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TRICARE bills 101

PETERSON AIR FORCE BASE, Colo. -- You just returned from a long anticipated and much needed Hawaiian vacation, and except for a visit to an emergency room, you and your family had a great vacation. Upon your return, you receive a bill and a threatening letter from the medical facility in Hawaii, for the medical services rendered. What do you do?

Don't panic! Understand that your TRICARE Prime coverage offers health care benefits when you are traveling away from home. You can travel to another state or overseas locations, knowing you will be covered if you are injured or become ill during your travels. Be proactive and make sure your information in the Defense Enrollment Eligibility Reporting System is current and accurate prior to departure.

In most cases, you will not need to file claims for health care services. Your healthcare provider will typically file the claim with TRICARE on your behalf. There may be times, however, when you will need to pay for care at the time of service and subsequently file a claim for reimbursement. You will be reimbursed for TRICARE-covered services at the TRICARE-allowable charge, less any co-payments, cost-share or deductibles.

If you need to file a claim for reimbursement, complete a TRICARE DOD/CHAMPUS Medical Claim-Patient's Request for Medical Payment (DD Form 2642). Forms can be downloaded from the TRICARE website at www.tricare.mil/claims. You'll send the claim with copies of your out-of-pocket receipts to the appropriate mailing address for the region you're assigned.

If you do receive a bill, you can call your regional contractor's toll-free number and select the option for claims assistance, or visit a local TRICARE Service Center at either Evans Community Hospital, U.S. Air Force Academy Hospital or the Peterson AFB Clinic. Local TSCs are open 7:30 a.m.-4:30 p.m. Monday through Friday.

If you ever need to appeal a claim, you may appeal the denial of a requested authorization of services, a TRICARE decision of a requested authorization of services, as well as TRICARE decisions regarding the payment of claims. Submit appeals to your regional contractor. For information on submitting pharmacy claim appeals, refer to the Express Scripts, Inc. website at www.expressscripts.com for details.

If an unresolved debt results in a collection action, you can contact the local beneficiary counselor and assistance coordinator/debt collection assistance officer at your local TSC. The counselor for Peterson AFB can be reached at 556-1016.

Peterson SFB Schriever SFBCheyenne Mountain SFSThule AB New Boston SFS Kaena Point SFS Maui