Tricare Help: Simple letter should prevent name confusion - Getting out, military health issues - Navy Times

Tricare Help: Simple letter should prevent name confusion

Q. I work in the airline industry and need to enroll in my employer’s insurance soon. I have Tricare Standard as my secondary insurance — my husband is deceased. However, the Tricare coverage is under my married name, and everything with my employer is under my maiden name. Will this cause a problem when I try to file a claim with Tricare as my secondary insurance?

A. Your problem is a simple administrative issue requiring an explanatory letter. Write to your Tricare claims processing office — the same place where you submit Tricare claims — and explain the situation. Send the letter to the claims processor now, and send another copy with the first claim you submit to Tricare as second payer.

If it doesn’t take, you will know after you submit your first claim to Tricare as second payer.

If Tricare writes back asking for more information, no appeal is needed. Just reply immediately, explaining everything again, and include a copy of the letter Tricare sent you so they know what you’re talking about.

If Tricare denies the claim, it isn’t a disaster; just file an appeal. It must be in writing and state the specific matter in dispute: For example, “Tricare denied claim number X because I used two different names on the claims. I have attached an explanatory letter.” Attach a copy of the explanatory letter with the appeal letter. Include a copy of Tricare’s explanation of benefits showing the claim denial.

Send the appeal letter, the explanatory letter, and Tricare’s EOB showing the denial to the address of the Tricare office that denied the claim (It’s on the Tricare EOB). Be sure to answer all questions Tricare asks. That should resolve the name problem.

Q. As a gray-area reserve retiree, can I buy into Tricare Standard or Tricare Prime? If so, can I cover both my wife and myself?

A. Tricare eligibility is established by federal law; you can’t buy into it as you would a commercial insurance plan. You haven’t given me enough details for me to tell you whether you’re eligible, but you can get an official answer from the Defense Enrollment Eligibility Reporting System support office at 800-538-9552.

Keep in mind that DEERS cannot create eligibility where none exists. Only the military services can determine eligibility.

If you are not eligible, there is a commercial health insurance plan — the Continued Health Care Benefit Program — created with the cooperation of the Defense Department to provide coverage similar to that of Tricare Standard.

Coverage can be purchased in short-term blocks. It was designed to meet the short-term needs of people who have recently lost Tricare eligibility. Find out more online at www.tricare.mil/chcbp.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In email, include the word “Tricare” in the subject line and do not attach files.