Insurance Problem - Tricare/Preauthorization Process
Community Greeter
Join Date: Aug 2011
Posts: 16,246
It is o.k. to ask......and, if anyone has experience, they will try to help....
Be patient.....and give enough time for enough people to see and read your thread.....
I don't have experience with what you ae taking about, or I would try to answer...lol.....
Be patient.....and give enough time for enough people to see and read your thread.....
I don't have experience with what you ae taking about, or I would try to answer...lol.....
Member
Thread Starter
Join Date: Aug 2014
Location: East Coast
Posts: 83
Thanks....here's the question/issue.
My son had an alcohol incident in the military. He was offered Intensive Outpatient option. It would not have prevented separation and he declined IOP. It would have been covered by Tricare.
A week after he separated he decided to go to inpatient rehab. He contacted the same facility. He told them he was separated and asked for the inpatient option. He told them he was covered by Tricare and UHC. He was admitted four days later.
Eleven days into treatment (at the end of the work day) he's told he is not covered by Tricare (for preexisting conditions). Despite having an out of network option with UHC he's told that is not an option either.
The following morning I contact the business office (as directed by a liaison). The manager pulls up the file and informs me that indeed they had not contacted Tricare between Nov 2016 and his admission date and that b/c they had not taken care of this properly, there was no liability for the first 11 days (8K). He tells me he will look into options for ensuring he can stay there including a discount b/c we are out of network.
The following day, everyone in the billing office seems to NOT communicate. My son is pulled in the next day (again at the END of the day) and told there is no Tricare and no secondary insurance option. (Again, I call UHC and am told that is NOT the case, in fact NO ONE from the facility has called.) At that point he calls his dad and he comes home.
My question is how to proceed. Is there a BBB who can arbitrate this? The billing office wont speak to me and I have more information than my son does. The facility in general seems to be circling the wagons to protect themselves, their processes, and to ensure they get their 8K.
He got to the point where he was willing to admit a problem. We were all happy with the clinical care. I do not understand why he was even admitted. He would have NEVER chosen this facility if he knew it was going to result in a bill AND the inability to complete the rehab.
Ideas are welcome.
qwer1234
P.s. So far, he seems to be staying on the recovery path. He's living with his dad who is sober 8 years. Making it to his meeting every day and establishing some friends his own age. One day at a time.
My son had an alcohol incident in the military. He was offered Intensive Outpatient option. It would not have prevented separation and he declined IOP. It would have been covered by Tricare.
A week after he separated he decided to go to inpatient rehab. He contacted the same facility. He told them he was separated and asked for the inpatient option. He told them he was covered by Tricare and UHC. He was admitted four days later.
Eleven days into treatment (at the end of the work day) he's told he is not covered by Tricare (for preexisting conditions). Despite having an out of network option with UHC he's told that is not an option either.
The following morning I contact the business office (as directed by a liaison). The manager pulls up the file and informs me that indeed they had not contacted Tricare between Nov 2016 and his admission date and that b/c they had not taken care of this properly, there was no liability for the first 11 days (8K). He tells me he will look into options for ensuring he can stay there including a discount b/c we are out of network.
The following day, everyone in the billing office seems to NOT communicate. My son is pulled in the next day (again at the END of the day) and told there is no Tricare and no secondary insurance option. (Again, I call UHC and am told that is NOT the case, in fact NO ONE from the facility has called.) At that point he calls his dad and he comes home.
My question is how to proceed. Is there a BBB who can arbitrate this? The billing office wont speak to me and I have more information than my son does. The facility in general seems to be circling the wagons to protect themselves, their processes, and to ensure they get their 8K.
He got to the point where he was willing to admit a problem. We were all happy with the clinical care. I do not understand why he was even admitted. He would have NEVER chosen this facility if he knew it was going to result in a bill AND the inability to complete the rehab.
Ideas are welcome.
qwer1234
P.s. So far, he seems to be staying on the recovery path. He's living with his dad who is sober 8 years. Making it to his meeting every day and establishing some friends his own age. One day at a time.
Member
Thread Starter
Join Date: Aug 2014
Location: East Coast
Posts: 83
Originally Posted by velma929 
Are you in the US? have you contacted your local state representative? Your state likely regulates insurance companies. Some one may be able to rattle a cage in the state capital.
My other thought was a complaint to BBB or Tricare. This facility is in network for Tricare and sees a LOT of patients that way.
Member
Join Date: Jul 2004
Location: Starting over all over again
Posts: 4,426
Originally Posted by qwer1234
Is it ok to ask questions about this topic here?...
Getting insurance to pay for treatment is definetly a big challenge in many countries. Such questions are completely apropriate.
Mike
Moderator, SR
Community Greeter
Join Date: Aug 2011
Posts: 16,246
qwer....your local member of the House of Representatives. they usually have a staff that works on such matters, for constituents....at least, they can steer you in the right direction.....
You can go to the website for your local government and find the right office and phone number......
You can go to the website for your local government and find the right office and phone number......
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