TRICARE and You: Getting help with billing and other issues

Do you have a TRICARE bill you don’t think you should have received or have questions about how to resolve a billing issue? Do you have concerns about the wait time for a referred appointment or need to find a primary care doctor? This post contains information regarding TRICARE billing solutions, access to care standards, and other pertinent details regarding TRICARE network.

No comments

This blog is the most recent in a series helping members of the Coast Guard family understand how to use their TRICARE benefits. The blog series will continue every Monday, right here on Coast Guard All Hands.

TRICARE and You Image
TRICARE and You Image

Written by Cmdr. Paul Fawcett

As good of a program as TRICARE is, sometimes there can be issues that can leave you, the user, with questions. TRICARE is a huge system, serving millions of members, dependents and beneficiaries every day, and navigating the system can be tough. Fortunately, we’re here to help! Some of the more common problems and suggested solutions are below.

Billing

If you received a medical bill that you don’t think you should have received, or aren’t sure why you got it, you can take some of the following actions:

Verify

  • Make sure it’s your bill. Does the name, address, social security number, and date of birth on the bill match yours or your dependents?
  • Make sure the procedure listed on the bill was one you or one of your dependents completed.

 

Why

  • You may be receiving a bill as part of a copayment for a procedure. If you’re a TRICARE Prime enrollee, you don’t pay copays; however, if you’re on TRICARE Standard, you do. If you aren’t sure, check your enrollment at web beneficiary enrollment (https://www.dmdc.osd.mil/appj/bwe/indexAction.do) to be sure. You’ll need a CAC enabled computer. You can change enrollment if you’re not enrolled to the program you want, but it can’t retroactively affect your bill.
  • If your procedure was elective in nature, you may receive a bill as it may not be covered by TRICARE. You can search the TRICARE website at www.tricare.mil to see if that’s the case. You should normally know this before undertaking a medical procedure. If TRICARE issues you a referral for a procedure, it is authorized and not elective.
  • Other reasons for receiving a bill often involve administrative issues such as the medical provider billing using the dependents Social Security Number instead of the sponsor or improperly coding a medical procedure.

 

Action

  • Collect and review your referrals and bills. Have them available when you work with TRICARE and your service to solve your billing issue.
  • Call TRICARE. There are three TRICARE regions, each with its’ own phone number. If you’re not sure what region you’re in, visit the regions page at http://www.tricare.mil/About/Regions. Regional phone numbers are:
    • TRICARE North: 1-877-TRICARE (1-877-874-2273)
    • TRICARE South: 1-800-444-5445
    • TRICARE West: 1-877-988-WEST (1-877-988-9378)
  • If, after calling TRICARE you still haven’t been able to resolve your billing issue you can call the Coast Guard Health Benefits Assistance (HBA) line at 1-800-9-HBA-HBA.

 

Access to Care

1) Getting an appointment: TRICARE is required to provide you with access to the care you need within the standards of their contract. Unless your case is urgent, and your physician agrees that is the case, TRICARE isn’t required to get you care sooner. The access to care standards are:

Tricare Access to Care Chart
Tricare Access to Care Chart

2) Finding a doctor: If you are searching for a doctor, you can research at http://www.tricare.mil/FindDoctor to locate one that accepts your plan. If you can’t find a primary care doctor after calling a minimum of five doctors on the list they provide, you should seek help in getting one.

3) Help with appointments: If you’re experiencing difficulty with providers meeting the access to care standard, or you can’t locate a primary care manager;

    • Call TRICARE, explain your problem and ask for help. Call the regional numbers listed above. If you’ve made a significant effort to find a doctor, TRICARE should assist you and not just give you a new list.
    • Call the HBA line at 1-800-9-HBA-HBA or email CGHBA@uscg.mil.
    • Notify your CG clinic administrator if you note severe problems such as wait times well outside of standards for an appointment or inability to locate a primary care manager at all.

 

FAQ’s

Q: You mentioned TRICARE Prime and TRICARE Standard. I’m not sure of the differences between them. Where can I find more information?

A: See our previous Blog Post at http://allhands.coastguard.dodlive.mil/2016/03/21/tricare-and-you-prime-vs-standard-enrollment/ for more information. Other previous posts on a multitude of TRICARE topics can be found by typing “TRICARE and You” into the search bar in the upper right corner of this page.

 

Q: I received a bill and realized I was enrolled to standard and I didn’t want to be. I incurred costs I didn’t intend. Can I retroactively fix that?

A: Unfortunately, no. Managing your enrollment is your responsibility. If you’re unsure and need help, seek assistance from your TRICARE, or contact HBA by phone at 1-800-9-HBA-HBA or by email at CGHBA@uscg.mil.

 

Have more questions about your TRICARE benefits? Leave a note in the comments below!

Leave a Reply