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October 7, 2004
[Have an opinion about the issues discussed in this article?
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By Fred Zimmerman,
Stars and Stripes European Edition
CAMP FOSTER, Okinawa — To ensure beneficiaries are getting all
they’re entitled to, Tricare is spreading the word about the proper
way to file a claim when treatment is received outside the military
medical realm.
The first step to receiving any care outside a military treatment
facility for Tricare patients is getting a referral from the primary
care manager, according to Arlita McClintock, former Tricare
marketing representative.
If care is received without a referral, the Tricare point-of-service
option will apply, meaning it will cost the patient.
The rules apply mostly to nonemergency care; Tricare generally
will cover emergency care with or without a referral.
Only those enrolled in Tricare Prime — Tricare Extra and Standard
patients aren’t covered — are able to seek non- emergency services
without referrals under the POS option, according to Brandie Morse,
Tricare enrollment specialist at U.S. Naval Hospital Okinawa. She
said there is an annual deductible of $300 for an individual and
$600 for a family under the POS option.
Once the deductible is met, the patient’s cost will be 50 percent
of the Tricare allowable charge plus any additional charges from
non-network providers.
McClintock said that once a referral is obtained, patients should
visit their military facility’s health benefits adviser to receive
all the required documents: DD Forms 2161, Referral for Civilian
Medical Care; 2642, Tricare Claims Form; and as needed, 2527, Statement
of Personal Injury.
Once care is received, the health benefits adviser can help the
beneficiary file the claim and can explain the entire process from
start to finish, Morse said.
If the adviser receives the bill or receipt, he or she will file
the claim for the patient to Wisconsin Physician Services, the subcontractor
that files all claims for Tricare’s Western Pacific Region. If the
patient receives the paperwork, he or she can take it to the adviser,
who will help file the claim.
Morse said that if a patient is referred to an approved Tricare
doctor, the doctor’s office usually will file the claim for him
or her, unless the office specifies that it can’t.
If care is received without a referral, McClintock said, the patient
must file the claim, which must include DD Form
2642 and an itemized bill with the patient’s name, hospital name,
address, phone number, date of service and description of each service.
Once the process is complete, McClintock said, Tricare will mail
the beneficiary an explanation of benefits and/or a check for reimbursement.
She said if the beneficiary wants to be paid in U.S. currency,
he or she must note that on the claim before it’s filed; otherwise,
the reimbursement will be paid in local currency.
For more information on filing a claim, visit your local Tricare
service center or your medical facility’s health benefits adviser.
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©2004 Stars & Stripes. All opinions
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