions. Know before you buy.
My daughter’s stateside – how can I enroll her?
February 12th, 2010 | TriCare Help | Posted by Military Times
Q. I am currently deployed in Iraq. I’m stationed in Germany, but I have a 2-year-old daughter in North Carolina. How do I enroll her in Tricare? She is already on my DEERS.
If your daughter is properly registered in DEERS, her Tricare eligibility is assured already. You can confirm her eligibility by contacting the DEERS Support Office, toll-free, at 800-538-9552. You are responsible for keeping her DEERS record up-to-date, but the person taking care of the child should know that phone number in case eligibility questions arise.
Every time a Tricare claim is processed, the processing computer automatically contacts the DEERS computer. It asks DEERS if the patient on the Tricare claim was eligible for Tricare on the date he or she received the medical care. If the information reported on the Tricare claim form matches the information in the patient’s DEERS record, the claim will continue processing. If the information on the claim form does not match that in the DEERS database, the claim must be denied until the discrepancy is resolved.
Will Tricare cover new orthopedic surgeries?
February 11th, 2010 | TriCare Help | Posted by Military Times
Q. I broke my leg a little over a year ago and have had two reconstructive surgeries that have since proven to be a complete waste of time. My leg is still in pieces. This horrible care was provided through my employer’s insurance.
Last month I married a soldier, and I am now trying to be seen at one of the best hospitals around, hoping that Tricare will approve my claim to be referred to a good orthopedic surgeon. I’ve been told that Tricare will most likely deny my claim because I have been previously treated by my employer’s insurance provider. Is that true?
Although no one can guarantee your unrestricted or unlimited access to the surgeon of your choice, I’m certain that your request for a particular provider will be given fair consideration. Tricare has no limits or restrictions on medically necessary and appropriate coverage for pre-existing conditions.
Please keep in mind that our country is at war, and there are a very large number of orthopedic and reconstructive surgeons with extensive experience in the rebuilding of shattered limbs. Many of them are employed at military medical facilities. Your care, however, is not limited to military medical facilities.
How does Tricare work with Medicare Part D?
February 6th, 2010 | TriCare Help | Posted by Military Times
Q. I am retired military, age 65. I know Tricare pays last, but do you have to fill prescriptions with Medicare first and then submit to Tricare for any expenses not covered? Or can I use the Tricare mail order prescription service as my preferred prescription service?
All Tricare beneficiaries are automatically eligible for, and are automatically enrolled in, the free Tricare Pharmacy Program and are eligible for its complete benefits. It is recognized as one of the best pharmacy plans available. They do not need any pharmacy insurance other than the Tricare Pharmacy Program.
You can find detailed information about the Tricare Pharmacy Program online. If you want it, additional printed information is available from the Tricare worldwide pharmacy benefit administrator, Express Scripts Inc. The toll-free number is 877-363-1303.
Health Affairs does not recommend that Tricare beneficiaries enroll in the Medicare Part D Pharmacy Program. The only Tricare beneficiaries who are likely to derive any significant advantage from Medicare Part D are the few whose incomes are below the federal poverty level and who qualify for financial aid to pay their Medicare Part B monthly premiums.
Because you have other health insurance (Medicare Part D), you are not eligible to use TMOP. That is because of the way Tricare is required by law to coordinate its benefits with Express Scripts Inc. which, for TMOP services, is not only the plan’s administrator, but also the provider of the drugs under TMOP.
When you enrolled in Medicare Part D, you had several commercial pharmacy plans to choose among, depending on where you live. Each plan has its own rules for using its benefits. You must follow that plan’s rules for all your pharmacy services and use it first, before you may use your free Tricare pharmacy plan.
You may find that your commercial plan under Medicare Part D will not pay for certain drugs. Although Tricare has special rules for dispensing certain drugs, if your doctor can document the medical necessity of that particular drug in your particular case, Tricare will make it available for you without penalties.
If your Part D pharmacy plan charges you a co-payment or a deductible for your prescription services, you may file a claim with the Tricare Pharmacy Program for partial reimbursement of those expenses.
If you have to pay a premium for the Part D pharmacy plan, however, you may not file a claim with Tricare for the premium payment. Tricare will reimburse you only for your co-payment and deductible on the cost of the drugs, but not for any cost of the insurance plan.
You will probably need help to learn how to file a claim with Tricare as second payer for your prescription drugs. I suggest you call Express Scripts for that help. If you use the Tricare Pharmacy Program exclusively, there are no claims to file.
You may also want to discuss with Express Scripts your need, or the advisability, of continuing to be enrolled in Medicare Part D. Call Medicare if you choose to withdraw from your Medicare Part D enrollment. It is easy to do, and there is no penalty.
How can I get my hearing aid covered?
February 5th, 2010 | TriCare Help | Posted by Military Times
Q. Is there any coverage for hearing aids under Tricare for Life? I think the answer is “no,” but I’m just checking.
You are right that federal law doesn’t let Tricare pay for hearing aids, just like it can’t pay for glasses, either. But it’s not quite as bad as you might think.
There is a program called RACHAP (Retiree At Cost Hearing Aid Program) that allows retirees only (not their family members) to buy hearing aids at the government’s cost. It is not related to Tricare in any way.
I haven’t had any dealings with them or talked with anybody who has. In fact, I’d appreciate it if you tell me what happens when you contact them and whether it works to your satisfaction. Good hearing aids are expensive, so even with the government’s discount, you are going to have some pocket-book pain.
Did I lose coverage when I got married?
February 4th, 2010 | TriCare Help | Posted by Military Times
Q. I’m 17 and I just got married. My father is in the Air Force. Am I still covered by his Tricare?
No, at midnight of the day you married you automatically lost all the Tricare eligibility you had from your father’s service.
You can confirm that by calling the DEERS Support Office, toll-free, at 1-800-538-9552. You or your father must notify DEERS of your marriage.
Artificial insemination while husband is deployed?
February 4th, 2010 | TriCare Help | Posted by Military Times
Q. I am a Navy wife and we have been trying to conceive for two years. My husband is on a sub and leaves for three months at a time every three months. Would Tricare cover artificial insemination so that we can continue to try when he’s gone?
I sympathize with your problem, but I don’t have good news for you.
Tricare is not allowed to provide coverage for any kind of technical assistance with conception, including artificial insemination, even with your husband as sperm donor.
I have not heard of any exceptions being made, but you might want to write to the Tricare Headquarters, Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043, to inquire. Explain your situation and include a daytime phone number. Please don’t get your hopes up.
Are acupunture or chiropractic care covered?
February 3rd, 2010 | TriCare Help | Posted by Military Times
Q. Will Tricare pay anything for acupuncture or a chiropractor? I use them and they seem to work; I no longer take allergy meds. I still have a regular doctor too. I had the coverage when I had my employer’s insurance.
Tricare is currently forbidden by federal law and regulation to pay for chiropractic care or acupuncture. I am aware that there are people with strong feelings about the effectiveness of both of those treatment modalities, both for and against, and both have been the subject of considerable public dispute and debate.
Tricare is not a health insurance policy or an insurance company. It is a federal health benefits program created and governed by federal law, which determines who is eligible and when, which medical services Tricare may cover and which are excluded, the amounts it may pay for each medical service and the manner of payment, the portion of the costs of care that are the beneficiary’s responsibility to pay, and the like. Only Congress can change it.
What about hair implants?
February 3rd, 2010 | TriCare Help | Posted by Military Times
Q. Will Tricare cover and pay for hair implant surgery? I’m male, and I had a thick head of hair prior to joining the military. I’m now showing signs of baldness. It’s not hereditary in my family. I feel that lack of sleep, nutrients, stress, missions and shots received while in the military have caused my hair to thin.
I’m sorry, but Tricare is not allowed to pay for medical, surgical or other services performed solely for cosmetic purposes or psychological reasons. Tricare benefits are determined by federal law and regulation.
If you believe your hair loss is a result of your military service, you may want to file a claim with the Department of Veterans Affairs.