Tricare Help: How can I better understand my explanation of benefits? - Military Health, Tricare programs - Military Times

Tricare Help: How can I better understand my explanation of benefits?

Answering your questions on Tricare.

Q. I sometimes find it hard to understand Tricare’s explanation of benefits forms. Where can I get help?

Each Tricare contractor maintains a website — find yours at www.tricare.mil/contacts — with a link to information for the beneficiary. That link will provide full explanations of EOBs issued by that Tricare Regional Center and will answer any questions you may have about the way your claim was processed.

Many of the problems experienced by Tricare beneficiaries result from not understanding the program’s rules — your rights and your responsibilities, especially in the matter of claims filing. Very often, problems result from simple clerical errors when claims are filed. Other problems can result from failure to provide additional information when requested.

I strongly recommend that beneficiaries spend some time studying the information on www.tricare.mil. The better you understand Tricare, the better it will serve you.

Q. I have Medicare parts A and B due to disability. It’s my only health insurance. I will be 60 in February. What do I have to do to get Tricare for Life at that time? When I have TFL and Medicare denies payment for a service, will Tricare also deny payment?

For official information regarding your Tricare for Life enrollment, please call the Defense Enrollment Eligibility Reporting Service support office at 800-538-9552.

Regarding Medicare’s denial of a claim or a particular item on a claim: Medicare will automatically forward the claim to Tricare when processing is completed. If the medical service in question is covered by Tricare, Tricare Standard will process the claim for the item as if it were your only health insurance for that item.

That means all Tricare claim-processing rules will apply. You will be assessed any amount of your annual $150 Tricare deductible not previously satisfied on other claims, and you must pay out of pocket your usual 25 percent cost share of the remainder after the deductible has been subtracted from the amount allowed by Tricare.

If the item is not covered by Medicare or Tricare, you’ll have the sole responsibility for paying for it.

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Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or e-mail us. In e-mail, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice anytime on our blog.