Do we have to report insurance policy payments to Tricare?
May 9th, 2012 | TriCare Help | Posted by Military Times
My husband and I have an insurance policy that will pay us $100 for each day we are in the hospital for cancer treatment. Do we have to report that to Tricare when we file claims?
Policies that pay a specified and fixed amount directly to the beneficiary for each day of hospitalization and don’t specify that the payments are for medical bills are income protection policies. They are not health insurance and do not have to be reported to Tricare.
If surgery is covered, why did the hospital send a bill?
May 1st, 2012 | TriCare Help | Posted by Military Times
My father is retired Air Force and just recently had retinal re-attachment surgery. He has Medicare as well as Tricare for Life, so I don’t understand why he received a bill from the hospital for over $300. Does Tricare not cover the surgery?
Ordinarily there should be no unpaid balance under Tricare for Life; the combination of payments by Medicare (primary coverage) plus those by Tricare should have paid the Medicare claim and all providers’ bills in full.
The balance most likely results from an error in the way the Medicare claim was filed or processed.
Your father will need to research the matter by comparing the itemized bills for the balance with the explanations of benefits from Medicare and Tricare. He can find contact information for help on the Tricare website.
Just found out Dad isn’t signed up for Part B; what now?
October 21st, 2011 | TriCare Help | Posted by Military Times
My father, an Army retiree, turned 65 in April and has not yet enrolled in Medicare Part B. Are there any penalties for late enrollment? He was recently hospitalized, and I need to know the quickest, and easiest way to help him do this right away so as his insurance doesn’t deny all the bills that he recently had.
If a Tricare-eligible retiree or retiree family member becomes legally entitled to free Medicare Part A, federal law requires that he must be enrolled also in Medicare Part B at that same time. Failure to be enrolled also in Part B results in the immediate loss of Tricare eligibility until the beneficiary has Medicare Part B in force.
Your father should immediately contact the Social Security Administration at 1-800-772-1213 for guidance to enroll in Medicare Part B.
The legal provision to which I refer is part of the law that governs Tricare eligibility. It does not apply to active duty family members or to civilians.
Without delay, your father also needs to contact the Defense Enrollment Eligibility Reporting System, better known as DEERS, at 1-800-538-9552 for an official determination of his Tricare eligibility.
If your father is not enrolled in Part B, it is most likely that his Tricare eligibility was automatically terminated on the first day of the month when he turned 65.
It is unlikely that he can get retroactive coverage for care he received while he was ineligible, but DEERS can give you an official answer.
How do we decide between Tricare Prime and FEHBP?
September 8th, 2011 | TriCare Help | Posted by Military Times
My husband is retiring from the military and now is eligible for the Federal Employee Health Benefits Program through his new job. He has minimal health issues, but I have a history of cancer and other problems. Should we enroll in FEHBP or use Tricare Prime? The premiums alone for FEHBP equal or exceed Tricare’s yearly $3,000 catastrophic cap. If we had both, could the FEHBP deductibles, copayments and premiums count toward Tricare’s catastrophic cap?
I cannot tell you exactly what you “ought” to do regarding your health insurance coverage; nobody can make that decision except you and your husband. But I can give you as much information as possible about Tricare to help you make that decision.
Tricare Prime functions as a Health Maintenance Organization (HMO). Tricare Prime providers (called network providers) are under contract with Tricare to provide the services mandated by law and regulation to beneficiaries enrolled in Prime.
They have privately negotiated with Tricare the fees they will charge for each of their services, but that’s between Tricare and the provider only. All the patient must be concerned about is the flat rate of $12 he or she must pay per office visit, or the flat rate of $11 per day for hospital stays.
Prime is not available everywhere. It is usually found within a 40- 50-mile radius of a military treatment facility. Tricare beneficiaries enrolled in Prime have priority access, right after active-duty family members, to free care at the MTF.
As with commercial HMOs, you must seek all care, except bona fide medical emergency care, from providers in your local network.
If you take a trip, clear it first with Tricare Prime, because on the road, “routine” care will not be covered inexpensively. There are considerable penalties ($300 deductible, 50 percent cost share) on claims for unauthorized care by non-network providers.
People have exactly the same problems with commercial HMOs under the FEHBP. Personally, I like HMO care except for the limited choice of providers, and the inconvenience if one travels. They are most like military sick call. The big ones have everything — labs, etc. under one roof, plus centralized record-keeping, central appointments, and the like. Big civilian HMOs may even own their own hospital. And their low cost is a big factor.
Like many things in life, it’s a trade-off. Study assiduously; know before you buy. You can download a free Tricare Prime handbook here.
FEHBP deductibles and cost shares do not count for your Tricare catastrophic cap, however. Only Tricare’s deductibles and cost shares count.
Unhappy with care at base hospital; can Tricare help?
August 1st, 2011 | TriCare Help | Posted by Military Times
Q. My wife has issues with sleeplessness, weight gain and possible hormone imbalance issues. She’s been seen at our local base hospital a dozen times by both women’s clinic doctors and family practice doctors. The docs continue to bounce here back and forth with no resolution of the problem and will not send her off base for another opinion or possibly to see a specialist who works with female hormone problems. How can we get a Tricare referral? We’re almost to the point of paying for off base care out of pocket if necessary, but it’s hard to believe Tricare wouldn’t cover this problem.
Tricare is unrelated to military health services. It has no authority to require or even recommend that the military refer a patient to civilian care or specialists.
If you and your wife have a complaint about care she received at the military hospital, go through the chain of command at that hospital first. If unsuccessful, then ask for guidance about the next step for filing a complaint.
You may want to ask for advice from the Tricare Headquarters. That address is Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. TMA does not have an e-mail address or telephone number suitable for public contact.
Be cautious before buying additional insurance
May 18th, 2011 | TriCare Help | Posted by Military Times
Q. An insurance company will pay $200 for each day I am hospitalized for cancer. Is that a wise investment?
Until you have read the fine print in the policy itself, you cannot know how the insurer defines, for payment purposes, what it means by “hospitalized for cancer.”
I’m almost certain that the ad contains other words or phrases that lack a solid operational definition. Those definitions are at the heart of any considerations you make.
How long must you be hospitalized before the policy makes its first payment? Must “cancer” be the primary diagnosis? (I’ve never heard of anyone being hospitalized for “cancer” as the sole, primary diagnosis.) What kind of cancer, affecting what parts of the body, in what ways, with what effects, are usually key parts of an admission diagnosis.
Before you buy, request a copy of the policy and read it carefully to learn what medical conditions you must meet and the way the doctor must write his admission documents for the policy to pay anything. You’ll be glad you did.
I support my mother – can she get Tricare?
January 27th, 2011 | TriCare Help | Posted by Military Times
Q. Can I get Tricare coverage for my mother while I am on active duty? She has been my dependent for the last 8 months and she has lived with me for the last 6 years. I pay all of her bills and I also pay for her medical expenses. She does not receive any assistance from the government. She does not have a job or receive retirement pay. She is 59 years old.
Regardless of a uniformed service member’s duty status — active duty or retired — his or her parents are not eligible for Tricare, even if they are legally classified as dependents. That is a matter of federal law. You can confirm that by calling the DEERS Support Office, toll-free, at 1-800-538-9552. DEERS is a federal agency under the Defense Department. It deals with eligibility issues only.
There remains a possibility that your mother could be allowed free medical care at the military hospital where you are stationed. To that end, please contact the hospital’s Patient Administration Office.
The authority to grant that permission lies exclusively with the hospital’s Commanding Officer. It is subject to the availability of space and personnel, and the hospital’s technical ability to provide the care she needs. It is a privilege, not a right provided by law. It can be withdrawn at any time according to the needs of the service.
If granted, permission will apply to that particular military hospital only. It is not transferable. That is, if you are assigned to a different military facility, you would have to seek permission again at your new duty station’s hospital.
In Tricare for Life, why do I also need Medicare Part A?
September 27th, 2010 | TriCare Help | Posted by Military Times
Q. When I get Medicare, I know I’m required to enroll in Medicare Part B. But I know Medicare starts with Part A, which is free. What am I supposed to do with Part A? Why do I have it?
The program called Original Medicare, which is what most Tricare For Life beneficiaries enroll in, consists of Part A and Part B, which pay for different kinds of medical services.
Part A is called Hospital Insurance. Although it covers a few other things, it mainly helps pay for hospital bills. These are things the hospital itself provides — room and board, special diets, general nursing services, use of hospitals’ facilities and personnel such as X-ray equipment and technicians, laboratory services, and use of the operating room.
The hospital files a claim with Part A for those charges. Your hospital bill does not include your doctors’ bills, even for services you receive while in the hospital.
Part B is called Medical Insurance. Its primary purpose is to pay providers of professional services, such as your physician, surgeon, the radiologist who interprets X-rays, and the pathologist who interprets the lab results. Those providers all bill Medicare Part B whether you receive their services in or out of the hospital.
For a more complete description of things paid by Parts A and B, look in your Medicare Handbook or go to Medicare’s official website.
We’re moving; can I still get Prime?
June 3rd, 2010 | TriCare Help | Posted by Military Times
Q. My husband will soon be deploying and my son and I will be moving away from post. We will live in the same state, but we will not be near a military base. We are currently covered by Tricare Prime. Will I be able to continue care at another hospital in our new town? Or should I switch to Standard? I am currently being seen regularly for physical therapy for my back.
Tricare Prime is not available everywhere. It is usually available only within a one hour drive-time of a military hospital — about 40 – 60 miles.
You must call your Tricare service center and ask whether Tricare Prime will be available at your new address. If it is not, you will have to switch your enrollment to Tricare Standard after you arrive at your new address.
At that time, it would be wise for you to look into buying a Tricare supplement from one of the retired military associations. Examine the fine print written to find the one that best meets your and your family’s needs.
Supplements differ from one another in more than just their price. Some require a deductible; some have limits on pre-existing conditions. That’s why you need to reveiw several in order to make sure the supplement you buy meets your own particular needs.
Can coverage be reinstated for disabled adult son?
May 24th, 2010 | TriCare Help | Posted by Military Times
Q. My husband is still active duty. My question is about coverage for our oldest son, who is 25. He has learning disabilities, ADD, dylexia and seizures. He was on medication for seizures, but when he lost his Tricare coverage due to his age he stopped taking his seizure medication, as he could not afford it (he works a minimum-wage job). He recently went to the hospital by ambulance because he had a seizure. As he was diagnosed with the seizure disorder before he lost his Tricare coverage, why does he not qualify for medical care?
I assume your son’s Tricare eligibility ended when he was 21. If he became disabled and incapable of self-support before he was 21, his Tricare eligibility could have been extended indefinitely, for as long as the disabling condition lasted, even for life. Having a seizure disorder would not automatically qualify your son for extended Tricare benefits unless it made it impossible for him to work.
For official information and advice regarding Tricare eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552. Alternatively, your husband should talk with his military personnel section.
Your husband should talk with his military hospital and inquire about the possibility of restoring your son’s Tricare eligibility. Your case could be damaged because you have waited so long, and because he does seem to be able to be self-supporting to a degree, at least. It’s worth the effort. At the worst, they say no.
He should also ask at the hospital whether it is possible to arrange for your son to get some help there. Your husband should start with the hospital’s Executive Officer and work his way up through the chain of command to the Commading Officer.
Has your son applied with the Social Security Administration for disability benefits? If not, he should contact that office.
Finally, nobody is certain about all the implications of the new health care reform law as it is implemented over the next several years, but to some extent, it may help people like your son.