RAO Davao City

United States Military Retiree Activities Office Davao City, Philippines

TFL HOSPITAL COVERAGE – May 1 2008

Posted by Service Officer on April 30th, 2008

The retired enlisted Association (TREA) has learned that some hospitals are playing games with Medicare and as a result, some Tricare users are ending up owing hospitals large amounts of money. The rule that if medical care providers accept Medicare they must accept Tricare apparently is not always applicable. It turns out that the hospitals still accept Tricare, and they still accept Medicare payments if the patient has previously been treated in that hospital. However, they are not accepting any new Medicare patients. Thus, if the Tricare insured has not previously been a patient at that hospital, the patient ends up having to pay the Medicare portion of the bill out of pocket. The Medicare portion for TFL beneficiaries is normally 80% but under these conditions payment under Tricare Standard should apply the same as it does for overseas users. They pay 25 % of the bill in addition to the $150 deductible since Medicare provides no coverage outside the USA. Although this seems very unfair and is really “playing games” with Medicare and with patients, it is legal. Accordingly, Medicare eligibles need to make sure anytime they are having scheduled hospitalization that the hospital will take both Tricare and Medicare if they are a new patient in that hospital. If not, verify with your Tricare regional office if Tricare Standard rules will apply. Also, it might be prudent to check with your local hospital what their policy is in the event you will have to use them for emergency treatment in the future. [Source: TREA Washington Update 18 Apr 08 ++]

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