MILITARY UPDATE
Problems plague TRICARE for Life startup
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
Elderly military retirees and TRICARE officials are struggling with two challenges that suggest a rough beginning for TRICARE for Life, the military's new supplemental insurance plan for 1.6 million Medicare-eligible beneficiaries.
Officials learned in late January that 160,000 elderly beneficiaries have had TRICARE claims rejected because their military identification cards have expired. The large number suggests that a lot of beneficiaries don't use their IDs, or that information packets were mailed to many people no longer eligible for TRICARE.
It also was learned that beneficiaries with questions about claims have difficulty contacting the primary claims processor, Palmetto GBA of South Carolina. A huge number of TRICARE users who telephone Palmetto — 78 percent by one estimate — either are blocked by busy signals or face long waits to discuss their claims because of insufficient phone lines and operators.
But TRICARE officials say that despite the startup problems, most users are discovering that the program is a robust supplement to Medicare, perhaps the best in the country. I asked a small sample of readers of this column about their own experiences with TRICARE. Most said they were pleased with the coverage and with claim payments that left no out-of-pocket costs.
But the latest problems, monitored now by senior Defense officials, landed atop a half-dozen other issues, including a well-publicized data transfer glitch that for several months prevented automatic payments to healthcare providers of 195,000 beneficiaries. Many of those rejected claims are still unsettled, though the data glitch itself has been solved, officials said.
After Medicare pays its share, other health insurance plans are billed and TRICARE becomes third payer. Problems can arise if it is not known whether other health insurance has been dropped or retained. To ease this claims backlog, officials have begun taking beneficiaries at their word, over the phone, that the status of their other health insurance has changed.
Some officials have suggested taking similar action to clear up 160,000 rejected or delayed claims caused by expired IDs. After all, many of these beneficiaries might be in nursing homes or living far from a military ID office.
Other officials fear a blanket solution will result in payments for care of hundreds, perhaps thousands, of persons who are ineligible.
An alternative would be to reject the claims but to explain why, where people should go to get new IDs, and how to resubmit claims.
Palmetto's difficulty in answering its phones is a real disappointment because that company processes 85 percent of all claims. TRICARE officials likely will order Palmetto, and regional TRICARE contractors to quickly expand phone lines and staffs.
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.
