Tricare Changes

[ginooooo]

Subject: Health Care Reform - TriCare

This is how the healthcare reform will change the Military benefit - Tricare. This will effect everyone who has dedicated their life to the military and were promised this benefit in return for their many sacrifices. Some reward.

read this all the way through!!!!!

PASS THIS TO ALL MILITARY RETIREES

Please pass on to all your military retired friends so they can be educated on how the "health care reform" will change our tricare benefits. Read article at very bottom of e-mail string for more information. v/r This is true. It is on pages 77, 172, 218, and 434. You have to dig to see the charges.

We (retirees) would lose the Medicare for life benefit and would have to pay. We would lose TRICARE as a total care package. We would not be allowed to keep TRICARE so when Obama stands and says if you like what you have you can keep it, he lies. This is a "Heads Up" on a battle we are facing now and down the road with the new Administration. The Congressional Budget Office (CBO) has already drafted proposed legislation that would basically reduce our TRICARE for Life benefits to a system whereby we pay deductibles and co-pays up to $6,301 the first year for you and your spouse, with future years being indexed to increase with inflation. What can we do? The article below, obtained from an Air Force Association and written by BG Bob Clements, best describes what we can do.

Please read it and check the links for CBO language and do what Bob says-Send this email to every Military Retiree you know and write and email your Congressman often. For those of you that might have voted for "Change", you should do it more than often! TRICARE FOR LIFE'S FUTURE.... TRICARE For Life was instituted to correct the broken promise that military retirees would receive free healthcare coverage for life and it covers the Medicare co-pay. Now a heavy assault has begun on Veterans'/Retirees' benefits to pay for other programs our President promised during the campaign. And it is a high priority of his administration.

The one item of most interest to Retired Military is in Article 189. If approved by Congress the first assault wave would hit in 2011 and would hit hard. It would initiate cost sharing to require retirees to pay the first $525 of medical cost and 50% of the next $4,725 for a first year cost of $2,888 per person. It would be indexed to increase with inflation. A reason given for this action (for PR effect) is "overuse" by Retirees. For those of you who are covered by TFL you will want to pay attention (Below) to what BG Bob Clements has surfaced about the future of TFL. In any case, on page 189 of the Congressional Budget Office report, see the note below on how to get to that spot, there is a strong recommendation to eventually eliminate the program as it is too expensive. Just another move to slight those of us who dedicated much of our adult lives to the defense of our country. Strongly recommend that you contact your elected officials and register your strong opposition to the elimination of the TFL program. Heads-up from BG Bob Clements,USAF Ret (P38 Bob).

The following has been added to the Congressional Budget Office Web Site

*www.cbo.gov/ * <http://www.cbo. gov/>*

* a. Budget, Options, Volume 1: Health Care *

*(**www.cbo. gov/doc.cfm? indexâ„¢25* <http://www.cbo. gov/doc.cfm? index=9925>*) For those who have never opened one of these web sites from OMB: *

* 1) double click on the above URL *

* 2) click on PDF *

* 3) click on the binoculars *

* 4) do a search for TFL ..

Now here it is folks and I will guarantee if you sit around on your behind and do nothing about it as they bring these options forward this coming year, you will lose one of the best healthcare benefits that the Medicare eligible retired military have..It is short of the promises made that we fought so hard for back in the late 90s and early 2000s but it is still the best healthcare program that anyone in the United States has, bar none. People who are professionals always look for the channel of least resistance when it comes to cutting money out of the Federal and DOD budget. I can tell you this straight on, military retirees are one of those channels of least resistance noted for sitting around, doing nothing, and waiting for ole Joe to do it for them. You had better wake up. Your medical benefits are prime target. If you lose them, you have nobody to blame but yourself. Let me repeat that ... you have nobody to blame but yourself. The way to secure your benefits is to write to your members of Congress and to keep writing and writing and writing. ONCE IS NOT ENOUGH!! Keep repeating the above statement until you are blue in the face.

Now I'm going to make one more statement to all of you younger people out there who are not yet eligible for TRICARE for Life. HEALTH CARE WILL EVENTUALLY BECOME THE DOMINATING FACTOR IN YOUR LIFE. Remember that . . . . it will impact you big time with the utmost in cruelty unless you are fortunate enough to die from a heart attack or get run over by a truck. The service organizations will put up a fight, but, they will need your help and can't do it by themselves.. I hope this makes it clear as to what you can expect if you do nothing. To show you how stupid these professionals can be at times just read the data on the noted sites closely. You will see that in spite of the MTFs (Military Treatment Facility) need to get patients back to keep their doctors busy and the hospitals from going to clinic status, these people from OMB would employ a means to keep retirees from using MTF facilities by charging them a fee for services. How dumb can you get. Even if you are an Obama fan, and believe that changeth cometh, TFL option from OMB will not go away. They need the money they spend on you for other programs for people who produce nothing but votes to keep their boss in office.

If you know of anyone who is Retired Military, Please forward this on to them. Remember- TFL is an "Earned Benefit" that's been granted by a previous Congress. *

[moe666]

One of the realities of life is that the federal government will probaly go broke over health care. Eventually we will all have to pay more for this benefit no matter what promises were made in the past

[ginooooo]

One of the realities of life is that the federal government will probaly go broke over health care. Eventually we will all have to pay more for this benefit no matter what promises were made in the past

I agree and a sad situation. We retirees are now 2nd class citizens like the SS folks. Looking for cuts in the federal government and those who need it the most are going to get hosed.

[kandahar]

One of the realities of life is that the federal government will probaly go broke over health care. Eventually we will all have to pay more for this benefit no matter what promises were made in the past

This is a curious statement. The government referred to IS broke and has been, for a long time. The definitions of broke, in this case:

1. Bankrupt

2. Lacking funds

3. Having little or no ready money

Operating on borrowed funds is "broke". And operating on "borrowed funds" is what they are doing, and have been doing, whether in the case of an outright loan or through the sale of bonds. To be considered solvent, or "not broke", they would have to be in the position of being able to repay the debts/ buy back the bonds, at any time. Of course, they cannot do that. If all markers were called in right now, the government would cease to operate for lack of money to pay salaries. Slowly but surely, our terminology has become skewed in order to make us feel less vulnerable about our own insolvencies and then we extend that to the entity that is in place to provide services, management of state affairs and security to us.

As ginooooo said, promises were made. But they can't all be kept. So all are going to have to do with less. I think it is truthful to say that most vets, standing in line for healthcare, would gladly let the elderly and the children go in front of them in the line. Choices have to be made. The country cannot have it all, nor can the population, as individuals. The day of reckoning is here, even though most continue to bury their heads in the sand and hope it affects someone else.

This isn't meant in any way to lessen the recognition that vets have earned, nor to lessen the importance of promises made to them. It is meant only to bring to light the reality that all of the promises and guarantees can't be kept. If they are kept for one group, then another will suffer. In light of that, if one vet has coverage from a second career, current employer or other source, then he/she should use that coverage and let the Federal benefits stay available for someone who doesn't have secondary coverage. For someone who, due to inheritance or other circumstances can easily pay for their healthcare out of pocket, they should do so, leaving more funds available to those in need. Confusing want with need is harmful. Exercising rights that aren't necessarily needed, is harmful. In another scenario, I have the right to bear a concealed weapon in my home state. I also have the right to kill anyone who enters my domicile uninvited. Just because I have those rights doesn't mean I will exercise them. I wouldn't necessarily kill an intruder if I thought there were other options that would be effective and less devastating to said intruder and intruder's family. Each individual needs to care enough for the country that he/she makes the correct choices in his/her circumstances that those choices will help to insure the survival of the group as a whole. Those choices are often of very small consequence and deciding in favor of the group as a whole is no big deal. For others, the same decisions would would lead to bankruptcy and are therefore a very big deal. Individuals need to make the correct choices.

Lots of other problems have led the country to this predicament and those need to be resolved. Offering billion and trillions to other countries who need help is often the wrong thing to do, when the offering country is in such bad shape that it is about to fail. Better to close the checkbook for a few years until the account is in the black again. I think EVERY offer of financial aid to another country, for another disaster or rebuilding, needs to be put to a vote of the people, not the elected officials. Those officials aren't representing your interests when they make those gestures.

It is up to the people of the offering nation to insist on getting their own house in order before handing out borrowed funds to other nations in need. Once spending is in check and balanced properly with incoming funds, the smart, legitimate and final decisions can be made. And at that time, worthwhile promises to the citizens of the offering nation can be honored. But it all starts with each of us, as individuals, to make those personal decision at our own personal level. You can't expect the representatives of the people to act on one set of standards when we are living another set of standards. We tend to point the finger at big government. In some cases, that is correct and the "right" thing to do. In other cases, it can be correct, but is still the wrong thing to do, because we have other options, that are more "right" for the survival of the country as a whole. It is up to individuals to hold the government accountable to the standards of individuals instead of giving them a blank check.

So, if the Tri-Care shortcomings bothers us, we need to fix what is causing it, not to fuss about the Tri-Care itself. Because even if we spoke loud enough to get the Tri-Care back on track, it is at the expense of others that we hold dear in our lives. Children should come first. Elderly second. Vets third. And the rest, last.

Edited September 26, 2010 by kandahar

[sceadugenga]

What is it about Americans and a public health care system?

Do they really believe that it's only a short step away from the hammer and sickle flying over the White House?

But then I know one or two who believe it already is....

[kandahar]

What is it about Americans and a public health care system?

Do they really believe that it's only a short step away from the hammer and sickle flying over the White House?

But then I know one or two who believe it already is....

Of course, I realize that this thread is not CR related.

And, I am not a person to get involved with the health care system or not. I'm on my own and I know it and I like it. They have had a decent health care system for a large portion of the population for years.

Hammer and sickle. Hmmm..... It really isn't about that, as far as how I view it. It is about promising something for a group, knowing that the only way to provide that something is to borrow more money or to take away something that they have already given/promised to another group in previous years. Plainly speaking, the money just isn't there. And even more plainly speaking, instead of fighting about socialism or what is being stolen from Peter to pay Paul, I think a much better procedure would be to do as I stated above. Demand solvency, first. Then make the decisions on what can be offered and sustained.

As for ginooooo and the plight he describes, that is the perfect opportunity for that particular group (vets) to rise up and lead the nation in demanding solvency. Solvency fixes most of the problems. Spending the tax dollars of the individual on outside projects, without the consent of the individual ( through a vote ) is just bad business. If you want to take tax dollars from everyone to build an interstate highway in the country, then the officials should have that power to make that decision. But to take your hard earned money and to pump it into a bottomless pit in another country is a really bad concept. So, someone needs to take the lead.

But, yes, I am aware that some of the more radical thinking is that national healthcare is the beginning of the end. Every camp has its extremest and nuts. Maybe I am one or both of those. No person who is crazy knows they are crazy. They think they are normal and the rest of the world is skewed.

Now, where did I put my sharp sickle.....................?

Edited September 26, 2010 by kandahar

[ginooooo]

We would be glad to get the local insurance there, however, wife has RA bad, being a pre-existing condition, the insurance companies will not cover her. Obama care will not apply there. Both of us would revert to Tricare Standard, pay out of pocket 1st and then make a claim. Sucks.

[villagefarang]

Not sure that you are going to get a lot of sympathy from those of us who pay our own way, 100%. Plus pay for you with our taxes.

Edited September 26, 2010 by villagefarang

[ginooooo]

Not sure that you are going to get a lot of sympathy from those of us who pay our own way, 100%. Plus pay for you with our taxes.

I guess you do not know about Tricare Standard and basically what you are saying is retired military do not deserve what used to be free medical for life and has morphed into paying for it out of my military retirement check and being forced later at age 65 to use it as a secondary and get Medicare which runs about $130 a month from SS checks. And your taxes are paying for that?

[villagefarang]

Just saying... This is a pretty international group here and your beef with your government handouts, really has nothing to do with Chiang Rai. Perhaps you have some Chiang Rai related questions that we can help you with.

[mcgriffith]

As Kandahar did point out, this topic is not Chiang Rai specific.

According to Thai Visa guidelines, it may possibly scrape by being in the Insurance In Thailand sub-forum.

Moved there, with a live link remaining on CR.

[moe666]

What is it about Americans and a public health care system?

Do they really believe that it's only a short step away from the hammer and sickle flying over the White House?

But then I know one or two who believe it already is....

Politics and the stupidity of a under educated population who cannot think for themselves.

[ginooooo]

As Kandahar did point out, this topic is not Chiang Rai specific.

According to Thai Visa guidelines, it may possibly scrape by being in the Insurance In Thailand sub-forum.

Moved there, with a live link remaining on CR.

The original post was info only for any American retirees living in the Chiangrai/Phayao area and thought it was appropriate for this group. Sorry if others think not.

[jazzbo]

Politics and the stupidity of a under educated population who cannot think for themselves. Maybe ... but as an un-insurable American I decided to think for myself and that is the main reason (other than pulchritude) that I am in Thailand with a BUPA Platinum policy...

[ginooooo]

Politics and the stupidity of a under educated population who cannot think for themselves. Maybe ... but as an un-insurable American I decided to think for myself and that is the main reason (other than pulchritude) that I am in Thailand with a BUPA Platinum policy...

Wife has precondition problem with RA and already checked there-they will not insure-hence we are going to rely on my military "benefits" and pay out of pocket 1st before claiming per the laws. Different strokes for different folks.

[pmarlin]

Except none of it is true, or at least most of it. US Military retired are not going to see any changes under the new heath care paln except that thier children will get increased benefits, like TRICARE coverage up to age 26.

[pmarlin]

Except none of it is true, or at least most of it. US Military retired are not going to see any changes under the new heath care paln except that thier children will get increased benefits, like TRICARE coverage up to age 26.

neeed to add, a CBO proposal is not law or will cause any changes to Law.

[Thaigreg]

Except none of it is true, or at least most of it. US Military retired are not going to see any changes under the new heath care paln except that thier children will get increased benefits, like TRICARE coverage up to age 26.

Wrong! I've had a claim at Tricare since the 10 Oct 2010. After numerous phone calls with customer service about the long delay in this claim being paid. I was told that changes effective the 1st of Jan 2011, resulted in my claim being returned. I was told that my paid receipt from the hospital was not sufficient proof of payment. This infor was told to me on the 6th of Jan, my claim was returned on the 10th.

[Pib]

This CBO proposal has been coming out year-after-year for years; and rejected year-after-year for years by Congress. But maybe someday portion of it will be enacted.

Additionally, the wife and I have filled numerous Tricare claims over the last year, with the last two occurring for medical service received in early Jan 11. Several others in the Aut and Oct 10 timeframe. Sent in the the claims with hospital receipts (actually emailed via the Tricare contractor secure web site) like always (receipts from a Bangkok hospital), claim processed in about 10 days by Tricare, reimbursement checks mailed out/rec'd. Reimbursement check for the early Jan 11 medical service in the mail as we speak. I suspect your particular receipt does not provide enough detail or may appear as a "bill-due" versus a receipt (i.e., you have not paid already).

Also, for you Tricare Overseas/Standard folks out there, don't forget that certain annual Clinical Preventive Procedures such as the annual flu shot, mammograms for females, PSA tests for men,and a couple other Clinical Preventive Procedures are now 100% reimburseable with no yearly deductible requirement. But these procedures need to be clearly identified on your claim and reciepts. Plus, for any of these procedures accomplished since mid Oct 08, you can call or write the Tricare contractor for "full/100%" reimbursement to the previously submitted claims where you may have not got nothing due to not meeting the yearly deductible yet or only getting back 75%.. A few months ago I got fully reimbursed for the wife's Aug 2009 mammogram, and when filling the wife's Aug 10 claim for her annual checkup the mammogram protion was reimbursed at 100%...and when we filed our Oct 10 claims for our annual flu shots we got 100% reimbursed. And no, I'm not active duty on Tricare Prime; I'm just a long time military retiree on Tricare Overseas/Standard. Go USAF!...whoops, gave away the branch of service I was in. Cheers.

Edited January 21, 2011 by Pib

[Thaigreg]

This CBO proposal has been coming out year-after-year for years; and rejected year-after-year for years by Congress. But maybe someday portion of it will be enacted.

Additionally, the wife and I have filled numerous Tricare claims over the last year, with the last two occurring for medical service received in early Jan 11. Several others in the Aut and Oct 10 timeframe. Sent in the the claims with hospital receipts (actually emailed via the Tricare contractor secure web site) like always (receipts from a Bangkok hospital), claim processed in about 10 days by Tricare, reimbursement checks mailed out/rec'd. Reimbursement check for the early Jan 11 medical service in the mail as we speak. I suspect your particular receipt does not provide enough detail or may appear as a "bill-due" versus a receipt (i.e., you have not paid already).

Also, for you Tricare Overseas/Standard folks out there, don't forget that certain annual Clinical Preventive Procedures such as the annual flu shot, mammograms for females, PSA tests for men,and a couple other Clinical Preventive Procedures are now 100% reimburseable with no yearly deductible requirement. But these procedures need to be clearly identified on your claim and reciepts. Plus, for any of these procedures accomplished since mid Oct 08, you can call or write the Tricare contractor for "full/100%" reimbursement to the previously submitted claims where you may have not got nothing due to not meeting the yearly deductible yet or only getting back 75%.. A few months ago I got fully reimbursed for the wife's Aug 2009 mammogram, and when filling the wife's Aug 10 claim for her annual checkup the mammogram protion was reimbursed at 100%...and when we filed our Oct 10 claims for our annual flu shots we got 100% reimbursed. And no, I'm not active duty on Tricare Prime; I'm just a long time military retiree on Tricare Overseas/Standard. Go USAF!...whoops, gave away the branch of service I was in. Cheers.

The bill/receipt clearly states that I PAID IN CASH. Why take 3 months to tell me that this is insufficient proof?

[Pib]

The bill/receipt clearly states that I PAID IN CASH. Why take 3 months to tell me that this is insufficient proof?

Does the bill/receipt clearly identify what was accomplished during the visit. For example here's a snapshot of a portion of a Dec 10 receipt for some blood tests done on the wife for a new medication she started taking a few months ago. Now the rest of the full page receipt has the hospital address/letterhead at the top, phone, fax, etc. The receipt is mostly in English but maybe 20% of the form wording is in Thai. The amounts are in Thai baht. The cashier also stamps and initials the receipt. And I always write-in the Doctor's name at the bottom of the receipt along with his address phone number which is the same as the hospital. I even circle the patient's name, date of service, etc., just to focus the claim adjuster's attention to information I know they will be looking for on this part English/part Thai receipt. Sometimes I remember to ask the doctor for a form which he fills out and signs summarizing what the visit was for....the hospital has a one page form letter that is quick and easy for the doctor to fill out...he also puts his Signature stamp on the form (in English) and signs it. I get this form handed to me along with the paid receipt. But when I failed to remember to ask for the form and didn't send it along with the receipt, Tricare still provided reimbursement no problem. I always remember to put the best description my layman brain can muster in Block 8a of the claim form as requested on the claim form.

Below is a cut and paste from page 3 of the claim form identifying the itemized bill/receipt requirements.

Quote:

ITEMIZED BILL: Ask your provider to complete the HCFA Form 1500 for you. If the provider refuses, complete this form and attach an itemized bill which must be on the provider's billing letterhead. The bill must contain the following information:

1. Doctor's or provider's name/address (the one that actually provided your care). If there is more than one provider on the bill, circle his/her name;

2. Date of each service;

3. Place of each service;

4. Description of each surgical or medical service or supply furnished;

5. Charge for each service;

6. The diagnosis should be included on the bill. If not, make sure that you've completed block 8a on the form.

End Quote.

If your receipt don't have this level of detail it may be the reason Tricare says the receipt is insufficient. Also, remember you can email in the completed DD Form 2642 with receipts from your Tricare account by using the Secure email under your account. That way, you'll save a stamp and mailing time (and possible loss in the mail) in getting it sent to Wisconsin. Plus you can see/print-out a copy of the Claim Explanation of Benefits (EOB) online to...you don't have to wait for it to arrive via snarl mail. Normally, when I email in my claims I get an email a few days later that a Tricare rep openned/read my email, and forwarded the claim to the claim adjusters. Then around 10 days later I see the processed claim EOB appear. I read it...if something is wrong I call them immeidately, ask them about the EOB, and if they agree they probably made an error on the claim processingthey immediately send an email to the claim adjusters with an explanation of the problem based on the phone conversation...if the claim adjusters agree, they will generate an "Adjusted EOB" (i.e., corrected EOB) over the next 5-10 days. Now the first EOB still gets mailed out along with any reimbursement check attached...and the Adjusted EOB gets mailed out along with any reimbursement check. In fact, when you see the EOB online, it probably got mailed out the day before. This has happenned to me a few times, especially with the Preventive Clinical Procedures that are suppose to get reimbursed at 100% but initially only got 75% until the Adjusted EOB was issued making it a full 100% reimbursement. If you don't have a Tricare online account, definitely get one by going to the Tricare web site...it will only take a few minutes to create one. But if you have one, you already know this.

Good luck in getting everything straighten out and reimbursed for what reimbursement is due. Cheers.

[Thaigreg]

The bill/receipt clearly states that I PAID IN CASH. Why take 3 months to tell me that this is insufficient proof?

Does the bill/receipt clearly identify what was accomplished during the visit. For example here's a snapshot of a portion of a Dec 10 receipt for some blood tests done on the wife for a new medication she started taking a few months ago. Now the rest of the full page receipt has the hospital address/letterhead at the top, phone, fax, etc. The receipt is mostly in English but maybe 20% of the form wording is in Thai. The amounts are in Thai baht. The cashier also stamps and initials the receipt. And I always write-in the Doctor's name at the bottom of the receipt along with his address phone number which is the same as the hospital. I even circle the patient's name, date of service, etc., just to focus the claim adjuster's attention to information I know they will be looking for on this part English/part Thai receipt. Sometimes I remember to ask the doctor for a form which he fills out and signs summarizing what the visit was for....the hospital has a one page form letter that is quick and easy for the doctor to fill out...he also puts his Signature stamp on the form (in English) and signs it. I get this form handed to me along with the paid receipt. But when I failed to remember to ask for the form and didn't send it along with the receipt, Tricare still provided reimbursement no problem. I always remember to put the best description my layman brain can muster in Block 8a of the claim form as requested on the claim form.

Below is a cut and paste from page 3 of the claim form identifying the itemized bill/receipt requirements.

Quote:

ITEMIZED BILL: Ask your provider to complete the HCFA Form 1500 for you. If the provider refuses, complete this form and attach an itemized bill which must be on the provider's billing letterhead. The bill must contain the following information:

1. Doctor's or provider's name/address (the one that actually provided your care). If there is more than one provider on the bill, circle his/her name;

2. Date of each service;

3. Place of each service;

4. Description of each surgical or medical service or supply furnished;

5. Charge for each service;

6. The diagnosis should be included on the bill. If not, make sure that you've completed block 8a on the form.

End Quote.

If your receipt don't have this level of detail it may be the reason Tricare says the receipt is insufficient. Also, remember you can email in the completed DD Form 2642 with receipts from your Tricare account by using the Secure email under your account. That way, you'll save a stamp and mailing time (and possible loss in the mail) in getting it sent to Wisconsin. Plus you can see/print-out a copy of the Claim Explanation of Benefits (EOB) online to...you don't have to wait for it to arrive via snarl mail. Normally, when I email in my claims I get an email a few days later that a Tricare rep openned/read my email, and forwarded the claim to the claim adjusters. Then around 10 days later I see the processed claim EOB appear. I read it...if something is wrong I call them immeidately, ask them about the EOB, and if they agree they probably made an error on the claim processingthey immediately send an email to the claim adjusters with an explanation of the problem based on the phone conversation...if the claim adjusters agree, they will generate an "Adjusted EOB" (i.e., corrected EOB) over the next 5-10 days. Now the first EOB still gets mailed out along with any reimbursement check attached...and the Adjusted EOB gets mailed out along with any reimbursement check. In fact, when you see the EOB online, it probably got mailed out the day before. This has happenned to me a few times, especially with the Preventive Clinical Procedures that are suppose to get reimbursed at 100% but initially only got 75% until the Adjusted EOB was issued making it a full 100% reimbursement. If you don't have a Tricare online account, definitely get one by going to the Tricare web site...it will only take a few minutes to create one. But if you have one, you already know this.

Good luck in getting everything straighten out and reimbursed for what reimbursement is due. Cheers.

Hi Pib

I've had numerous claims processed and paid by TRICARE since being here in 2003. I've always used Bangkok Hospital Pattaya, who give you an itemized bill after you have paid by cash or credit. This particular bill was paid by both cash and credit and I had the transactions receipts. My point is if I had withdrawn cash from my checking or saving account how am I to prove I paid the bill? My bank statement would only show that I made a cash transaction to myself. I only would have proof from the hospital with a paid receipt, which I sent to TRICARE and was told that is was insufficient proof.

Thanks for your valuable information. I just discovered this week after talking to TRICARE about faxing my claims and the customer service rep explained how to process claims online. I had previously used snail mail. I have also had previous claims denied and reprocessed online after talking to them. It seems that since this claim is a rather large one that they are trying anything to delay or deny payment.

Greg

[Pib]

You are welcome. When I pay my bill at the hospital the bill/receipt I was talking about earlier and which I included a partial snapshot actually says Bill in one place and Receipt in another. The hospital hands me this bill/receipt at the cashier (it's still a bill at that second in time), then I pay with cash or credit/debit card (I've done both), they then hand me back the same bill/receipt but they have now stamped and initialed it as Paid. When paying with a credit card I use to also include that little payment slip with the hospital receipt, but I've stopped doing that as the bill I paid via cash of course has no such receipt like a credit card slip, so I just mail in only the hospital bill/receipt now....but I do circle the Receipt word on the hospital bill/receipt....I don't circle where it says bill. I guess it just boils down to how convincing the receipt looks, the claim processor, and maybe some other factors.

Regarding submitting the claims online. What I do is complete and sign the claim form. Then I scan it along with the receipts/docs and make them one multiple page file with my scanner software. I make that one file either a multi page JPEG or PDF and then upload just one attachment as the claim...makes it look like you are just scrolling through/viewing a multi page file. You can send up to 3 attachments in a variety of formats, not just JPEG or PDF, as long as the total don't exceed 5MB. If you scan in gray tone or black & white, say around 150dpi, the document is very clear and small in size...usually less than 1MB...with 5MB allowed you can scan and attach a "bunch" of receipts with the claim.

Then I send a Secure email from my Tricare account with the attachment(s) per the Tricare directions below, which they emailed me when I asked last year about how to submit claims without using snail mail. Basically I choose the email subject category of Other...I then expand it a little for my own benefit like Claim for 15 Dec 10 Medical Service, with a few words in the Email text body area to say attached is a claim, attach/upload the attachment(s), and then hit send. It will probably take a minute or so for the email to upload the attachment and complete its Send operation. I usually upload the claims in the morning/before noon when my TOT internet seems to be the fastest; I've tried to upload some claims in the evening and the upload times out before being completed...that's a TOT issue...not a Tricare issue. You can then see the email in the Sent box...but you can't pull up the attachment. Then if you check your regular email like on gmail or something, you will see you got an automated email from Tricare saying they got your email. Then you just need to watch your Tricare Secure email account for a few days and you should get a response by a real person your email has been opened/read/forwarded along to the Claims section. Usually you get that real person response in 1 to 3 business days, but there has been a few cases of it taking longer depending on how many thousands of such emails from all over the world are before they get to yours...they open/read them in sequence received. As the emails come in they are split out to different customer reps, so if you email ended up in the inbox of a rep you called in sick for a few days then it may take longer for a response. If you haven't got a real person response after about a week, call them up, they can see where your email is bogged down, and if it is due to a rep being overloaded/out sick they can pull the email from that reps box and get the mail moving along. I had to do this once late last year when SOS International had just taken over the contract and apparently still had a few staffing issues. But my claims over the last few months have been opened/read/moved along within a few business days. It sure sure beats the hell out of snail mail,! Below is a partial quote of their response/directions:

Partial Quote

Also, you are able to email claims through the Tricare Overseas website and fax claims to 608-301-2250. Here are the instructions you will have to follow:

1. Sign in with your username and password.

2. Once signed in your homepage is displayed. Under the Contact Customer Service section choose the link "Send/View Secured Message".

3. Click on "New Message". This will then give you the option to choose the subject of the email:

A. Claim Status

B. Eligibility

C. Other Health Insurance

D. Personal Profile

E. Other

You can only send an attachment when the subject is Other Health Insurance or Other.

4. Once you choose your subject "Other" you will be allowed to attach 3 documents which is no larger than 5MB total. The documents can be attached my clicking on the "Browse" option.

End Quote.

Good luck on getting a receipt that satisfies Tricare...maybe get the hospital to sign a short document that you have paid in full XXXXXX Baht on day X for medical service rendered from XXXX to XXXX. Have them to throw in some official looking stamp on the receipt that Thai's like to use...heck, my hospital even uses one of those fancy stamps on my receipts. Unfortunately, there are a lot of folks out there who have tried to fraud Tricare with fake receipts----I'm Not Implying You Are---and that can end-up making it harder on all of use ex-military folks to get claims processed. Heck, it got so bad in the P.I. that apparently retirees can only use limited number of pre-approved by Tricare hospitals/clinics/doctors, where us folks here in Thailand can still use whoever we want to---but ones that provide good receipts! (grin). Once again, good luck in getting your claim reimbursed soon...I'm sure it will work out.

Cheers,

Pib

[Thaigreg]

You are welcome. When I pay my bill at the hospital the bill/receipt I was talking about earlier and which I included a partial snapshot actually says Bill in one place and Receipt in another. The hospital hands me this bill/receipt at the cashier (it's still a bill at that second in time), then I pay with cash or credit/debit card (I've done both), they then hand me back the same bill/receipt but they have now stamped and initialed it as Paid. When paying with a credit card I use to also include that little payment slip with the hospital receipt, but I've stopped doing that as the bill I paid via cash of course has no such receipt like a credit card slip, so I just mail in only the hospital bill/receipt now....but I do circle the Receipt word on the hospital bill/receipt....I don't circle where it says bill. I guess it just boils down to how convincing the receipt looks, the claim processor, and maybe some other factors.

Regarding submitting the claims online. What I do is complete and sign the claim form. Then I scan it along with the receipts/docs and make them one multiple page file with my scanner software. I make that one file either a multi page JPEG or PDF and then upload just one attachment as the claim...makes it look like you are just scrolling through/viewing a multi page file. You can send up to 3 attachments in a variety of formats, not just JPEG or PDF, as long as the total don't exceed 5MB. If you scan in gray tone or black & white, say around 150dpi, the document is very clear and small in size...usually less than 1MB...with 5MB allowed you can scan and attach a "bunch" of receipts with the claim.

Then I send a Secure email from my Tricare account with the attachment(s) per the Tricare directions below, which they emailed me when I asked last year about how to submit claims without using snail mail. Basically I choose the email subject category of Other...I then expand it a little for my own benefit like Claim for 15 Dec 10 Medical Service, with a few words in the Email text body area to say attached is a claim, attach/upload the attachment(s), and then hit send. It will probably take a minute or so for the email to upload the attachment and complete its Send operation. I usually upload the claims in the morning/before noon when my TOT internet seems to be the fastest; I've tried to upload some claims in the evening and the upload times out before being completed...that's a TOT issue...not a Tricare issue. You can then see the email in the Sent box...but you can't pull up the attachment. Then if you check your regular email like on gmail or something, you will see you got an automated email from Tricare saying they got your email. Then you just need to watch your Tricare Secure email account for a few days and you should get a response by a real person your email has been opened/read/forwarded along to the Claims section. Usually you get that real person response in 1 to 3 business days, but there has been a few cases of it taking longer depending on how many thousands of such emails from all over the world are before they get to yours...they open/read them in sequence received. As the emails come in they are split out to different customer reps, so if you email ended up in the inbox of a rep you called in sick for a few days then it may take longer for a response. If you haven't got a real person response after about a week, call them up, they can see where your email is bogged down, and if it is due to a rep being overloaded/out sick they can pull the email from that reps box and get the mail moving along. I had to do this once late last year when SOS International had just taken over the contract and apparently still had a few staffing issues. But my claims over the last few months have been opened/read/moved along within a few business days. It sure sure beats the hell out of snail mail,! Below is a partial quote of their response/directions:

Partial Quote

Also, you are able to email claims through the Tricare Overseas website and fax claims to 608-301-2250. Here are the instructions you will have to follow:

1. Sign in with your username and password.

2. Once signed in your homepage is displayed. Under the Contact Customer Service section choose the link "Send/View Secured Message".

3. Click on "New Message". This will then give you the option to choose the subject of the email:

A. Claim Status

B. Eligibility

C. Other Health Insurance

D. Personal Profile

E. Other

You can only send an attachment when the subject is Other Health Insurance or Other.

4. Once you choose your subject "Other" you will be allowed to attach 3 documents which is no larger than 5MB total. The documents can be attached my clicking on the "Browse" option.

End Quote.

Good luck on getting a receipt that satisfies Tricare...maybe get the hospital to sign a short document that you have paid in full XXXXXX Baht on day X for medical service rendered from XXXX to XXXX. Have them to throw in some official looking stamp on the receipt that Thai's like to use...heck, my hospital even uses one of those fancy stamps on my receipts. Unfortunately, there are a lot of folks out there who have tried to fraud Tricare with fake receipts----I'm Not Implying You Are---and that can end-up making it harder on all of use ex-military folks to get claims processed. Heck, it got so bad in the P.I. that apparently retirees can only use limited number of pre-approved by Tricare hospitals/clinics/doctors, where us folks here in Thailand can still use whoever we want to---but ones that provide good receipts! (grin). Once again, good luck in getting your claim reimbursed soon...I'm sure it will work out.

Cheers,

Pib

Again the receipt is the same type I've received from the hospital numerous times before and TRICARE has accepted with no problems. Also it is always STAMPED in red ink PAID in addition to stating that the monies were paid by cash or credit card. Thanks for listening to my rantings.

Greg

[longball53098]

First let me say thanks to Pib for the info here.

I am happy to learn that I can file a claim via the secure message system with Tricare Overseas. I will definitely give that a try next time. As I always scan my paperwork for safekeeping this will make sending in a claim that much easier.

About the receipt issue? In reading the JUSMAGTHAI web site and info posted there from the RAO and the Tricare reps it seems they indicate that Wisconsin is getting tougher on payments because of this fraud issue and they suggest going the extra mile with receipts to be sure it satisfies any questions they(Wis) have about payment for services. The nurse at JUSMAG I talked with recommended if paying with any type of bank card to make a copy of that payment slip and include with the hospital/doctor office receipts/bills. To date I have never been denied a claim for a receipt issue.

And about this 100% reimbursement for some checkups and things? Pib, can you point me to a place to find where it says this on Tricare website? I tried finding this once and had no luck. Another retiree asked me about this also and I had no good answer.

[Pib]

First let me say thanks to Pib for the info here.

I am happy to learn that I can file a claim via the secure message system with Tricare Overseas. I will definitely give that a try next time. As I always scan my paperwork for safekeeping this will make sending in a claim that much easier.

About the receipt issue? In reading the JUSMAGTHAI web site and info posted there from the RAO and the Tricare reps it seems they indicate that Wisconsin is getting tougher on payments because of this fraud issue and they suggest going the extra mile with receipts to be sure it satisfies any questions they(Wis) have about payment for services. The nurse at JUSMAG I talked with recommended if paying with any type of bank card to make a copy of that payment slip and include with the hospital/doctor office receipts/bills. To date I have never been denied a claim for a receipt issue.

And about this 100% reimbursement for some checkups and things? Pib, can you point me to a place to find where it says this on Tricare website? I tried finding this once and had no luck. Another retiree asked me about this also and I had no good answer.

It was caused by a law change....a change for the better. I first picked the info via Tricare news letters starting mid last year, such as the two news letters attached. See page 4 of 1st Atch and page 5 of 2nd Atch. It's also on the Tricare website, but can be hard to find. Personally I think Tricare could have done/could be doing a better job in advertising the change.

Please note the new law applies to the specific clinical preventive services received on or after Oct. 14, 2008. You can request reimbursement for the specific preventive care services received on or after Oct. 14, 2008. Reimbursement requests can be made by phone or in writing to your regional Tricare contractor, which is SOS International in Wisconsin for us. Basically, no cost share (i.e., the 25% part) or deductible applies. It could be the first claim for the fiscal year when you haven't meet your deductible yet, and you still get reimbursed at 100% with no deductible applicable. But your claim/reimbursement needs to be VERY CLEAR that it was one or more of the Clinical Preventive Procedures. I had one past claim that fell in this category....a 2009 mammogram for the wife. So, I wrote up a short official looking memo, had the wife sign it, I scanned it, and then sent a Secure email with the letter attached....just like I file my claims now. I got fully reimbursed. And when the wife did her 2010 mammogram and both of us got our annual flu shots, we got fully reimbursed with no deductible. And you know how Thai hospital/doctor bills usually breakout the medical visit costs into subcosts say just to get "one each annual flu shot" into a doctor fee, a nursing fee, a supplies fee, and then whatever specific thing that was given like the flu vaccine. Well, you get reimbursed for that "entire" office visit since the purpose of the visit was to get the flu shot, or the mammogram, etc. We always do annual exams in the Queen's birthday month since our hospital usually gives 20% off during the entire month for annual exams (saves Tricare and me money) and then get the annual flu shot in Nov. This also helps to lump less of the 100% reimbursable and 75% reimbursable w/deductible medical services into one receipt, which can make it even harder for the Tricare Claim Review to pick out/figure out what is preventive to be reimbursed at a higher rate and the other stuff to be reimbursed at the 75% rate. I always try to make it as easy and clear for the Tricare Claim Reviewers since each one probably has to process around a 100 claims per day. Submitting clear, detailed, complete claims also helps to keep my blood pressure down by not having to make a later call to Tricare or submit additional claim paperwork to get reimbursed properly.

Another point about the preventive services and being clear on the claim submitted: a person might initially think the wife's annual mammogram would automatically be seen as preventive by a Tricare Claim Reviewer. But as Tricare Claims contractor explained to me on the phone when I initially didn't get reimburse as required (but I did later with another doc I got from my hospital) that Tricare doesn't know if it the "annual preventive" mammogram unless it is clearly documented/identified as such, since mammograms could be occurring throughout the year/multiple times like in cases where a woman is suspected of having breast cancer. So those multiple/throughout the year mammograms would be reimbursed the normal way (i.e., 75% with deductible). The Rep said there are about a dozen different CPT codes doctors/hospitals can utilize when submitting claims for mammograms which identify exactly why the mammogram was given...and only one code applies to the annual preventive mammogram. Now, I know Thai hospitals/doctors don't use the AMA CPT codes, and us individuals who file our own claims don't use those codes in our claim submission...just mentioning these codes to illustrate that many different versions of mammograms exist. Take a look at those code numbers that are on your EOBs, those are the CPT codes that the Tricare Claim Review "picked and entered" based on how descriptive you made block 8a of your claim form was and how descriptive your medical receipt was.

Would also recommed that military retirees signup for automatic email distribution of Tricare newsletters, as I've found these newsletters to be very helpful in keeping abreast of the latest benefit changes.

Cheers,

Pib

IMPORTANT Standard_News_012810_L_.pdf

IMPORTANT eStandard_News_i10_Lo.pdf