6 MDSS has tips to avoid TRICARE, debt collection issues
Are you aware that if you avoid medical bills, it could end up on your credit, affect purchasing a home or car, and could be an issue with your security clearance? The
TRICARE Service Center staff wants to make sure you know what to do to ensure this does not happen.
When your Primary Care Provider authorizes you to seek care at a civilian specialist, the network specialist will file the claim with TRICARE South Claims in Camden, South Carolina. The specialist will send you monthly statements advising you of the total charges. Pay close attention to the remarks on the statement to see if the specialist needs any additional information from you. Beneficiaries should allow four to six weeks for processing.
Once TRICARE South Claims has processed the claim you will receive a TRICARE Explanation of Benefits. This will explain how the claim was processed and what the provider was paid. Many times, there is a crossover from the time the check was issued and the statement cut-off date from the specialist. If you know you have received the Explanation of Benefits, and are still getting a bill, please contact that specialist and verify they have received payment. Do not wait until the bill becomes a problem before you try and resolve it!
Below are some frequently seen examples. You need to know what steps to take in the beginning, to avoid problems down the road.
An individual is taken by ambulance to a local hospital. Ambulances are not going to ask for insurance information at the time of transport. They will deal with the emergency, which is their priority. The patient will receive a bill from the ambulance company, and it will ask the patient to please provide your insurance information. The patient should call immediately upon receipt and provide the information. The patient should contact the provider to advise him/her of the visit the next business day and ask for any follow-up care as needed.
A patient is seen by an Emergency Room doctor on call. These doctors will bill the patient separately from the hospital. Although the patient provided this information to the hospital, the Emergency Room doesn't always get this information from the hospital. It is imperative for the patient to contact the emergency physician's billing company to provide them with the proper insurance information so they can file the claim. The patient should also contact his provider to advise him/her of the visit the next business day and for any follow-up care as needed.
A patient is assigned to the TRICARE South Region but on vacation in California when he suddenly becomes sick. He visits a local Urgent Care Center or hospital Emergency Room. Since this facility or location is in another region, they assume the claim will get filed to WPS in Madison, WI. The patient should advise them he is visiting from Florida, and the claim will need to be filed with TRICARE South Claims, P.O. Box 7031, Camden, SC, 29020-7031. If the patient can't do that at the moment, then he should let them know as soon possible. As always, the patient should contact the provider to advise him/her of the visit the next business day and for any follow-up care as needed.
If you can't resolve an issue yourself, contact PGBA at 800-403-3950 and see what the issue is. Lastly, patients should contact one of the qualified staff members at the TRICARE Service Center and seek their assistance on resolving the bill. It is harder to resolve these issues if the provider can prove they have sent statements or called. It is the patients' responsibility to ensure these are not ignored.
If you take the steps shown here, you should never have to worry about medical bills becoming an issue on your credit.