Tricare Medical Coverage

[JimGant]

Sorry if this is repetitive. My searching on "Tricare" kind of hit around the edges, but wasn't very definitive.

Having just hit age 65, and now on Tricare for Life (requiring Medicare B premiums be paid), I wondered about treatment -- and reimbursement -- here in Thailand, as I've never had any medical problems in Thailand. Turns out, some hospitals will accept Tricare, charging you only the 25% co-pay -- based on the Tricare established rates. The following from the JUSMAGTHAI retirees' newsletter:

THAI HOSPITALS WITH PARTIAL PAYMENT ARRANGEMENT: TRICARE entitled military retirees and their family members or survivors as an inpatient [admitted over night] normally pay the bill and then use the DD FORM 2642 to claim their cost share. There are hospitals in Thailand that will assist and inpatient to arrange for a partial payment, a minimum of 25% for covered services, and then the hospital presents its claim to theTRICARE processor Wisconsin Physicians Service. This arrangement requires that the inpatient coordinate FIRST with JUSMAGTHAI’S TRICARE Office. Without the TRICARE Office’s assurance of an inpatient’s current TRICARE eligibility, hospitals in Thailand will not provide this arrangement.

The hospitals are:

BANGKOK: BANGKOK, GENERAL, BANGKOK NURSING HOME, BUMRUNGRAD, PRARAM 9, SAMITIVEJ, & THE HEART BY SIRIRAJ.

CHIANG MAI: CHIANGMAI RAM 1 & MCCORMICK

PHUKET: BANGKOK PHUKET

SUPANBURI: THONBURI-UTHONG

UDON THANI: AKE-UDON INTERNAIONAL

CHONBURI: PHAYTAI SRIRACHA GENERAL

If you want additional information and to corrdinate partial payment arrangements: Tel: 02-287-1036/34 Ext 511 & 512. E-mail: [email protected] & [email protected]. Web: http:www.jusmagthai.com/medial.htm1. Street address; JUSMAGTHAI, TRICARE SERVICES, 7 SO. SATHORN RD. BANGKOK 10120 THAILND.

TIRCARE OFFICE RETIREE CUSTOMER SERVICE HOURS; Starting April 01, 2009, walk-in service will be accepted only on Wednesdays and Thursdays. 0800-1100 and 1300-1500 and Friday 1300-1400. Walk-in service will be limited to 20 minutes. For complicated issues please call or e-mail for an appointment. For urgent or emergent care, contact the TRICARE Office anytime. (Tel: 511 or 512).

For the entire newletter, see here

And, a letter from the JUSMAGTHAI Tricare service rep, with an attached application form, has, in part, the following:

3. We are very stringent about verifying TRICARE eligibility prior to us attempting to negotiate a PPA with a medical provider. For that reason, if you need to make a PPA with a medical care provider under this local TRICARE initiative, we first need a legible copy of the patient’s valid DoD-issued Uniformed Services ID Card (front and back) to verify eligibility through DEERS (Defense Enrollment Eligibility Reporting System). Note: The JUSMAG-THAI Personnel Section performs DEERS verification only during normal duty hours.

4. Once DEERS eligibility is verified, the sponsor/patient must ensure the care provider contacts our office at the earliest possible point in time before patient admission so we can try to negotiate a PPA. Not contacting us in a timely manner before scheduled patient admission results in the patient paying 100% up front. Moreover, if you seek medical care during non-duty hours, you must wait until the next duty day to have your DEERS eligibility verified. Real Case: E.R. patient was admitted on a Saturday and [mistakenly] expected an automatic 25%-75% PPA between TRICARE and the hospital--again, PPAs are NOT automatic! PPAs are negotiated

The full letter is here

The last paragraph begs the question: how do you pre-negotiate a PPA for unknown emergencies? A possible answer was on the Udorn forum, where someone pointed out that, the hospital in Udorn that accepts PPAs will issue a blanket PPA card, pre-negotiated while healthy, for any subsequent admissions.

I would imagine other hospitals, including your choice, might do the same...... That's next on my agenda to check out (I'm in Chiang Mai, where CM Ram 1 and McCormick are the only hospitals negotiating PPAs).

Another interesting observation is, the hospitals negotiating PPAs agree to accept Tricare rates of reimbursement. These rates, by Stateside standards, are quite low compared to the outrageous price charged by hospitals and doctors. But in Thailand, they may actually be *higher* than the going Thai rate -- and result in added profit for Thai hospitals. Maybe you'd be better of not mentioning Tricare, and paying a lower Thai rate.........

Anyway, I can probably manage to self-insure for the 25% co-pay of the Tricare rate -- plus, there's a cap ($3000?) for out-of-pocket payments.

But, of course, costs for Tricare will go up -- maybe dramatically -- based on the health care changes being discussed in DC.

[retiredusn]

Thanks Jim, Good information.................

[wallacern]

Please keep us updated on your quest for pre-approval. I have been dealing with the tricare office at JUSMAG for three years and it has been pretty up and down. Lots of lost paperwork, hospital says they sent it, JUSMAG tri-care says not received. JUSMAG tri-care sitting on claims for weeks before forwarding them to WPS.

My regular hospital makes a call to JUSMAG tricare on every admission to make sure I am still tricare elgible. Last week the JUSMAG tricare office was closed for the entire week resulting in my paying the entire bill for an emergency overnight stay where I received blood transfusions and other expensive drugs.

I complained to the Tri-care office in Okinawa and thier answer was that I am responsible to pay my own medical bills and then seek reimbursment from WPS.

Good luck,

Mike

[PeaceBlondie]

I retired from USAF in 1965. Filed 2 or 5 TRICARE claims since. No way was I having $100/month in Medicare premiums deducted from my SSA check.

[JimGant]

No way was I having $100/month in Medicare premiums deducted from my SSA check.

As I recall, you have other health insurance -- so paying for Tricare coverage is optional for you.

For some of us, Tricare is our only affordable option. And, in comparison to some of my civilian retired friends, $100/mo premium is quite a good deal.

[JimGant]

I complained to the Tri-care office in Okinawa and their answer was that I am responsible to pay my own medical bills and then seek reimbursment from WPS.

Hmmm. I guess I should expect to pay up-front in many cases. I assume this is the situation with all out-patient visits, as PPA, as spelled out, applies only to over-night stays in hospitals.

Paying up-front would not be a problem, as long as they take plastic. My only real concern would be if they charged more than the allowable Tricare rate. If that happens in the States, by someone who doesn't accept Tricare, you're only liable for 15% over the Tricare rate. I was never really sure how that would ever be enforced -- but for sure, outside the US, you're responsible for whatever they want to charge.

However, since doctor and hospital costs over here are considerably less than in the US, at least in most cases, the chance of overstepping the Tricare rates should be minimal. I hope.......

[BigSnake]

In a word, Suck. Tricare is a real pain in the neck

[samran]

But, of course, costs for Tricare will go up -- maybe dramatically -- based on the health care changes being discussed in DC.

Can I ask why you think this may happen? Am interested why you hold this view - as a non-American.

[JimGant]

Can I ask why you think this may happen? Am interested why you hold this view - as a non-American.

Obama's quest to bring the 40+million uninsured Americans into the tent -- and the cost of doing so -- is the buzz of American newspapers today. One thing is for sure -- those of us with health insurance will pay more to incorporate the uninsured -- more money, less services, or both.

But Tricare is a separate issue. For many years the costs (e.g., the deductible has been $150 for over a decade) have held steady. Now, the drumbeat is: raise the fees. Even the Pentagon agreed. But, the suggested one-year jump -- almost a total catch-up -- was so huge, Congress put a hold on it. And the scandal of the recent sub-standard service for war-wounded at the Walter Reed Army hospital also helped Congress hold off from adding further insult -- for now.

But, that will all pass. And Tricare premiums and deductibles will certainly go up. But, hopefully, not in the total catch-up mode.

[noise]

I have been dealing with the tricare office at JUSMAG for three years and it has been pretty up and down. .....

Why are you submitting paperwork thru JUSMAG? I sent them my first claim for review and comments in draft. Then sent it and a couple of follow up claims directly to the U.S. Got my reimbursements with no comment about not having gone through some other agency. I was told JUSMAG will just review your forms for completeness and clarity (e.g., the doctors reports are readable and understandable if written in English).

[noise]

I retired from USAF in 1965. Filed 2 or 5 TRICARE claims since. No way was I having $100/month in Medicare premiums deducted from my SSA check.

When I applied for TRICARE FOR LIFE I was told I had to have medicare A & B even though medicare reimbursements were not possible in/from Thailand. The explanation was that treatment/reimbursement is via medicare first and then the remainder from tricare. If I made myself ineligble for medicare treatment/reimbursement (by not paying the premiums), I was ineligible for tricare for life.

So you are saying you do not pay for medicare part B but receive tricare reimbursements?

[samran]

Can I ask why you think this may happen? Am interested why you hold this view - as a non-American.

Obama's quest to bring the 40+million uninsured Americans into the tent -- and the cost of doing so -- is the buzz of American newspapers today. One thing is for sure -- those of us with health insurance will pay more to incorporate the uninsured -- more money, less services, or both.

But Tricare is a separate issue. For many years the costs (e.g., the deductible has been $150 for over a decade) have held steady. Now, the drumbeat is: raise the fees. Even the Pentagon agreed. But, the suggested one-year jump -- almost a total catch-up -- was so huge, Congress put a hold on it. And the scandal of the recent sub-standard service for war-wounded at the Walter Reed Army hospital also helped Congress hold off from adding further insult -- for now.

But, that will all pass. And Tricare premiums and deductibles will certainly go up. But, hopefully, not in the total catch-up mode.

Thanks for your post. Health economics holds alot of interest for me so your answer was fascinating.

I suspect that your fears are slightly misplaced, and that you won't see an increase in premiums. One of the reasons I suspect that premiums don't go up is that many (but not all) of the people who are uninsured are actually low risk, relatively healthy people who don't feel they need any form of insurance (ie I feel young, healthy, invincible...why do I need insurance??).

The problem with a system where these people remain outside of the 'system' is that people who do choose to get insurance are also more likely to need it (ie, I am getting old now, better get some insurance, just in case). As such, premiums are higher cause costs (ie treatments) are there more frequently as people get older. Another way of saying it is that people who voluntarily chose to get insurance do so cause they are more likely to need it. It makes the premiums higher for everyone.

Getting these 'uninsured people' into the system will actually mean that while they are paying in, they aren't taking out. Hence, more money for the folk who need it.

Combined with cost savings measures forcing doctors to act a bit more efficiently (remember, doctors, the AMA, are actually one of the most powerful UNIONS in the US, out to pad their nests as much as possible) I suspect that costs won't rise.

These are (albeit simplisticly explained) the major reason why Americans pay more for the same medical services than those in other comparable countries.

Edited June 20, 2009 by samran

[JimGant]

samran,

There's a lot of info about fixin' the American health system floating around currenty. The cost -- by the independent Congressional Budget Office (CBO) -- opened a lot of eyes this week, as their estimate came in way ahead of what some had imagined. So, health care reform may yet show up DOA, as did the Clinton attempt.

I applaud Obama in his efforts -- but was disappointed in his speech to the AMA, where he said he wouldn't propose caps on medical malpractice suits. I don't know if the CBO figured that huge cost into their figures, or not -- but they must have. It is just short sighted by Obama to ignore how malpractice premiums severely bloat the cost of medicine.

But, there's another thread on this subject floating around this forum somewhere...so further discussion would be redundant.

I just know Tricare is due for some cost adjustments. And if they are in line with inflation, I have no real argument. It's just the 'catch-up' proposal by some (including flag and general officers, who wanted the savings to buy more F-22s) that annoy -- and worry -- me.

[PeaceBlondie]

I retired from USAF in 1965. Filed 2 or 5 TRICARE claims since. No way was I having $100/month in Medicare premiums deducted from my SSA check.

When I applied for TRICARE FOR LIFE I was told I had to have medicare A & B even though medicare reimbursements were not possible in/from Thailand. The explanation was that treatment/reimbursement is via medicare first and then the remainder from tricare. If I made myself ineligble for medicare treatment/reimbursement (by not paying the premiums), I was ineligible for tricare for life.

So you are saying you do not pay for medicare part B but receive tricare reimbursements?

NO. I do not get Tricare benefis or Medicare. I have retired civil service coverage instead.

[wallacern]

I have been dealing with the tricare office at JUSMAG for three years and it has been pretty up and down. .....

Why are you submitting paperwork thru JUSMAG? I sent them my first claim for review and comments in draft. Then sent it and a couple of follow up claims directly to the U.S. Got my reimbursements with no comment about not having gone through some other agency. I was told JUSMAG will just review your forms for completeness and clarity (e.g., the doctors reports are readable and understandable if written in English).

If you pay the hospital bill in full and then file with Tri-Care (WPS) for reimbursement there is no need to involve the JUSMAG Tri-Care office.

However, for in-patient care where I only pay 25% of the bill at the hospital and Tri-Care agrees to pay 75%, the hospital sends the bill for 75% to the Tri-care office at JUSMAG. Thats where the lost paperwork etc comes in. Normally, I would not care if it takes many months for the hospital to get reimbursed thier 75%. The real problem comes in after I have paid $3,000 and thus reached the $3,000 catastrophic cap. At that time the hospital still requires me to pay them 25%, however, tricare doesn't reimburse me that 25% until the entire claim is completed and since the hospital is billing the Tri-Care office at JUSMAG and they in turn are billing WPS it regularly gets AFU. Even if all goes smoothly, WPS send two checks to JUSMAG. One for the hospital and one for me. JUSMAG requires that I come to thier office and sign for my check. Of course my check is in US dollars so then I mail it back to the states for deposit. (I pay for my 25% with a US credit card so I need the reimbursment in the US to pay the credit card bill.) WPS refuses to send my 25% reimbursment check to my US address and they don't have direct deposit.

Normally the whole operation would not be a big deal. However when I am taking chemotherapy, I have treatments once a month (sometimes more) that requires two nights and three days in the hospital. My 25% of the bill is usually about $1500. After six months or so there are claims, lost paperwork and reimbursment checks strung out all around the world.

Hope this was more informative than just a rant.

Mike

[JimGant]

Hope this was more informative than just a rant.

Good info. Many thanks.

Just to clarify -- is having to go to JUSMAG to pick up your reimbursement check standard policy? Or just a product of having exceeded the $3000 cap? I had thought WPS would mail any and all reimbursements to your home address.........

And you opt for dollar reimbursement, to send back to your US bank. But you could opt for baht, right?

After reading your experience, I'm going to do the best I can to keep my cancer in remission .

[wallacern]

Hope this was more informative than just a rant.

Good info. Many thanks.

Just to clarify -- is having to go to JUSMAG to pick up your reimbursement check standard policy? Or just a product of having exceeded the $3000 cap? I had thought WPS would mail any and all reimbursements to your home address.........

And you opt for dollar reimbursement, to send back to your US bank. But you could opt for baht, right?

After reading your experience, I'm going to do the best I can to keep my cancer in remission .

If JUSMAG files the claim on behalf of the hospital my claim gets bundled with the hospital claim. WPS then deals only with JUSMAG since they filed the claim. JUSMAG insists that I show up in person and sign for the check. (not sure what will happen when I am to sick to make a trip to JUSMAG).

If you are filing your own claims WPS will send the reimbursment check to your house and in Baht if you ask for it. I never asked JUSMAG to request my check to be in Baht.

The checks from WPS must be deposited within 120 days or WPS will "bounce" the check. That actually happened to me about six months ago. That was a check in USD.

Best of luck to you.

Mike

[Searcher25]

Thank-you for the post Jim. Very, very helpfull!