block30

Hello all, I'm looking for a little advice.

I was just wondering if anyone has had problems with Tricare? I'm a Guard guy using TRS and my wife and I are trying to get reimbursement for some care that our baby needs. Normally I have been quite satisfied with Tricare when the doctor's office is billed...they seem to know how to handle insurance companies.

However, now that my wife and I trying to get reimbursement for treatment we paid for out of pocket, we are getting the absolute run-around (to make a long story short). I'm honestly floored and angered at how much of a sh-- show it has been dealing with them and how long this has gone on.

Just curious if anyone has had problems and or has submitted a complaint about Tricare?

FlyBoyd

We had a point of service debate/debacle in 1995 (out of region asthma attack/ER visit) that took three years to settle...and we did everything by the book...no really...we did. I finally walked into a TRICARE office one morning and told them I wasn't leaving until it was fixed. I made sure they understood I was going to be a PITA all day everyday until they unscrewed what was wrong. 4 people on phones working the problem (initial input by someone was incorrect and they "can't" change it after the fact) for a couple hours...It was fixed by lunch.

After that, we go the extra mile to get the referral. Other than emergent situations (broken arm, viral meningitis, etc) we have forced the system to work within acceptable timelines. Word of advice - when seeking the odd referral make sure and have the doctor request more visits than you actually need. It limits the hoop jumping when procedures don't go as planned and you have to go back.

We just moved and our new PCM is awesome. They have a website where you can input referral request. They then determine if they even need to see you and will request the referral without an initial visit. We're 50-50 on them needing to see us to get the referral.

full of luv

Block,
I've had special needs kid for 10 yrs with a couple of other kids on Tricare. Bottom line is each region is differentc contractor who we have had diff experiences with. Also if you. Are prime or standard will affect your experience as well. Mostly in the end we have persevered and gotten what we need but it's been squeaky wheel and appeals a few times to get what we needed.
If you do prime coverage is pretty good as long as your condition follows. A standard protocol.

BFMthisA10

Tricare Standard.
Didn't make the switch until three years ago, and ever since I have wondered what took me so long. The service upgrade that my family gets just by not having to fight through the base hospital is staggering.

Sputnik

I've had the family on standard for a while, and completely agree with you.

However, I'm about to retire and planning on keeping same--standard for retirees also seems like a great deal. But I'm also not always the sharpest knife in the drawer, missing anything? Seems like worst case $3k/yr (someday I'll learn to stop writing in non-OPR) with no cap, or are there higher order effects I haven't seen yet?

Apologies for thread drift

block30

Funny you say this, because as of April Tricare stopped allowing walk ins to their offices! Also, I am thinking of filing a grievance, and surprise, surprise the link to their grievance form is dead!

Thanks all for your replies!

e6bpilot

Yep, they canned all their service reps and everything has to be done via phone now. It has changed the game somewhat. Now anytime you want personal service, you have to navigate the phone menu maze. It is a lot easier to say no over the phone, for sure, but I have had decent luck with them when I have had problems. My main problem with them is that when my doctor makes a mistake in the bill, they would rather not pay it then call and fix it. Now I, the layman, have to call the doctor and tell them they screwed up a code on the bill. It is frustrating. I will also second what Boyd said above about getting the referral beforehand. It will save you a lot of grief later.
Getting ready to switch to retired Prime. Hopefully I will never set foot in another military health clinic again. The copays are worth it to me.

Grumble

Welcome to the new normal. If they can make it more painful to file a claim, maybe you'll just pay the small stuff out of pocket. Those small victories can add up to huge savings. I've had to see an ortho specialist the last few months for my shoulder. Last few years this would have been a nonevent. Now I have to jump through my own butt for three weeks faxing and mailing paperwork for $150 reimbursement.

About to make the jump from Std to TRS. Expecting it will be painful.

tinman1

I just made the switch from standard to prime. I'm fairly new to tricare so I didn't really know the difference, but since my wife is active duty it seemed like prime was the better deal. It's nearly impossible to get an appointment on base in a reasonable time frame. Couple that with the fact that I'm a commuting regional pilot and it's nearly impossible to get scheduled for a convenient time. I'm seriously re-evaluating my decision to switch over to prime.

e6bpilot

If you are having trouble getting an appointment, be the squeaky wheel. Write down specific examples, days, times, situations, and appeal to tricare for an off base PCM. When they deny it (and they will), go show up in person with your letter in hand and ask to speak to the clinic HMFIC. That is how I got my whole family off base.