MILITARY UPDATE
TRICARE-for-Life getting on track after rocky start
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
The new TRICARE-for-Life program is solving computer and benefit-eligibility problems that by late January had the TFL system bouncing three of every 10 claims filed on behalf of elderly beneficiaries, military healthcare leaders say.
In the past two weeks, more than 200,000 previously denied claims have been reprocessed for payment.
The claims denial rate of 30 percent is down to 23 percent and falling, said Thomas Carrato, executive director of the TRICARE Management Activity, based in Falls Church, Va.
"We had hoped (the start) would be a flawless execution but it has not been," said Carrato. Nevertheless, he said, computer glitches are being corrected, many elderly are having "other health insurance" obstacles removed with a phone call and most military seniors are finding TFL "is an absolutely wonderful benefit."
As of last Tuesday, Medicare providers had filed more than 7.6 million claims from TFL users. Typically, Medicare pays its share and then passes on the unpaid balance of the bill to TRICARE claim processors.
Three major problems are to blame for more than 2 million claims being denied since TFL began in October. First came the "names glitch" discovered last fall. The Defense Manpower Data Center had left off 195,000 TFL beneficiaries from the list of eligible beneficiaries sent to Medicare. The problem, affecting 13 percent of all people eligible for TFL, was corrected by December. But many beneficiaries had to re-file claims with TFL to ensure their doctors were paid.
The second problem is other health insurance. TFL officials urged beneficiaries last summer to notify them if they had any other insurers and if they planned to drop that other insurance before Oct. 1, when TFL took effect. By law, other health insurance must be billed as second payer to Medicare, leaving TFL as third payer.
Only 60 percent of those surveyed returned their forms and half of those still failed to indicate if they would drop their Medigap coverage to use TFL. Even if they did drop old coverage, some insurance companies were slow to notify Medicare of the change. By mid-February, more than a million TFL claims had been denied because Medicare or TFL records showed, often in error, that the patient still had other health insurance.
To ease the backlog, TFL processors are accepting the word of beneficiaries over the phone on whether they have dropped or kept their old insurance. The problem will "self-correct" over time as TFL builds its data files, said Carrato. Meanwhile, the proportion of beneficiaries who updated their insurance information has climbed from 40 percent last January to 63 percent by last Tuesday. Yet half of all claims being denied still involve this issue.
The third problem is expired ID cards. Through January, more than 160,000 claims from 65,000 dependents and survivors had been denied because the Defense Enrollment Eligibility Reporting System (DEERS) showed they lacked current IDs.
Again, said Carrato, the process for correcting the problem can start with a call to TFL's toll-free number: (888) DOD-LIFE (363-5433).
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