16 September, 2010

Love/Hate Relationships

We all have them. We can have a love/hate relationship with just about anything, really. Cars, TVs, computers, the internet, any form of technology, doctors, working out, insurance companies, etc. Today, I got to fully experience my love/hate relationship with TriCare. What fun!

Yesterday, I received a bill in the mail from the doctor I saw about my knee in July. Before that, I got one of those lovely TriCare summary things. Both of them showed I owe about $70 for the visit. Now, I have two problems with this:

1. I'm on TriCare Prime. This should mean that I have ZERO copays/fees after a doctor visit.
2. Even if I were on TriCare Standard, the copay would have been about $20.

My reaction: What the h&$%?!?!?!

I attempted to contact them yesterday, but apparently they keep banker's hours. Whatever. So, I called them back first thing this morning. And, oh, you guys are going to just looooove this. 

I don't know if I mentioned this before, but the PCM that TriCare assigned me is a civilian. When I called to make the appointment with said PCM, the receptionist told me that he doesn't practice...that he's more like their office manager. Uhhh, ok.... So, I settled for seeing another physician in the same office. This is where the problem is. Now, when I talked to Ms. Sweet Lady with TriCare she said that I shouldn't have been charged because  - theoretically - they're in the same office and have the same tax ID number (used to bill TriCare/other insurances). But, the PCM they assigned me has TWO tax ID's. One he uses to bill insurance companies and then another one... The other one is the number that the doctor I actually saw used to bill TriCare.

So, the claims department argued with Ms. Sweet Lady and then she told me I'd have to file an appeal. She even asked me if I wanted to file an appeal!! Hahahaha! Are you kidding me?! Of course I want to file an appeal! I'm on TriCare freakin' Prime! The whole point of being on Prime is so that you don't have to pay anything out of pocket!!!! Once I got all the info I needed, I sat down and typed out an letter to the claims department. I copied all the info that they need and put that sucker in the mail. I said all the polite, "to whom it may concern" type crap, but what I really wanted to say was:

Dear TriCare Idiots,

Why can't you just be SMART and realize that the PCM you assigned me doesn't practice in that office? Why can't you notice that my PCM and the doctor I saw have the SAME ADDRESS? Why couldn't you just freakin' assign me a PCM that was ON POST, since that's kind of the whole point of having Prime. Why do you insist on causing me stress? Why can't you people just get your freaking act together?!

Oh, and I also changed my PCM to a doctor on post so that I don't have to deal with this BS every time I go to the doctor. Why they couldn't have just assigned me one on post in the first place, I have no idea. As a bonus, TriCare completely covered my almost $200 eye doctor bill. 'Cause it makes sense for that to happen after they say I owe $70 for a doctor visit. Yeah. I don't get it.

Thanks for listening to {er, reading} my rant. I feel much better now. =)


Canadianbloggergirl said...

Gotta love insurance companies right? Well I hope you win the appeal, you certainly should.

I've never lived in the USA and required a doctor, but this story sure makes me glad that I have Canadian Health Care. (honestly not trying to rub it in)

From what I hear your president is doing something for health care so everyone has it? Or am I wrong?

JG said...



I know other people this has happened to. Since they have a contract with Tricare, and you are on Tricare Prime, they are not allowed to bill you for anything. Anything they get has to come from Tricare - that's what the contract says - and if Tricare doesn't pay "enough", well, tough on them. Anyway, it's the doctor's fault and his office should be handling it, not making you deal with it.

Chelsea Pearl said...

this does sound very annoying. I hope that you win so no money has to come out of your pocket.
I have yet to have this happen to me with Tricare but we will see. It's a long time from now until the hubs retires from the Navy so problems are bound to come about.
Good luck with everything!
I love the letter you wanted to send to them lol Don't you just wish you could send it?

Mr. Superman & Mrs. S. said...

How aggravating!!!

Crazy Shenanigans said...

How annoying! I avoid the doctors office because of all the issues with insurance and then the run around about bills and such!

Kathryn said...

Tricare is so messed up, I havve had several problems with them as well. But one thing I will say, is you do not want to see the doctors on post. They are awful or at least here they are, but I hear they are pretty much everywhere. It took a year and a half and a lot of problems and no results from the idiot doctors on base before tricare would let me see a civilian doctor. Now I am really happy and actually getting the help I need. Hope everything works out for you.

Goodnight moon said...

Okay...this is what you DO...since you have TCP, you are absolutely right...you are not suppose to pay for anything. Your PCM are being jerks and are trying to get you to pay for it. Tell them that you are TCP so they HAVE to write off the difference that TCP doesn't pay them. You are NOT responsible for that difference. They just don't want to write it off. That is their problem, NOT YOURS!

I have had this issue before in the past too...and I've told them the same thing that I just told you, and they wrote the differenc off. Alot of dependants don't know to say that, and the office continues to send you bills and even threatens to send you to collections...but they can't do that!

Good luck!!!!!

And thanks for linking up for the Milspouse Weekly Roundup!