TRICARE

Nothing can stir the emotions of a military spouse more than hearing "TRICARE". The system is not perfect, but it can function fairly smoothly for you if you follow the following suggestions. These are suggestions given by seasoned and new spouses in recruiting.

Keep a TRICARE journal. It does not have to be anything fancy. A spiral bound 70 page notebook works fine. If you want more organization, use a 3 ring binder with dividers and seperate the family members. Use pocked dividers and place the EOB (explanation of benefits) for each medical visit/procedure in the family member's section. In this journal, you need to write certain information when dealing with an unpaid claim or other TRICARE issue. This information is:

{1}Time and date of call. Include length of time on hold.
{2}Name of TRICARE representative spoken to. Do not be afraid to ask them to repeat their name and supply both first and last name

{3}Location of the Representative. Remember that a family member calling from Pennsylvania could be speaking to a representative in Connecticut.

{4}Write down exactly what the representative tells you.

{5}If you are transferred to another representative, ask the first representative to give you the full name of the person you are transferring to or the office. Write down time of transfer, name and location of new representative.

{6}If getting authorization or setting up an appointment, write down the name, location and phone number of the medical office personnel who is assisting in setting up the appointment.

{7}Write down any authorization numbers

NEVER DESTROY OR DISPOSE OF ANY TRICARE EXPLANATION OF BENEFITS until you are 100% sure that the claim has been settled. Good rule of thumb is to keep all paperwork until PCS or ETS.

Educate yourself and be prepared to communicate between your doctor's billing department and the TRICARE office. Again, write down names of people spoken to. Many TRICARE problems are caused by a simple coding error at the doctor's office level.

Be prepared to use the website(TRICARE) and call as many Dr's as it takes until they find one that will take TRICARE. Print out the list of doctors on the website. This print out can be used as proof if a claim is denied. Print directly from the site, do not copy and paste to a new document.

Make sure a referral to any specialists is actually a specialists who is in the network. Verify with both the doctor's office AND by calling the TRICARE 800 number for your region.

Be sure to call your PCM in at least 24 hours of getting emergency care. Not all PCMs check to make sure.

Make sure the bills Tricare is paying is not for someone else. Report it to Tricare immediately if it happens.

Make a periodic check to insure you haven't been dropped from DEERS. This can happen when systems are updated or transferred.

If you have a problem with a doctor, such as poor medical care, malpractice and such. FILE a grievance with Tricare against the doctor, especially when it comes to specialists. If you don't, and would ever need such a specialist in the future, and said specialist is the only one in the network, you'll be forced to see that specialist or pay POS (point of service) bills. This means all bills related to the specialist and all tests said specialist orders.

Make sure that all referrals are updated every 3 months; it is possible to get a year referral if your condition is a lifelong illness Example:Psorasis. Always make sure that your referral has not expired before going to the doctor.

Make sure to update your TRICARE information everytime you move as well as Deers information.

If you would like to volunteer to help other spouses or would like to have a sponsor spouse, please click on the angel to email the webmaster.

Visitors since 17 January 2003
Last updated 17 January 2003

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