Well, Pretty much I was confused as hell until my husband called up Skip Munger from Tricare/DEERS. He said that my surgeon needs to get my referrals through my PCM (Primary care manager) on base and HE can pretty much override the whole thing and make Tricare approve of my referrals.

As long as my PCM orders tests , Tricare will approve it no matter what. We had no idea that we could do this. Before, my surgeons were ordering the referrals and that's why there were so many problems.

I couldn't believe how simple it was, and had someone explained it to us from the very beginning, we could have avoided the whole thing!

Here's basically how it breaks down:

My mom worked in Social Security for like 15 years and knew a lot of people. She got into contact with her friend Carol who's really high up in Medicare.Carol contacted Sandy about what was going on. Sandy called me on Monday and explained that Tricare is Primary no matter what. Because Richard is active duty. She kept reiterating this point over and over. She gave us Skip's number who's the head of DEERS/Tricare and who approves the claims and such.

I called Skip on Tuesday but hadn't heard anything back. Well, today I got a call from Allison who also works in Medicare in the Seattle office and works with Sandy. She said Medicare IS primary and Tricare IS secondary and that they are "working on it". Apparently, Allison called me because Congressman Don Young contacted the Seattle Medicare office. So, two different contacts produced two different results.

Well, my husband called Skip again today and left a message on Skips voicemail. We just got a call back from Skip stating that if we can get my surgeon to go through my PCM in ordering the tests, Tricare WILL approve the referrals. We can skip all the hassle with dealing with Medicare.

We had no idea we could do this! So, My husband is on the phone right now with referrals to connect them to my surgeon's office to get my diagnostic tests scheduled. I'll be calling my surgeon's office to let them know referrals from the DAFB medical clinic will be calling and to give them the Diagnostic Imaging Request form. That'll give referrals all the info they need to order the tests.

And as long as it's coming from my PCM, it will only go to Tricare to approve. And Tricare MUST approve anything and everything from my PCM.........

WHEW, so...that's what's been going on the past few days.

Come join me in Open Discussion!
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Watch your words, for they become actions.

Watch your actions, for they become habits.

Watch your habits, for they become character.

Watch your character, for it becomes your destiny."-

That's great, Jen. Glad everything is working out so well.

Thanks for sharing.

That's great Jen. I just did a 3 way with Kaiser,ChampVA, and Medicare. And it worked out in my favor too.

Squeaky wheel gets the grease....

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I've learned that the people you care most about in life are taken from you too soon and
all the less important ones just never go away.
And the real pains in the ass are permanent.

That's great ... and I know it's a load off your mind.  But, the most important news will be when you get word that you personally are in the clear.

 

That's fabulous.  It's sad that you need to bitch, moan and scream to get them to listen.  But, such is life in 21st century America and I couldn't be more happy for you.  Now, go get well. 

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"We are all equal, but we definitely are not the same"
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I wish they had cancer ombudsmen available as a national service for cancer patients like Jen.

As in: When a patient encounters such problems, she doesn't spend a minute worrying about it. Just sends it to the ombudsman to untangle and deliver good results.

The last thing a cancer patient needs is to expend energy or endure the stress of managing the convulated paperwork/insurance dance. It's sad enough they have the disease; sadder yet they endure the pain and anxiety; and absolutely ridiculous that they have to manage the delivery of their own, justifiable care!  

Now, you see, I'm the typical conservative frozen by ambiguity. Of course I would want an individual I "know" to receive this ombusdsman help. Like Jen. But a national program to help all cancer patients with the paperwork and other system failures?

Hell, no! What's that going to cost me? Why don't they or their friends and family take care of them? We always have.

*****
We'll be friends until we're old and senile. Then we'll be new friends.
-Anon.

Jen, I am so glad you got that settled.  I know the insurance issue weighs very heavily on you.  I just want you to get better.

 

~~life isn't about how to survive the storm but how to dance in the rain~~

Only dead fish go with the flow - Sarah Palin

As in: When a patient encounters such problems, she doesn't spend a minute worrying about it. Just sends it to the ombudsman to untangle and deliver good results

Excellent idea!

Jen, thanks for sharing the good news. Now, get well!! XOXO

I hope all your news is good news,Jen.

Glad to hear you got the insurance part settled.

I'm very happy to hear the problem is solved Jen. I'm sorry I assumed the doctors you were seeing were all military and that they knew who would be primary. Should have remembered what assuming do.

Good news to follow for you.....I'm feeling it! I've been getting good news the last couple of days from clients and I'm sure you will benefit from the good that is going around too!

Just finished up my paper work with the property tax board regarding my tax exemption on my property from the VA. So much paper work, so much time, and such a headache. Have to cross all the T's and dot all the i's, but that $171,992 exemption on my property tax is worth it.

A couple of days ago it was hassling with Kaiser to get me off of Medicare and back on to my ChampVA thru the Veterans Administration. got that done too.

Life is good...Except for the heat. It's between 106-108 today depending on where you're standing, so I'm staying in the house.

***********************************

I've learned that the people you care most about in life are taken from you too soon and
all the less important ones just never go away.
And the real pains in the ass are permanent.