TRICARE Managers Pledge Help for Confused Claimants
By Douglas J. Gillert
American Forces Press Service
WASHINGTON, June 18, 1998 Nancy Carter thought she was entitled to some benefits after her Army husband died while on leave in 1968. But nobody seemed able to help her.
"I was 23 years old and really had no idea what I was entitled to," said Carter from her home in Quincy, Ill. "I couldn't get any straight answers, so I just basically gave up."
Over the years, Carter suffered numerous health problems that cost her thousands of dollars. A couple of years ago, she learned through a newsletter published by Gold Star Wives, a military widows association, that she might, indeed, have been eligible all those years for health benefits.
Friends told her to contact the Office of CHAMPUS in Aurora, Colo., now the TRICARE Management Activity. Folks there asked her to submit a letter explaining her predicament. She also wrote to her congressman.
Going over some files recently, Air Force Chief Master Sgt. Kevin Brown saw Carter's letter. He immediately called and told her, "I can help." He did. After soliciting more facts from her, Brown called the Scott Air Force Base, Ill., personnel office and arranged for Carter to get a military dependent identification card. With the ID card, Carter can apply for CHAMPUS (now TRICARE Standard) reimbursement.
"Her eligibility will extend back to 1965, but under claims rules, we can become a second payer six years back," Brown said. "At least we can help her recover some of her costs."
Carter, who is now on extended sick leave from her job after a recent illness, said she's profoundly thankful for Brown's assistance. "Without him, I don't know what I would have done," she said. "He gave me some numbers to call and for the first time, I had someone I could talk to."
Cases like Carter's aren't unusual for the TRICARE Management Activity. Brown, who serves as the agency's senior enlisted adviser, often tackles them himself. He recalled handling the case of a retired general officer whose father had questions.
"The father didn't know his CHAMPUS insurance ended when he turned 65," Brown said. "Although he didn't get an answer he liked, at least we were able to clear up his confusion."
Brown and others in the TRICARE Management Activity, which just recently replaced the old CHAMPUS headquarters, are on a crusade of sorts. They want to make the often-confusing world of health care claims easy for claimants to understand. And they want to make sure people like Nancy Carter don't fall through the cracks and miss out on benefits they're entitled to.
One way they're clearing up confusion is through a management training course held monthly in Denver for health benefits advisers from military medical facilities. Another way is through visits by Brown to enlisted academies and regional military conferences where he explains in plain English how the program works.
"I take a no-nonsense approach, putting the complexities of health and dental care in laymen's terms," Brown said. "I don't normally use slides, but when I do, I can talk between the lines to get to the meat of the program."
Brown also regularly preps the top noncommissioned officers of the service branches before they present congressional testimony on quality of life issues. He's also building a DoD-wide network of senior enlisted men and women to help him make health benefits more understandable to service members and their families.
"If people aren't sure about their benefits or claims, they should contact their TRICARE Service Center or the health benefits adviser at their installation hospital or clinic," Brown said. "If they're still unsure of their rights, they also can call us. We'll give them straight answers they can understand and assist them in every way possible to settle claims and disputes."
For assistance with health benefits claims and other TRICARE health concerns, call (303) 676-3526. The activity's World Wide Web site address is http://www.ha.osd.mil/main/tmaorgpg.html.