How will my daughter be covered while studying abroad?
October 17th, 2009 | TriCare Help | Posted by Military Times
Q. I’m a retired soldier and my daughter is covered under Tricare Prime as a dependent. She will be studying abroad in Bath, England, next semester. Will she be covered? What additional insurance will I need to provide her?
Tricare Prime is not available overseas for retirees or their family members. Your daughter will have to rely on Tricare Standard, which requires a $150 deductible per fiscal year and a 25 percent cost share. Local providers may require up-front payment of fees at time of service. You can read more about Tricare Standard and the Tricare Pharmacy Program online.
Unless she is eligible for a commercial health insurance policy that will cover her as primary payer to Tricare outside the U.S., you may want to consider buying a Tricare supplement through one of the military associations. Most supplements pay, at least, the patient’s Tricare deductible and cost share. Compare several plans, and make sure you read the fine print carefully before buying. Be certain it states in the body of the policy itself that it is a specially written plan, designed to be a Tricare supplement, and that it covers Tricare claims for medical care received outside the U.S.
There will be some problems with the Tricare Pharmacy Program due to international laws concerning mailing of prescription drugs outside the U.S. If there is a U.S. Consulate in Bath, it is possible that she can arrange to have drugs sent to that address. To get official clarification about that matter and advice about filing prescription claims, call Express Scripts Inc. at 1-866-363-8779.
I strongly suggest that you contact the Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, Co 80011-9043, to discuss your daughter’s plans officially with Tricare Management. Among other things, if your daughter is 18 or older, you will need to file with Tricare a statement, signed and dated by your daughter, authorizing Tricare to deal with you concerning matters of her medical care and Tricare claims. This is a Privacy Act concern if she is, or will be, 18 or older. That way, you can help her with claims and/or medical care should the need arise.
Mixed messages on cancer treatment
September 25th, 2009 | TriCare Help | Posted by Military Times
Q. I have been diagnosed with prostate cancer and I am considering High Intensity Focused Ultrasound as my treatment option. I will be traveling outside the U.S. for this treatment since it is not approved here. My insurance is Medicare and Tricare For Life. Medicare will not cover anything outside the U.S., and initially Tricare has told me they will not cover it. However, I have spoken with several people who have Tricare who say they have been reimbursed for this procedure. How I should proceed?
First of all, I can give you only unofficial advice on this matter, since I have no official relationship with Tricare or the Defense Department. Neither I nor my published works should be considered as representing or speaking on behalf of Tricare.
You should contact your Tricare claims processing contractor to ask for an opinion about whether the procedure can be covered by Tricare, but I don’t know whether one will be forthcoming. I think that for Tricare to say the procedure will be covered could be considered to be a prior authorization, which Tricare is not allowed to provide unless a prior authorization for a procedure is required.
Failing a reply you consider adequate from the Tricare claims processor, I recommend that you write to the Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. (The Tricare Management Activity is a federal agency under auspices of the Office of the Assistant Secretary of Defense for Health Affairs. It is charged with certain management and/or directive functions regarding operation of the Tricare program.)
If you decide to have the procedure you describe, and if payment of your claim is denied, I believe your only initial option in that case would be to file an appeal of the denial of your claim. Of course, filing an appeal is no guarantee that an adverse determination will be reversed.