Donald R. Green, a 79-year-old retired Navy chief in Bremerton, Washington, says TriCare for Life (TFL) is saving him and his wife a combined $250 a month in health insurance premiums.
Rosie McVeigh of Long Beach, Mississippi, the widow of a retired Air Force master sergeant, figures she now saves $1,300 a year on Medicare supplemental premiums, which for her is a "big chunk of money."
And just like her former Blue Cross/Blue Shield supplement, premium-free TFL is picking up whatever healthcare costs Medicare won't pay, McVeigh says. Not only is she satisfied but her doctors are as well.
"When I told them I am now on TriCare for Life, no one had a problem. They just made a copy of my military ID," said McVeigh. Except for claims being processed "weeks slower" than she experienced with Blue Cross/Blue Shield, McVeigh said she could not be more pleased.
TriCare officials say the positive experiences of Green and McVeigh are representative of the TFL program since it was launched in October 2001. But the launch also had plenty of flaws, caused by computer programming and benefit-- eligibility problems, which have frustrated many TFL users.
By February, however, those problems had been identified, discussed with the press and beneficiary representatives, and were being corrected.
In late January, TFL was bouncing three of every ten claims filed on behalf of elderly beneficiaries. Two weeks later, more than 200,000 previously denied claims had been reprocessed for payment, dropping the claims-- denial rate of 30% down to 23%, said Thomas Carrato, executive director of the TriCare Management Activity.
"We had hoped [the start] would be a flawless execution but it has not been," said Carrato. Still, he said, computer glitches were being corrected, many elderly were having their "other health insurance" obstacle removed with a phone call, and most users were finding TFL to be "an absolutely wonderful benefit." Carrato, a retired rear admiral who had been TriCare's operations chief through part of the Clinton administration, said TFL has made a huge difference in the medical system's relationship with elderly beneficiaries.
"It's night and day," he said. Before TFL, seniors faced limited space-available care at military treatment facilities and select access to a TriCare Senior Prime demonstration. Otherwise, they were on their own.
By March, however, Medicare healthcare providers across the country had filed more than eight million claims from TFL users. Medicare routinely pays its share and then passes on the unpaid balance to TFL claim processors.
But three major problems were to blame for more than two million TFL claims being denied between last October and March. First came a names glitch discovered last fall. The Defense Manpower Data Center had left 195,000 TFL beneficiaries, 13% of all eligible, off the list of qualified beneficiaries sent to Medicare. The oversight was corrected by December, but the forgotten beneficiaries had to refile claims with TFL to ensure their doctors got paid.
The second problem centered on other health insurance. By law, other health insurance must be billed as second payer to Medicare before TFL. But only 60% of survey forms were returned, and half of those failed to indicate if the beneficiary would be dropping their Medigap coverage. By February, more than a million TFL claims had been denied because Medicare or TFL records showed patients still had other health insurance. To ease the backlog, TFL claim processors began accepting the word of beneficiaries over the phone on whether they had dropped their old insurance. The problem will self-- correct over time as TFL builds an "other health insurance" data file, said Carrato.
The third problem was expired identification cards. Through January, more than 160,000 TFL claims from 65,000 dependents and survivors had been denied because the Defense Enrollment Eligibility Reporting System showed they lacked current IDs. When the magnitude of the problem became known in February, TriCare officials took the unusual step of automatically reprocessing and paying all claims denied previously for expired IDs. The process for correcting the problem, said Carrato, can start with a call to TFL, at (888) DOD-LIFE (363-5433).
Despite start-up problems, said Dr. William Winkenwerder Jr., the new Assistant Secretary of Defense for Health Affairs, TFL is "the best benefit for seniors in this country." He and Carrato traveled together to stateside bases. The feedback from beneficiaries at each stop was that TFL was working "very well," said Winkenwerder. Combined with the mail-order TriCare Senior Pharmacy Plan begun last April, TFL is sharply lowering out-of-pocket medical costs for service elderly, he said.