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Tricare Help: If TFL pays all, why am I being billed?

Apr. 26, 2012 - 05:00PM   |   Last Updated: Apr. 26, 2012 - 05:00PM  |  
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Q. You have said many times that under Tricare for Life, when a medical service is covered by both Medicare and Tricare, Tricare acts as a secondary payer and will pay whatever Medicare does not. So why am I still getting bills from my doctor's office for $80 and more?

A. You state correctly that Tricare acts as a second payer to Medicare. Usually, the Medicare provider will forward your paperwork directly to Tricare to resolve any outstanding balance for the services you received.

However, note that I said usually in certain circumstances, beneficiaries themselves must file the second claim with Tricare. This occurs most often when the health care provider does not formally participate in Tricare that is, he is not a "Tricare-authorized provider."

It should be noted that a limited number of health care services are covered by Medicare but not Tricare, and vice versa. From your letter, I can't say for sure if that is the case in this instance.

I suggest you contact your provider and explain you're eligible for Tricare for Life military health care coverage, then ask whether your provider forwarded the unpaid portion of your bill to Tricare and if not, why not.

Then, gather up copies of all the documentation you received from your provider, including the detailed explanation of benefits that they should have sent you, and file a claim yourself with Tricare for the unpaid balance.

The claims form and all pertinent information about filing Tricare claims are available at http://www.tricare.mil/claims">www.tricare.mil/claims.

Q. I am the ex-wife of a career airman who is now deceased. We were married in 1953 and divorced in 1974. He enlisted in the Air Force in early 1947 and retired in late 1971. He remarried after our divorce. I remained single for years, but also eventually remarried in 2003. I am now on Medicare Parts A and B. Am I entitled to any Tricare for Life benefits?

A. To be eligible for Tricare as the former spouse of a military retiree, you must meet several criteria. First, you must have been married for at least 20 years. Second, at least 20 years of the marriage must have overlapped with the service member's active-duty time. Your ex-husband's service from 1947 to 1971 means even though you were married for more than 20 years total, only 18 of those years overlapped with his time on active duty.

However, even if your marriage did meet the 20-year requirement, you wouldn't qualify for Tricare because you remarried. Former military spouses who meet the 20-year criterion permanently forfeit all Tricare benefits by remarrying, and their Tricare eligibility cannot be restored even if the second marriage ends in divorce or death.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com">tricarehelp@militarytimes.com. In email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime at http://www.militarytimes.com/tricarehelp">www.militarytimes.com/tricarehelp.

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