Military Significant Others and Spouse Support - MilitarySOS.com
Results 1 to 9 of 9

Thread: Tricare Question

  1. Meow.
    Mandaaa's Avatar
    Mandaaa is offline
    Meow.
    Join Date
    Nov 2008
    Location
    Miami, FL
    Posts
    10,233
    #1

    Tricare Question

    Advertisements
    I'm frustrated and everyone is closed over the weekend, so I'm wondering if I could get some insight.

    Two weeks ago I sliced off a chunk of my finger. We had only just moved to Homestead and still getting situated. My husband had not yet in-processed at the new base (reserve base) and the hospital this base uses was on an Army base about an hour away. We located an urgent care facility that takes Tricare. They took us with no problem and told us we had 2 weeks to get a referral from my primary care provider (which confused me since we had out-processed with Nellis AFB and had yet to in-process with Homestead).

    Between the time when I hurt my finger to when my husband in-processed and we made it down to the hospital to get set up, a week had passed. We found out the hospital doesnt even see dependents and they gave me a civilian doc in a nearby city. When we told them about my finger and needing a referral so we dont get billed, the Tricare lady told us to contact Nellis and have them send a referral. She also said we need to contact them asap so that we dont get switched in the system to Homestead (or something like that). I contacted Nellis right after and gave them the information they needed.

    Fast forward to last night (yay for time differences), I got a call from Nellis and they told me our referral was denied because we arent with Nellis anymore. Now our 2 weeks are up TODAY. I tried getting in contact with my civilian doc to see if I could magically get a referral sent over, but they are closed till Monday. I tried getting in contact with Tricare to see if we could have a grace period till Monday and they are closed till Monday. Now I'm worried we are going to get a $150-300 bill because we were told to contact the wrong people for a referral...

    Does anybody know if there is any hope in getting this fixed? I've learned my lesson regarding getting injured during a PCS

    TIA!
  2. Senior Member
    ArmyCupcake's Avatar
    ArmyCupcake is offline
    Senior Member
    Join Date
    May 2008
    Location
    PA
    Posts
    12,076
    #2
    Yes. You can always appeal a denial. Plus they have you on record for trying to get the referral within the given time period.
  3. Meow.
    Mandaaa's Avatar
    Mandaaa is offline
    Meow.
    Join Date
    Nov 2008
    Location
    Miami, FL
    Posts
    10,233
    #3
    Thank you! That's good to know. I'm planning on contacting Tricare on Monday, but I was curious if there was any hope at this point. This has been the least exciting (and painful!) part of the PCS
  4. Senior Member
    itchywitch's Avatar
    itchywitch is offline
    Senior Member
    Join Date
    Feb 2007
    Location
    Twentynine Palms
    Posts
    2,735
    #4
    I have always been naughty and never called tricare after an er or urgent care visit, and have never recieved a bill.


    No one is guaranteed happiness. You can pursue it, but if you happen to find success along the way on that road to happiness, Conservatives believe you should not be demonized or penalized for it.
    Glenn Beck
  5. Senior Member
    Deifick's Avatar
    Deifick is offline
    Senior Member
    Join Date
    Sep 2012
    Location
    Southern California
    Posts
    1,262
    #5
    Breathe, honey! I hope your finger is healing.

    Tricare is so confusing, especially if your PCM SUCKS, like mine. (My PCM doesn't suck, but her lazy staff who gives you incorrect information does.) First, get a hold of your civilian PCM. Try to have them fax the referral. Continue to go about the process that way. Tricare may deny that claim because it has passed the 2 weeks, but try it first. If that does not work, Tricare always sends you a claim (you might also be able to view it online). There's an address on there that says send correspondence to this address if you do not agree with the amount you owe or the amount Tricare is paying. Write a letter to that address explaining what happened from the beginning and remember to include that you tried to get a referral.

    I went to urgent care because I was coughing for 2 months. My PCM didn't think it was urgent enough, so they wanted to schedule an appointment for three weeks later. My coughing got worse, and I went to urgent care, and I had bronchitis. Then I tried to get a referral from my PCM, and they scheduled a follow-up appointment (funny because that follow-up appointment would have been a week BEFORE my original appointment for the cough had I scheduled it), but they forgot to do the referral. Tricare charged me as a point-of-service because I didn't go to my PCM. I called Tricare. They told me to write a letter, and I did. I got a letter stating that they would pay for my urgent care visit. It just takes a while.
  6. Banned
    gunsgirl's Avatar
    gunsgirl is offline
    Banned
    Join Date
    Jul 2007
    Location
    lost
    Posts
    17,275
    #6
    it will be ok, on monday cal tricare and tell them that you were seen "in transit" and they will take care of it.
  7. Meow.
    Mandaaa's Avatar
    Mandaaa is offline
    Meow.
    Join Date
    Nov 2008
    Location
    Miami, FL
    Posts
    10,233
    #7
    Thank you so much ladies! I feel much better about this situation

    Quote Originally Posted by Deifick View Post
    Breathe, honey! I hope your finger is healing.

    Tricare is so confusing, especially if your PCM SUCKS, like mine. (My PCM doesn't suck, but her lazy staff who gives you incorrect information does.) First, get a hold of your civilian PCM. Try to have them fax the referral. Continue to go about the process that way. Tricare may deny that claim because it has passed the 2 weeks, but try it first. If that does not work, Tricare always sends you a claim (you might also be able to view it online). There's an address on there that says send correspondence to this address if you do not agree with the amount you owe or the amount Tricare is paying. Write a letter to that address explaining what happened from the beginning and remember to include that you tried to get a referral.

    I went to urgent care because I was coughing for 2 months. My PCM didn't think it was urgent enough, so they wanted to schedule an appointment for three weeks later. My coughing got worse, and I went to urgent care, and I had bronchitis. Then I tried to get a referral from my PCM, and they scheduled a follow-up appointment (funny because that follow-up appointment would have been a week BEFORE my original appointment for the cough had I scheduled it), but they forgot to do the referral. Tricare charged me as a point-of-service because I didn't go to my PCM. I called Tricare. They told me to write a letter, and I did. I got a letter stating that they would pay for my urgent care visit. It just takes a while.
    This was super helpful! I'll definitely be making phone calls tomorrow and hopefully my PCM understands. I dont know how weird it is for them to get a call asking for a referral when they have never seen me. But thank you for explaining the steps to me for what may happen. I feel calmer
  8. Senior Member
    Deifick's Avatar
    Deifick is offline
    Senior Member
    Join Date
    Sep 2012
    Location
    Southern California
    Posts
    1,262
    #8
    Yes, I basically yelled at my PCM over the phone because they didn't do the referral when I found out. Why would I set up a followup appointment without asking for a referral? They tried doing the referral after my followup appointment but kept saying that Tricare doesn't pay retroactive. They didnt fax it properly and didnt notice until i called to ask about it a week later.

    Tricare sent their statement, saying I owe $$. That's when I sent the letter. The address should be on the Tricare statement. It should say something along the lines of: if you disagree with this, send correspondence to this address. I have Triwest, so the address may be different. I think I also sent copies of my Tricare statement and the bill I received from the urgent care, along with my letter explaining what happened. I just wanted to make sure it was approved and they had everything. Hope things work out for you.
  9. Meow.
    Mandaaa's Avatar
    Mandaaa is offline
    Meow.
    Join Date
    Nov 2008
    Location
    Miami, FL
    Posts
    10,233
    #9
    Quote Originally Posted by Deifick View Post
    Yes, I basically yelled at my PCM over the phone because they didn't do the referral when I found out. Why would I set up a followup appointment without asking for a referral? They tried doing the referral after my followup appointment but kept saying that Tricare doesn't pay retroactive. They didnt fax it properly and didnt notice until i called to ask about it a week later.

    Tricare sent their statement, saying I owe $$. That's when I sent the letter. The address should be on the Tricare statement. It should say something along the lines of: if you disagree with this, send correspondence to this address. I have Triwest, so the address may be different. I think I also sent copies of my Tricare statement and the bill I received from the urgent care, along with my letter explaining what happened. I just wanted to make sure it was approved and they had everything. Hope things work out for you.
    I cant believe how complicated this can all get But thanks so much for the info! I'm hoping this can all be in the past soon enough.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •