OK, I am backasswards when it comes to HIPPA and Tricare and med collections so help.

[brazen]

Was billed for a service from the hospital Tricare denied the claim.

Hospital continues to bill me for it, and it now has been sent to a collection agency, what do I do?

[DragonFlyer]

First, get a copy of the EOB from Tricare to determine the reason for the denied claim. I have gotten a garden variety of "reasons", all of which were wrong and could be appealed. You can go to www.mytricare.com to get copies after registering your account. Don't get the information on the phone...you need proof. You can call to ask for a copy, but don't call just to find the reason without requesting a hard copy of that EOB!

 

Opt out and get all old addresses deleted.

 

Follow these steps exactly as they are given on WhyChat's site....

 

Make sure you dispute with the CRA's using WhyChat's pre-hippa letter if it is reporting. http://whychat.5u.com/hipaadisp.html

 

Dispute with the CA using this: http://whychat.5u.com/ltrcavalhipaa.html

 

Once you know and have evidence of the reason for the denial, you can dispute with Tricare and ask them to reprocess the claim. I need to know the reason for the denial to give the next steps.

 

Come back here and let me/us know the outcome of the above steps. Then we can go from there.

[jackgehr]

brazen,

 

In the past I've been able to negotiate with Tricare for prescriptions that at first try were denied. The denial can be fixed, what does it say on your explanation of benefits? In my case I had to get a letter from my Dr. that explained why I needed the meds, I sent that in and in about 6 weeks I received a reimbursement check. Haven't had a problem since then. This can be fixed.

 

Good Luck

[DragonFlyer]

Yes, jack is correct....the fact that Tricare is notorious for denying claims when a simple appeal can reverse it...I consider it a delay/stall tactic on their part. Like I said, they have a garden variety of reasons to deny claims.

 

The important part of my advice is to get that EOB and get proof of the denial, and for what reason. Once I know the exact reason, I have ammo and steps to take to get it fixed.

 

I've had stuff that were clerical errors, like the hospital entering the wrong tax ID in a box, or delays like Tricare requiring a third-party verification form (which they don't send you automatically) for the most stupid reasons. >:/

 

And for whatever reason they give...I have a response to each. LOL

 

But, it's also very important while you gather that info from your EOB that you go through the proper dispute process using WhyChat's HIPPA process. It has to be done at the same time you are dealing with Tricare.