Tricare Help -Tell Tricare if you lose other coverage

Since 04-17-06

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Subject: Tricare Help: Tell Tricare if you lose other coverage

 
http://tricare.osd.mil/eenews/downloads/041106 TRICARE Help.doc

April 17, 2006
Army Times

Tricare Help: Tell Tricare if you lose other coverage

By James E. Hamby Jr.
Special to the Times

Q. A couple of years ago, my wife quit her job and lost the health insurance we’d had for several years. A few weeks later, my next Tricare claim was denied because I didn’t file first with my other health insurance. I didn’t think to notify Tricare that my wife’s policy had been canceled. The policy was reported in our Tricare record as being in force. You need to tell other folks about that little problem so they don’t forget like I did.

A. Many thanks for the heads-up. It hadn’t occurred to me until you mentioned it.  When a Tricare beneficiary loses or cancels a health insurance policy, it’s important to advise the Tricare claims-processing office promptly by mail to avoid this problem.

You will need to include a letter from the other health insurance, on its official letterhead, that identifies all the persons covered under that policy, and the last date each person had coverage.

If the dates of medical care overlap the termination date of the other plan, you must include a copy of its explanation of benefits showing its processing of claims during any period while the plan was still in effect.

If one of the beneficiaries happens to be in the hospital at the time the other plan’s coverage ends, the hospital will not be happy. Its billing office will have to file one claim with Tricare as second payer for services provided until midnight on the last day of coverage. Then, it will have to file another claim, this time with Tricare as primary payer, for services provided after midnight.

Fortunately, that’s the hospital’s problem, not the patient’s.

Q. In a recent column, you quoted the Defense Enrollment Eligibility Reporting System about how to avoid the problems of claim denial immediately after becoming eligible for Tricare for Life if Medicare is slow to notify DEERS of an individual’s Part B enrollment. For those of us who are usually healthy and unlikely to need to see a doctor for weeks or months after becoming eligible for Medicare, are all of those steps really necessary?

A. “All of those steps” involve only a couple of phone calls and a three-line letter, but you asked whether they are really necessary for healthy folks.

Maybe not. But you’ll be trusting unknown employees at Medicare and at DEERS to do the job for you, and you’ll also be relying on your own aging body not to betray you and have a stroke or a heart attack before you are done reading this page.

Do you remember Jim Fixx, the famous “fitness guy”? He had a heart attack while on the jogging trail in 1984, and died right there. He was 52.

Although I never got beyond Tenderfoot in Boy Scouts, I still remember the motto: “Be  prepared.” If something personally important to me needs to be done, I prefer to do it myself if I can and not trust somebody else, especially a stranger.

The toll-free number for the DEERS Support Office is (800) 538-9552,just in case you, or your family, need it.

James E. Hamby Jr. may be reached by writing to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or by sending e-mail to tricarehelp@atpco.com. In e-mail, include the word Tricare in the subject line and do not attach files. If using regular mail, include an e-mail address if possible.
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Contributed,
YNCS Don Harribine, USN(ret)