Tricare Help: Why does Tricare say I owe money? - Military Health, Tricare programs - Military Times

Tricare Help: Why does Tricare say I owe money?

Q. I’m a military spouse with Tricare, as well as my employer’s insurance. My employer and the Tricare Outpatient Clinic told me Tricare would be my secondary insurance, but neither explained what that means. I continued to see my Tricare provider, who referred me to outside doctors when his own staffing was low. Triwest is now asking those outside providers it had authorized to pay it back, and sending me notices that I owe money. Triwest claims it did not know I had other insurance, even though I filled out papers at the Tricare clinic when I started coverage under my employer’s plan. What happened?

A. When a Tricare beneficiary has other health insurance, federal law requires that Tricare be the last payer. That means you must file all claims for civilian medical care first with the other insurance, and when it has paid its maximum and has issued an explanation of benefits, you may file a Tricare claim. The Tricare claim must consist of:

• A properly completed Tricare Claim Form DD 2642.

• Copies of exactly the same itemized medical bills as were sent to the other insurance.

• A copy of the other insurance’s explanation of benefits showing how it processed each charge.

Send the completed package to the Tricare claims processor for your state or ZIP code.

It sounds like Tricare paid in error because you did not file with the other insurance first.

Here’s what you need to do now: Write to the Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. Explain the problem in detail, include your full name as it appears on your military ID card, your husband’s name and his Social Security number, and a telephone number where you can be reached during the day. Include copies of any correspondence and documents that pertain to the problem. The more information you can provide, the better.

Q. I am retired from the Army, and I plan to be married soon. Can my new wife be enrolled in Tricare?

A. Your new wife will become legally eligible for Tricare at the moment you kiss the bride. For her to use Tricare, however, she must be registered with your uniformed service and with the Defense Enrollment Eligibility Reporting System. Call DEERS at 800-538-9552.

She should save all her medical bills starting on the day you are married. When she is properly signed up for Tricare, she can file a claim for those charges.

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