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Phone Call Can Resolve TRICARE Billing Issues

By Gerry J. Gilmore
American Forces Press Service

WASHINGTON, Aug. 17, 2000 – TRICARE beneficiaries are now just a phone call away from accessing help to resolve creditors' concerns over late or unpaid medical care bills.

While service members, retirees and family members consider the TRICARE health care system a valued benefit, they don't like threatening calls and letters from collection agencies harassing them over unpaid medical bills.

"These problems tend to occur when physicians are impatient for payment, as they have a right to be. (However,) the burden of dealing with this system, of any system, should not fall on the individual (service member)," said Bernard D. Rostker, undersecretary of defense for personnel and readiness, in a recent interview with the American Forces Information Service.

Service members and other TRICARE beneficiaries raised the bill-collector issue at the Military Family Forum May 31 at the Pentagon, Rostker said. He responded June 27 with a memorandum directing the services' health affairs organizations to establish the Debt Collection Assistance Officer program within 30 days.

Implemented July 26, this new program formally established DCAOs as local points of contact that service members and other eligible TRICARE beneficiaries, stateside and overseas, may use to resolve medical bill payment issues.

The new DCAO system, Rostker said, creates a formal method for beneficiaries "to gain help in dealing with what admittedly is, as is every health maintenance organization, a bureaucratic process."

He said there could be resolutions where beneficiaries owe money, "in which case we're prepared to work with him or her to find out how we can be most helpful in resolving that issue." He also noted "situations where the bill is misplaced ... we can work with the doctor or credit organization to resolve that."

The main thing, Rostker said, "is we don't want our people to feel they've been isolated. This is a part of the system and we want to be able to help them if and when this kind of situation occurs."

He said he has received varying feedback regarding the prevalence of conflicts involving TRICARE bill payment. "I've asked some people, and one of the services (said) they thought this happens a couple of hundred times a year, and other people think it occurs a couple of hundred times a month."

"We will know better how often this occurs by how people use this service," he said.

Before the DCAO program was implemented, DoD resolved dunning letters and bad credit reports involving TRICARE payments on an ad hoc basis, Rostker said. Besides this method not working very well, it left no central registry to track the resolution of late or unpaid TRICARE payments, he said.

"Now, it will come to our attention because we've taken on the responsibility of being the agent for our service members in trying to resolve these situations," he said.

TRICARE beneficiaries who've received dunning letters or bad credit reports can now just phone the designated debt collection assistance officer, who will coordinate a review/research process.

DCAO Program Manager Marcia Bonifas said the beneficiary provides the assistance officer with documentation -- collection agency letters, bills and contractors' explanations of medical benefits. The DCAO in turn sends the information to the contractor's bill processing or collections unit, she said.

"The debt collection assistance officer will ask the collection agency to hold up further work until the research is done, and that will be done in less than 30 days," Bonifas said. "We cannot force them to hold up, but we can ask for their cooperation."

Bonifas said the DCAO receives the completed research information and then notifies the beneficiary in writing.

Contractors will research claims less than six years old, Bonifas said, but they won't have any documentation for claims older than that. These older claims will be researched by a special TRICARE Management Activity claims evaluation office in Aurora, Colo., she said.

Although DCAOs can help beneficiaries to research and resolve TRICARE payment problems and related credit reports, they cannot provide legal advice or repair bad credit ratings, she said.

TRICARE beneficiaries can click a hyperlink button on the DCAO information Web site, http://www.tricare.osd.mil/dcao/, to identify their local assistance officers, stateside and overseas, Bonifas said. In a month or two, active-duty service members will see the phone number for their local DCAO on their leave and earnings statements, she added.

In addition, beneficiary counseling and assistance coordinators at all military hospitals and clinics and at TRICARE lead agent offices can provide assistance for all other TRICARE issues, such as claims, explanation of benefits and enrollment procedures, Bonifas said. BCACs are listed on the Web at http://www.tricare.osd.mil/. Rostker called the DCAO program a timely response to important service member concerns.

"We believe the program is in place, we have training manuals, people in place (who are) responsible by name, Rostker said. "We're looking forward to gaining feedback from our service members, their beneficiaries and families to make sure this program is the help we designed it to be."

For more information about TRICARE, visit the Military Health System/TRICARE Web site at http://www.tricare.osd.mil.

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