Why does Tricare need my original bill when it’s the second payer?
May 18th, 2012 | TriCare Help | Posted by Military Times
I have other health insurance, and when I file with Tricare as second payer, I always have a problem getting copies of the original bills from my doctor’s office. The other plan’s EOB says what medical services I got and the amounts it paid, so why isn’t that enough for Tricare’s use? Why are copies of the original bills required?
The way services are listed on the other plan’s EOB may not report a detailed description of the medical services you actually received. For example, there may be several different services labeled simply as “office visit” on the other plan’s EOB. Tricare and the other plan likely allow different amounts for each service, so the words “office visit” and the amount allowed by the other plan does not tell Tricare exactly what kind of medical service the patient received.
Tricare must know exactly what services you received in order to determine the amount it would have allowed for each of them if Tricare had been your primary coverage. If, as I suspect, the problem arises between you and the office staff, perhaps explaining it to your doctor will remedy the situation.
Who pays first, Tricare or private policy?
February 28th, 2012 | TriCare Help | Posted by Military Times
If I have Tricare, is a private insurance primary? What about a COBRA policy?
Regardless of the source of payment, by federal law, Tricare is always last payer to all other coverage with two exceptions:
- A genuine Tricare supplemental plan
- A welfare-related plan such as Medicaid.
This post has more details about filing a claim with Tricare after you file with another insurance plan.
Can new wife use Tricare with other insurance?
February 25th, 2012 | TriCare Help | Posted by Military Times
I am in the Army, active duty, and I recently got married. My wife has health insurance through the college she attends. Is there any way she can cancel that and go with Tricare? She paid for the year through September, so that’s about $900 of insurance she doesnt want to use. Any advice? Can I enroll her with two insurances?
Whether you wife can cancel her other health insurance and get a refund is strictly a matter between her and the other plan. Tricare has nothing to do with it.
She can retain the other plan just as it is now and use Tricare as second payer. That is, she must file all claims with the other plan first. Then, when it has paid its maximum, she can file a claim with Tricare which will usually pay the other plan’s deductible and copayment. Tricare makes a good supplement for the other plan in that case, because Tricare Standard is free.
Here’s how she can file a claim with Tricare after filing with the first insurance:
- Complete a Tricare claim form DD2642.
- Attach a copy of the same itemized bill that was sent to the other plan.
- Attach a copy of the other plan’s EOB reporting its processing of each of the charges on that bill.
- Send the claim to the proper Tricare claims processor for where you live.
After I marry Marine husband, can I get Tricare right away?
December 27th, 2011 | TriCare Help | Posted by Military Times
My fiance is on active duty in the Marine Corps. We are getting married in January. I am currently a flight attendant, so I have my own health insurance right now, but I plan to quit in April when I move to Florida to be with him. Once we get married, is there a waiting period for me to be covered under Tricare, or is it automatic after he has enrolled me?
You will become legally entitled to Tricare at the moment you are married. There is no delay.
If you receive medical care while you still have coverage by your present policy, you must file claims with that plan first. After it has completed all processing of the claim and issued an explanation of benefits, you may file a claim with Tricare as second payer. Tricare will pay all, or most, of what the other plan left unpaid — usually your copayment and, if applicable on that claim, your deductible. For instructions, filing address, and to download claim forms, visit the Tricare website or call your Tricare Service Center.
Here’s how you file a claim with Tricare as second payer:
1. Complete a Tricare claim form DD2642.
2. Attach a copy of the same itemized bill that was sent to the other plan.
3. Attach a copy of the other plan’s EOB reporting its processing of each of the charges on that bill.
4. Send the claim to the proper Tricare claims processor for the state where you live.
For you to use Tricare, your husband must contact his Personnel Section to register you in the Defense Enrollment Eligibility Reporting System, better known as DEERS. (Remember the name. You will soon learn that military folks speak in acronyms.)
DEERS maintains a confidential registry of military beneficiaries and the benefits to which each person is entitled by law. Once registered in the confidential DEERS registry, your name will appear on DEERS under your husband’s Social Security number. DEERS will report that you are eligible for Tricare.
When a Tricare claim is processed, the Tricare computer contacts the DEERS computer automatically. It asks whether the person on the claim was eligible for Tricare on the date he or she received the medical service(s) on the claim. If DEERS replies “yes,” the claim will continue processing.
If DEERS replies “no” for any reason, the claim will be denied at that point, and the patient will be sent an explanation of benefits. The Tricare EOB always reports the reason any claim is denied and tells the patient of his/her right to appeal the decision. That reason for denial must be addressed in order for the claim to be paid.
If you receive medical care after you are married but before you are registered in DEERS, save copies of all itemized bills and receipts until your Tricare registration is complete and you have been issued a uniformed service identification card. Then you may file a claim for reimbursement of your costs. Your Tricare coverage will be retroactive to your first minute of eligibility.
Why are Medicare and Tricare telling me opposite things?
December 7th, 2011 | TriCare Help | Posted by Military Times
My employer provides a Medicare-approved health insurance policy. I’ll be 65 soon, and Medicare tells me I don’t have to enroll in Part B as long as I continue to work for that company. On the other hand, Tricare tells me I must enroll in Part B as soon as I turn 65 and get Medicare. Two government health insurance plans are telling me exactly opposite things, and both say they are right. I’m caught in the middle. Can you help me?
Both Medicare and Tricare are correct in what they told you. They are talking about different rules that exist for unrelated purposes.
Both rules concern requirements for Medicare Part B enrollment.
One of the two is a Medicare rule concerning a penalty for late enrollment in Part B after becoming entitled to Part A. The rule says you may delay Part B enrollment in some circumstances. You hear about this rule from Medicare.
The other is a Tricare rule. It concerns the federal law requiring Part B enrollment when you become eligible for Part A entitlement in order to retain Tricare eligibility. The Tricare rule says you must enroll in Part B “now.” You hear about this rule from Tricare. (It does not apply to active-duty family members.)
Under the Medicare rule, those who become entitled to Medicare Part A have a grace period during which they must enroll in Part B or face a penalty that increases their Part B premiums for the rest of their lives. The penalty adds 10 percent to the Part B premium for each year someone delays Part B enrollment after becoming entitled to Part A. However, there is a situation in which Medicare can waive that late-enrollment penalty.
Some companies sponsor health insurance and even pay a part of the employee’s insurance premium. If Medicare determines that the company’s insurance plan provides benefits that are at least as good as Medicare’s, it is called a creditable plan.
The Medicare rule says employees enrolled in an employer’s creditable plan can delay enrolling in Part B without penalty as long as they work for that employer.
Once they leave that employer, they have a grace period during which they must enroll in Part B to escape the late-enrollment penalty.
Nothing in this Medicare rule applies to Tricare; the Tricare rule is quite different.
The law that governs Tricare has a provision to the effect that a Tricare beneficiary who becomes entitled to Medicare Part A must be enrolled in Part B to retain Tricare eligibility.
Tricare beneficiaries who become entitled to Medicare Part A must be enrolled in Part B or lose all Tricare eligibility until they are enrolled in Part B.
Shortly before your Medicare entitlement becomes effective, you’ll get a letter advising you of your Medicare award. It will contain a Medicare ID card showing that you are enrolled in Part A and Part B. At that point, you’re a Medicare beneficiary.
In the same packet, you will receive a form allowing you to opt out of Part B. I strongly recommend that you do not opt out; if you do, you will find yourself with no Tricare benefits of any kind.
When your other health insurance is under a different name
October 31st, 2011 | TriCare Help | Posted by Military Times
I work in the airline industry and can enroll in my employer’s insurance. I also have Tricare Standard as my secondary insurance — my husband is deceased. However, the Tricare coverage is under my married name, and everything with my employer is under my maiden name. Will this cause a problem when I try to file a claim with Tricare as my secondary insurance? I need to enroll in my employer’s insurance soon.
Your problem is a simple administrative issue requiring an explanatory letter. How quickly it gets resolved depends on who gets the letter and when.
Write to your Tricare claims processing office — the same place where you submit Tricare claims — and explain the situation. Make three or four extra copies. Send the letter to the claims processor now, and send another copy with the first claim you submit to Tricare as second payer.
If it doesn’t take, you will know in a few weeks after you submit your first claim to Tricare as second payer. If your claim is denied, it isn’t a disaster; you just need to file and appeal.
If Tricare simply writes asking for more information, no appeal is needed. Just reply immediately, explaining everything again, and include a copy of the letter Tricare sent you so they know what you’re talking about.
If Tricare denies the claim, then it’s time to file an appeal. The appeal must be in writing and state the specific matter in dispute: For example, “Tricare denied claim number X because I used two different names on the claims. I have attached an explanatory letter.”
Attach a copy of the explanatory letter with the appeal letter. Include also a copy of Tricare’s explanation of benefits showing the claim denial.
Send the appeal letter, the explanatory letter, and Tricare’s EOB showing the denial to the address of the Tricare office that denied the claim. It’s on the Tricare EOB. Be sure to answer all questions Tricare asks, if any. That should resolve the name problem.
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.
How do I keep coverage for younger husband when I get TFL?
March 25th, 2011 | TriCare Help | Posted by Military Times
Q. I’m a retired reservist and retired federal employee with employees’ health insurance. I have a civilian husband who is three years younger, but no children. I’ll be 65 in August and get Medicare and Tricare for Life. What can I do at that time to ensure I still have coverage for my husband?
When you transition to Tricare for Life on Aug. 1, your husband’s federal employee plan and Tricare coverage will continue unchanged until he gets Medicare at age 65 — assuming you keep your own coverage under the federal employees plan. Family members can’t be covered unless the former employee also is covered. Confirm this with the Office of Personnel Management.
For your own transition, you should apply for Medicare Part A and Part B at least 90 days before Aug. 1. If you enroll properly, your coverage will be effective on that date. If your Defense Enrollment Eligibility Reporting Service record reflects your Part B enrollment, you will retain your Tricare eligibility and become eligible for TFL.
TFL consists of full coverage by Medicare Parts A and B plus Tricare Standard. Because you must retain your federal employee plan coverage for your husband’s benefit, however, that plan — not Tricare — will be second payer on your Medicare claims. Tricare Standard will be last payer, and you must file those claims yourself.
Call the DEERS support office at 800-538-9552 to check the accuracy of your and your husband’s DEERS records.
When Tricare Standard becomes your primary coverage
March 4th, 2011 | TriCare Help | Posted by Military Times
Q. I am 62 years old and have been retired from the Navy for 21 years. I have worked at my current job for 18 years and have been covered by my employer’s insurance, with Tricare as my secondary insurance. Now, due to health complications, I have had to cut back on my work hours, and I no longer have my employer’s insurance. Will Tricare Standard take over as my primary insurer? If so, what do I need to do? How much will it cost? How can I get my prescriptions filled? I don’t live near a military base.
You probably already know that you must keep your DEERS registration and your military ID card up to date in order to have Tricare coverage. You can update your DEERS record by calling the DEERS Support Office, toll-free, at 1-800-538-9552. That office will also provide any guidance you need to update your ID card.
It may be, however, that you need some information about how to handle the effects of the loss of coverage by your employer’s health insurance plan. You will be told in advance when your coverage under that plan will end.
You must get an official letter from that insurance company that reports the last date that you will have coverage under that plan. That is, a report of the last date that plan will pay for your medical care. Call DEERS and ask to whom you should send a copy of that letter, together with a brief explanation of the reason the policy will be canceled — whom should you notify and when.
If you have made proper notification, DEERS and Tricare will know the last date of your other coverage. Tricare Standard will automatically become your only health insurance effective on the following day.
When Tricare Standard is your only coverage, you will become responsible for paying the $150 yearly Tricare deductible and your 25 percent cost share of the amount allowed on each Tricare claim. Otherwise, Tricare Standard is free; it has no monthly premium. All Tricare beneficiaries are automatically eligible for the Tricare Pharmacy Program at no cost other than the small copayments for drugs.
A month or two before you lose your employer’s plan, you may want to begin to research the coverage offered by one of the several Tricare supplement plans. Most of the retiree associations offer such a plan.
Write to several associations and request a copy of their Tricare supplemental policy. In that way, you can compare several to find the plan that best meets your needs. Check carefully the policy’s coverage of pre-existing conditions.
I suggest, also, that you contact the Social Security Administration to research possible coverage under the Social Security Disability Program.
If you qualify for that program, you will become eligible for Medicare after receiving disability benefits for 24 consecutive months. Otherwise, you will have to wait until you are 65 to qualify for Medicare and Tricare for Life.
Should I keep my employer’s insurance too?
February 23rd, 2011 | TriCare Help | Posted by Military Times
I have retired from civil service and just turned 60. I will be on Tricare starting in March. Would it be worth keeping my civil service health plan at $100 a month, or should I just go straight Tricare. What would be the benefit of keep two health insurances?
If you retain your federal employees health insurance, it will be your primary coverage. That is, you must file claims with that plan first. My answer in this earlier post outlines how Tricare works in such cases.
The advantage, and it is a big one, is that Tricare Standard, which is free, will act as a supplement for that insurance. Usually Tricare will usually pay whatever your employees plan did not pay — that usually is the deductibles and copayments, which can add up quickly. Except for the cost of your federal employees monthly premium, most of your medical care will be free.