Tuesday, June 21, 2011

I am having a huge issue with our Military insurance TRICARE Prime. I am getting nothing but the run around?

on a claim for reimbursement from a emergency "medically necessary" surgery that I had in april. My claim was mailed to tricare in July. I've spoke to several reps that tell me differently 'I can't find it" or "I found everything - but we need this" I've faxed over and over and had several reps say they would call me back. Today I went to my local office, who could only place a call in to Tricare to explain, and the rep she spoke with couldn't find anything. So she re-faxed. I called 2 hours after leaving the local office and asked for a supervisor, she saw my original claim that the other couldn't find, and the re-faxed claim that the local office sent in. Now what do u think i was told?- " we can not enter your claim until you write a letter stating that the 2 dr's that performed my surgery were partnered" Not like she couldn't note the account. Then she said the golden words, "soon as you send that in, we can enter your claim, and send you a denial letter" WONDERFUL - let me do all this extra stuff so you can deny it. And the reason they want to deny it is because the dr. did not have time to gain a pre-authorization (emergency) which at the min can take 72 hours to request. But last year my regular dr tried to get a referral from tricare to have the surgery..but they denied the referral stating they do not cover dental... i tried to appeal that several times, but got the same answer. But I attempted..and now that it was life or death, they want to deny refunding me my out of pocket cost of $21,000 because no pre-authorization. Like I said, I've heard several reasons from rep, and different request for more information...I'VE HAD IT with them. My question is... what can I do? Does anyone know who I could report this to on the GOV side, as far as, who do I complain to with authority on the Military side? After all, the GOV pays Tricare to provide medical insurance to the Military and benificaries. Any help, and guidance would be very helpful.
--------------------
Time to contact your congressman. Open the link. All you need is your zip code. I hate to see posts like this. We do have a senate armed forces committe, you know. I'd like to know wtf they do with themselves. http://armed-services.senate.gov/
Source

No comments:

Post a Comment