The errors, Chelle McIntyre-Brewer said, are caused by Tricare East contractor Humana and a series of problems in its system, combined with denials of coverage for what McIntyre-Brewer says are medically necessary, lifesaving procedures for their daughter Lorelei, 13.
'I can't even get over the apathy that Humana has," she said. "You take a look at it and say, 'You're not doing your job,' and they just don't understand that."
Lorelei was born in 2005 with a host of health problems, the most serious of which is hypoplastic left heart syndrome (HLHS), a birth defect that causes half of her heart to not work correctly. She has had multiple open and closed heart surgeries, said McIntyre-Brewer.
The family lives apart so Lorelei can receive care through Tricare Select at the Children's Hospital of Philadelphia and use the state's Medicaid program. Although most other insurance coverage pays before Tricare, Medicaid by law is paired as secondary coverage and can provide Lorelei with additional medical services.
Army Maj. Steven Brewer is stationed in Maryland.
The problems with coverage started when Humana took over the contract in what had previously been Tricare's North region, McIntyre-Brewer said.
First, Lorelei had a medical emergency after a separate emergency surgery to put a pacemaker in her heart. Her doctors wanted to give her a series of echocardiograms. When Humana denied authorization, saying the tests weren't necessary, McIntyre-Brewer decided to fight.
At about the same time, Humana began denying the family's claims. Lorelei, it said, showed in the system as having health insurance other than Tricare, which should be paying first, according to documents provided to Military.com by McIntyre-Brewer. She was told by representatives that the system showed the coverage started in 1988, more than 17 years before Lorelei was born.
Now, the family is sitting on a $65,000 medical loan, with several other medical bills already sent to collections. A Facebook post McIntyre-Brewer wrote about the battle has been shared almost 3,000 times.
McIntyre-Brewer asked Pennsylvania Sen. Bob Casey's constituent services office for help. Humana sent officials in that office a list of claims it said had been resolved, even while sending McIntyre-Brewer letters listing the same claims as outstanding.
"The Brewers will be pleased to note, Lorelei's record has been updated and the claim is being reprocessed," said one such letter, sent May 21.
A letter sent to the McIntyre-Brewers on July 12 lists those same claims and others as under investigation.
Officials with Humana told Military.com on July 23 that they're working to fix the problem quickly by working with the family and the provider and adding new steps to its claims processing.
"We are working with the providers caring for our beneficiary and our claims-processing partner to resolve this issue as quickly as possible," Robert Bertrand, a Humana spokesman, said in a statement. "We are also in communication with the beneficiary now and will keep them informed of our work to correct this issue."
McIntyre-Brewer said her husband received an email from Neil Mullaney, who heads Humana's government section, which includes Tricare, about 90 minutes after the statement was sent to Military.com.
Military leadership as a whole and her husband's command have been nothing but supportive, McIntyre-Brewer said. Now she just wants Humana to process the claims. As a professional medical advocate who works with international organizations and wounded warriors, she's used to walking through complicated cases. But this one, she said, should be cut and dry.
"Our family has been stretched to the max," McIntyre-Brewer said. "The least Humana can do is take care of my daughter."
-- Amy Bushatz can be reached at email@example.com.