Military Update
Data mix-up delays program benefits for elderly
Military Update focuses on issues affecting pay, benefits and lifestyle of active and retired servicepeople. Its author, Tom Philpott, is a Virginia-based syndicated columnist and freelance writer. He has covered military issues for almost 25 years, including six years as editor of Navy Times. For 17 years he worked as a writer and senior editor for Army Times Publishing Co. Philpott, 49, enlisted in the U.S. Coast Guard in 1973 and served as an information officer from 1974-77.
By Tom Philpott
A data transfer error between the Department of Defense and Medicare has left the names of more than 194,000 elderly beneficiaries off the list of those eligible for automatic claims processing under the new TRICARE for Life program.
The problem will be corrected by Dec. 1, said Steve Lillie, director of the over-65 benefits division at TRICARE headquarters in Falls Church, Va. But roughly 13 percent of program beneficiaries will need to file their own claims with TRICARE to ensure that healthcare providers get secondary payments under TFL.
The glitch means TFL isn't having the near-flawless launch that TRICARE officials had hoped. But beneficiaries and providers shouldn't be too concerned, officials said. The problem is temporary, and benefits will be paid in full.
Under the program, Medicare processes claims filed by providers, pays its share and sends the claims on to TRICARE to pay most, if not all, of the leftover costs. TFL beneficiaries receive two "Explanation of Benefits," from Medicare and TRICARE, but usually don't need to do more.
But some beneficiaries will face extra paperwork. Once Medicare pays its share, beneficiaries will have to file a TRICARE claim, attaching a copy of Medicare's Explanation of Benefits, so TRICARE knows what it owes.
Two groups of beneficiaries are affected: 10,600 widows and widowers of members who died while on active duty; and 184,000 beneficiaries who gave department officials early proof of enrollment in Medicare Part B, a requirement for eligibility.
The names of widows were left off the department's list sent to Medicare through a simple oversight. What happened to the larger group, however, was complicated.
Department officials in July gave Medicare names to run against its list of Part B enrollees. Left off the department list, however, were names of people who had already shown officials proof of enrollment in Medicare in Part B. Medicare used the list to supply the department with a health insurance claim number on each eligible beneficiary.
TRICARE then sent those claim numbers on to 64 Medicare claim processors nationwide. It was mid-October before officials discovered the list of claim numbers was incomplete.
"Since we didn't submit these names initially" to Medicare, Lillie said, "we didn't get the health insurance claim numbers back, hence we didn't submit their names to the Medicare claim payers. They got left out."
Because Medicare claim processors don't know to send these claims on to TRICARE, the beneficiaries will receive paperwork from Medicare suggesting they are liable to the provider for what Medicare won't cover. Beneficiaries will be asked to file a claim with TRICARE, attaching the explanation of benefits from Medicare.
"We're still going to pay for that care,'" Lillie said. "But until we can get the crossover process going for these beneficiaries, we're going to have to get them to send us the Medicare claim information so we can make the payment."
Those affected will receive a letter from TRICARE by early November explaining the glitch and how to file their claims for care received in October and November.
If beneficiaries have questions after reading the letter, they should call the TRICARE for Life call center at (888) 363-5433.
Beneficiaries also will be encouraged to show the letter to doctors who might be concerned "about getting their 20 percent from TRICARE,' " Lillie said. That seems better than a mass mailing to Medicare providers, he said, which could cause "more uproar than necessary, since most people aren't affected."
The list glitch is "hopefully the biggest problem we'll have to deal with" in launching TFL, Lillie said.
Retiree COLAS
Military retirees and survivors, Social Security recipients, and veterans receiving disability compensation will see a 2.6 percent cost-of-living adjustment effective Dec. 1. The increase in annuities and benefits, based on inflation over the past year, will appear in Jan. 2, 2002, paychecks.
Federal COLAs are determined by the annual rise in the cost of a market basket of goods and services as measured by the Bureau of Labor Statistics' Consumer Price Index for Urban Wage Earners and Clerical Workers.
The Federal COLA in January was 3.5 percent.
Military retirees who left active service in 2001 will receive a partial COLA, rather than the full 2.6 percent, because they were retired for only part of the year on which the COLA was based. Partial COLAs will partly depend on what quarter of 2001 the member retired.
More on SGLI
In last week's column on the Nov. 1 start-up of automatic spouse coverage under Servicemembers' Group Life Insurance, I should have made clear SGLI is a program for active-duty members and drilling reservists. It is not available to military retirees or service veterans. Those seeking details on SGLI, or converting to Veterans' Group Life Insurance on separation, can visit www.insurance.va.gov, or call the VA office at (800) 419-1473.
Questions, comments and suggestions are welcome. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, or send e-mail to: milupdate@aol.com.
