Tricare rejected provider claim

[Elderdude]

My mother-in-law received a bill from a lab for services provided to her skin cancer doctor. The lab stated that Tricare rejected the claim for insufficient data. MIL is a military widow approaching her 90's who has not had many complaints about Tricare before, (and, in my opinion, MIL's a hypochondriacal dingbat who makes plenty use this service.) My wife has seen the letter and I advised her to take it to the doctor who submitted the lab request and see if it was a clerical oversight either on the doctor's or the lab's submission.

Any retired military who have a comment about this?

 

[Nords]

Any retired military who have a comment about this?

I don't have any solutions beyond what you're already doing, but two suggestions:

The lab might have made a formatting/code error on their claim, and they have their own set of Tricare phone numbers to call for solutions.

If your MIL is near a military clinic, they have a "Tricare ombudsman" on staff who can talk her through her options for letting the doctor handle it, calling Tricare, and so on.

 

[braumeister]

I had a claim from a visit to my primary care physician rejected by Tricare last year.
I emailed Tricare from their website and asked about it. They replied within 24 hours, explaining that the doctor's office used the wrong code. They told me what the right code should be, and I informed the doctor's office.

Problem solved.

 

[Texas Proud]

Don't know if you can call... we had a dental claim rejected (obviously not this insurance) and after calling I found that the doc did not put down the birth date....


I kind of yelled at the girl on the phone... don't you have all the other info showing he (step son) is on the account Yes... then who CARES about a birthdate

Talked to the dentist office, they resubmitted with birthdate and it went through...

 

[M Paquette]

Don't know if you can call... we had a dental claim rejected (obviously not this insurance) and after calling I found that the doc did not put down the birth date....

I kind of yelled at the girl on the phone... don't you have all the other info showing he (step son) is on the account Yes... then who CARES about a birthdate

Once you realize that the claims processor's real job title is 'Loss Mitigation Processor', and what you call claims are what the processor calls losses, you'll understand why. The claim was probably initially rejected by machine, and it could be that the girl you talked to was the first human to look at the claim.

(Aeons ago, I did some on-site visits to look at machine vision problems, and one was to a claims processing back office. Sort of mind-numbing, and not in a good way.)

 

[Elderdude]

Thanks for your contributions everyone. Mother-in-law's lab work claim rejection by Tricare is no longer an issue. As we all suspected it was a clerical error. The dingbat is now happily schedualing her regular 30 or 40 doctor's appointments for the next two weeks.

 

[haha]

The dingbat is now happily schedualing her regular 30 or 40 doctor's appointments for the next two weeks.

She has discovered what to do all day.