Tricare and Radiation/Chemotherapy coverage

[longball53098]

Hey all you retired military expats living in Thailand and using Tricare Overseas as your primary insurance cover.

Do any of you have experience filing claims with Tricare for your cancer treatments?

I was operated on about 6 weeks ago for tongue and neck cancer at BNH here in Bangkok. We worked out the partial payment system and I paid the hospital 25% up front and they did the rest. The surgery cost has not shown up yet on my account with Tricare but only a few weeks since they submitted the claim.

My main questions are regarding Tricare coverage for OPD chemo and radiation therapy which I have just started. Radiation at King Chulalongkorn Memorial Hospital here in Bangkok a total of 30 sessions over 6 weeks and on Saturday the first of 6 chemo sessions over the same 6 weeks at BNH chemo center. All this is at my out of pocket expense and claim submission to Tricare.

So the question is does anyone have any, ANY previous experience here in Thailand with these treatments and Tricare claim submission and reimbursement? Or am I the new kid on the block and the first one?

[lopburi3]

Sorry can not help directly but suspect procedure will be about the same as I have to use of Federal Employee Plan Insurance from Blue Cross.  You seem to use claim form found here.

http://www.tricare-overseas.com/beneficiaries/claims/claim-forms

 

Expect they will want the same things so be sure you obtain these papers on each paid OPD visit:

1.  Small bill (A5) listing general categories and charge (basic bill).  This will be stamped paid by cashier and signed.

2.  Detail receipt (what we normally call itemized receipt) giving breakdown and costs (A4) size.  Normally this will also be signed and stamped.  You often have to ask for this.  Cashier can print easily at private hospital (but Chula may be an issue - no recent experience).  If not available probably good to include a statement to that effect.  

3.  Medical Certificate from doctor (this provides diagnosis which insurance require and is often not on bill).  You should advise nurse you need.  Again this might be an issue at Chula.

[Spaniel]

Why not call the US military retiree office at JUSMAG and ask them?   02 2054049      Ask for the retireee office.      I think they are only there 3 days a week, Tuesday, Wed & Thrs.

Edited February 1, 2017 by Spaniel
add additional info

[longball53098]

Thanks to Lopburi3 and Spaniel for the replies.

I have been doing plenty of claim filing over the last few years so the actual logistics of making the claims is for me pretty simple.

I also am in contact with Nurse Tida at JUSMAGTHAI on a almost regular basis. She always comes through with pretty good info and help/recommendations.

I am hoping to find someone that has experience filing claims for either chemo or radiation or both and has been successful. If not success on the first filing what pitfalls did Tricare throw at them and how did they solve the issues.

The first one I see already is Chula being a government facility does things their way and that means many forms and such are in Thai. So I need to provide proper docs for Tricare in English. A detail/itemized printout is my next challenge and I believe I have found a form on the JUSMAG site that can work for me

[lopburi3]

Chemo/radiation is specifically authorized for out patient payment in my Blue Cross coverage so expect that Tricare would also authorize.  It is a normal procedure for cancer treatment.

 

Chula had a translation department 10 plus years ago when we last used them that you could pay to have English documents provided so that might be an option.  SIL was senior nurse there and took care of it so do not know procedure to obtain.    

[longball53098]

Lop, thanks I will look in to this translation service.

Yes on the coverage. From JUSMAG nurse Tricare will cover as long as the treatments meet the US FDA approvals. I already know that the chemo that I will get meets USFDA. Waiting for answer on the radiation methods and system.

[longball53098]

Just received this message from Tricare rep in Singapore as to a question I sent them regarding coverage. I believe I fall in to the first paragraph about "clinically approved medical treatment". So I think I am covered.

"Dear Sir,

We have received your email inquiring about coverage of the treatment for
your medical condition.

Standard medical treatment that require use (clinically approved medical
treatment) of chemotherapy and radiation therapy are covered by the policy
under TRICARE For Life/ TRICARE Standard.

However, there are specifics that will require your attention;
1. If the therapy that is being recommended is under clinical trial then
further information is necessary to determine coverage.

2. Organ/Stem cell transplants will require completion of pre-approval form.


3. Inpatient hospitalization is a covered benefit for acute illnesses only
and not for the purpose of rehabilitative care.

If there is any further concerns or areas that you wish to clarify please
feel free to write back.

Thank you and take care."

[lopburi3]

Should not be any issue - just work on getting better.

1.  This will be a standard procedure rather than a clinical trial type procedure from what you have said (follow up cancer treatment using USFDA approved methods/materials).   

2.  NA

3.  NA

[Sheryl]

You'd know if you were in a clinical rial, you'd have had to have the trial explained to you and signed a consent form. Can safely assume this is standard treatment.