Research - Rehabilitation - Re-Employment
Dear Sgt Shaft
I do not know if you can help but I have contacted Tricare, members of Congress
and everyone I can think of including those in offices on military bases for
Tricare beneficiaries.
This problem concerns all those enrolled in Tricare and Tricare for Life.
My husband was treated in for Prostate Cancer with radiation. Medicare paid. Tricare denied him at every level.
The PROBLEM: No treatment approved by Tricare is offered in the state of Alabama. THE RADIATION ONCOLOGY CODES PAYABLE BY TRICARE were LAST UPDATED MARCH 27, 1991----that is over 16 years ago.
I have tried to find a state who offered treatment covered by Tricare Codes 61793,61795, 77261-77421,77427-77799 in the Tricare Policy Manuel Chapter 5 Section 3.1 August 1, 2002. Issue Date of the approved treatment codes March 27, 1991 Authority: 32 CFR 199.4(b)(2),(c)(2),(c)(3),and (g15).
I have learned Mayo Clinic in Rochester uses the one used on my husband in AL. AL uses this treatment and the most effective treatment available. I do not know when this treatment began.
The Doctor asked me about my breast biopsy, it was ok, and he said if I needed radiation treatment Tricare would not pay for it either. He told me this while my husband was having his PSA checked. He was treated for Prostate Cancer Nov 2006-Feb 2007 in AL. There were others also in the same situation, Tricare denied all. Tricare could not tell me where the treatments are that are being done for the thousands of claims they say are being paid for their approved treatments.
Should his cancer return he can not be treated as we do not have the funds to pay out of pocket.
No one will listen to me. No one will do anything. My senator said, should a bill ever come across his desk he would remember my comments.
Is there anything you can do, anyone you can contact? I received a letter from Mr. William N. Voharas, Atty-Advisor Appeals, Hearings, and Claims Collection Division from the Office of the Asst. Sec. of Defense. health affairs in Aurora, CO dated 3 July 2007 asking Tricare to review compensator IMRT still unproven treatment by Tricare. I am waiting to here from him.
Things do not look good. Tricare says they do not pay for Chiropractic care and Medicare does and compares this to why Tricare would not pay for Cancer Radiation Treatment.
Thank for listening to me.
Wanda S
Birmingham, AL
Dear Wanda
My sources tell me that there are many procedures that are covered by Medicare
but are still considered “experimental” by Tricare. They recommended that you
follow Tricare’s appeal procedures, and since you are already working with
Tricare Management Activities Appeals Office it appears that you are doing so
doing that. Hopefully by highlighting this dilemma in my column, the
Administration and Congress can resolve these ancient inequities in Tricare.
Dear Sgt Shaft
Please note that the Maryland Department of Public Safety and Correctional
Services (DPSCS) is now accepting applications for state death benefits for
military personnel (residents of Maryland) killed in Iraq and Afghanistan. The
application guidelines can be obtained by contacting my office. DPSCS is
administering the program as the benefits are provided by the same program that
covers law enforcement, public safety, fire and EMS personnel killed in the line
of duty.
The Secretary of Public Safety and Correctional Services may determine that a lump sum death benefit of one hundred twenty-five thousand dollars ($125,000) effective January 1, 2006, shall be paid to the spouse, children, dependent parents or to the estate of any of the officers listed in I.D. of the State or any political subdivision thereof, and military service members who is killed or who dies in the performance of official duties. The death benefit was $50,000 until January 1, 2006.
On June 1, 2006, the law was amended to include a Maryland resident who was a member of the uniformed services of the United States serving in the Afghanistan or Iraq conflict when killed or died as a result of injuries sustained in combat.
Reasonable funeral expenses, not to exceed $10,000, shall be paid to the surviving spouse; children; to the surviving parent or parents; or to the estate of any of the following officers of the State or any political subdivision thereof, who are killed or who die in the performance of official duties, the total sum will be reduced by the amount of the Workers’ Compensation funeral benefit. The current law does not include a funeral expense provision for military service members.
Additional information regarding the Death Benefit Program may be obtained from the Human Resources Services Division, Department of Public Safety and Correctional Services at (410) 585‑3408.
James A. Adkins
Secretary
Maryland Department of Veterans Affairs
The Jeffrey Building
16 Francis Street
Annapolis, Maryland 21401
Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax to 301-622-3330; call 202-257-5446 or email sgtshaft@bavf.org.
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