Research - Rehabilitation - Re-Employment

Sgt. Shaft 01/07/2002

Dear Sgt. Shaft:
Ever since I was pushed into Prime Care, I have experienced the same problem over and over and over. I am seeing a military doctor for diabetes and appointments are made by phone a month in advance through an appointments clerk. Nine times out of 10, when I call for an appointment, I am told that either I don’t have Prime Care or it is too early to make the appointment. Then when I call the next day I am told that all the appointment slots have been filled and no appointment times are available. When I call Prime Care to find out why the appointments clerk does not have information on my Prime Care status, I am told the computer system is down. When I ask that they take the information and give me a call when the system becomes operational, I am told they cannot do this. Do you know what happened to the old-fashioned way of doing business?

It has occurred to me that the system is designed to kill off the retired military population. It seems designed to get us so stressed by the stupidity of the system that we either die from a heart attack, die while waiting for the menu to get to our option, die while waiting for an answer to our problems, or get so thoroughly disgusted with the situation that we no longer care whether we get medical assistance or not. I have also concluded that TRICARE Prime (the entire system, actually) is just another government rip-off.

I am sure there are thousands of military men and women who have the same problem and not one military person, retired or active, that I have spoken to on this subject is satisfied with the TRICARE system – not even the doctors who provide the medical services. The system is not just bent, it is broken and must be fixed.

Thank you for listening.
Respectfully,
Steven F., USMC (Ret.)
Fredericksburg, VA

Dear Steven:
I have received numerous complaints regarding the very trying TRICARE system you mentioned above. TRICARE-eligible individuals have complained they have had to spend a great deal of time on the phone as they attempt to make an appointment for their medical needs. They have encountered frustration upon frustration over doctors’ referrals disregarded because of mis-processed appointments and their medical needs not met.

In a recent meeting, the TRICARE Management Activity (TMA) reported that, since the TRICARE For Life (TFL) program began October 2001, a glitch in the electronics claims processing system between Medicare and TRICARE has been detected. The temporary problem affects approximately 13 percent of TFL beneficiaries, so most are not affected. TMA has identified individuals who have the potential for claims problems as a result of this error. These individuals will receive letters advising them of the potential problem and what they should do. Beneficiaries may want to share the information in the letter with their Medicare providers. Their TRICARE claims will be paid.

In early July, the Defense Manpower Data Center (DMDC) and the Center for Medicare and Medicaid Services (CMS) conducted a data match to identify all TFL beneficiaries in the Defense Enrollment Eligibility Reporting System and in the CMS database. Another goal of the data match was to identify the Health Care Identification Number for each of those beneficiaries in order to electronically process the cross-over claims between Medicare and TRICARE. Approximately 195,000 individuals were inadvertently excluded from this initial DMDC-CMS data match.

While this error may delay payment of the TRICARE claims, it does not affect TFL eligibility. Without a Health Care Identification Number, Medicare will not automatically forward TFL claims to TRICARE for processing. This claims processing issue is a temporary inconvenience for the affected beneficiaries, and the problem should have been resolved by now.

Affected beneficiaries who received Medicare Explanation of Benefits for any bills from their hospitals or doctors before December 15, 2001, will need to complete the CHAMPUS (TRICARE) Claim Form (DD Form 2642). A hard copy of the form will be included in the mailing to each affected beneficiary. The claim for and instruction on how to complete the form are also available on the TRICARE Web site at www.tricare.osd.mil/claims. Beneficiaries will need to attach copies of the doctor or hospital bills and the Medicare Explanation of Benefits to the completed claim form and mail it to the appropriate TRICARE claims processor. (This also may be done for the affected beneficiary by the doctor or hospital billing staff.) Of course beneficiaries should keep copies of all records for their files.

Persons with questions can receive assistance one of the following ways:

1. Call 1-888-Dodd-LIFE (1-888-363-5433);

2. Visit the TRICARE Web site at www.tricare.osd.mil/tfl or www.tricare.osd.mil/claims;

3. Call your regional TRICARE Service Center; or

4. Call the regional TFL phone number on the list that was included in your mailing.

Remember, no action is needed unless you receive a letter from the TMA.

Shaft Kudos
The Sarge sends a salute to DC native and fellow Marine Corps Vietnam vet Wayne Miller, who carried the 2002 Olympic torch December 21 on its journey through the nation’s capital. Miller, severely wounded on July 4, 1969, is a manager at the Department of Veterans Affairs Silver Spring Vet Center and provides post-traumatic stress disorder counseling to combat-era veterans. In 1981, Miller taught Adapted Physical Education for the Lt. Joseph P. Kennedy Institute and volunteered as an International Special Olympics coach. He was later recognized by President George Herbert Walker Bush for his work with the Special Olympics. Miller has received Gold, Silver, and Bronze medals in skiing, basketball, swimming, softball, golf, discus throw, and javelin throw with the VA disabled veterans sports games. 

Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax to 301-622-3330; call 202-462-4430 or email sgtshaft@bavf.org.

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