Doctors and Health Insurance
Recently it seems like taking a friend of mine to the doctor's office and helping her deal with the uncertainty and frustration that often accompanies such vists has become my hobby.
She has TriCare Prime (military family health insurance), which is supposed to reimburse her for outside medical expenses but has not been doing so for the past several months. They also have been denying her appoints for these past few months as well, for reasons unknown.
Anyone have any tips on how to get them to start kicking in what they are supposed to for her outside medical expenses, which are necessitated only because they refuse to make appointments for her with her primary care physician? Or how to get them to start treating her like a proper patient again? Is there a patient advocacy board or anything?
Navigating the different layers of bureaucracy in the big business of healthcare can be daunting, so any advice would be appreciated.
Here's what I discovered:
ALWAYS GET Authorization for each appointment, specialty or treatment. To do this, you ask your regular doctor before he sends you to someone else, to call TriCare and get it pre-approved. Write down this code!
If you've moved to another region (like I did from North to South), TriCare services will be interrupted until you tell DEERS where your new location is. If they assign you to a military hospital, then that's where you need to go.
Also, if you've recently applied for SS Disability & were granted Medicare, TriCare will STOP paying unless you have both Part A and Part B of Medicare!!! (this was a very painful lesson for me!)
Once you have the Medicare A & B, Tricare will resume paying as your secondary insurance & will cover any meds Medicare doesn't.
If your friend has had any recent changes in her marital status, this may be the cause of TriCare not picking up the bills.
Go to www.tricare.mil to see an overview of benefits and to find out if you've been disenrolled from your insurance and what to do about it!
Good Luck!