By Katherine Rosario, Lyster Army Health Clinic Public AffairsJuly 11, 2013
FORT RUCKER, Ala. (July 11, 2013) -- Patients who have medical bills in debt collection are encouraged to bring their statements as well as all supporting documents to the Lyster Army Health Clinic Managed Care Division for further assistance.
Medical bills can be generated when claims information is incorrect, a patient is seen by a network provider prior to receiving authorization, a referral has expired or the number of referral visits has been exceeded.
Only authorized care will be paid by TRICARE. If a patient sees a specialist without a TRICARE referral, the referral is expired, or they have used their maximum number of visits, the patient is responsible for the bill.
"It is important to make sure you see your referred doctor before the referral expires," said Tyrrell Brown, chief, managed care operations for the managed care division. "Often, patients receive a referral for off-post care and make the appointment weeks later without remembering to look at the expiration date printed on the referral letter."
Soldiers, who convert from active duty to retired status but still need to see a network provider, will need to obtain a new referral under their current status.
"Patients may obtain a referral after speaking with their primary care manager, who will send the request to the referral management office for authorization," Brown said, adding that authorizations are sent in the mail to patients between seven to 10 business days after seeing their PCM.
After patients receive their authorization letter of care they may schedule their appointment with the provider identified in the letter. If they prefer to see another provider they can call the toll-free number on the letter to speak with a TRICARE representative to request to switch providers or locations to another network provider or facility.
"For more convenience, the referral management assistance line can be reached by calling Lyster's main phone number and selecting option three," Brown said. "The referral management staff will be happy to assist the patient in booking their network referral appointments."
TRICARE will not pay for retro-referrals, which are referrals put in after the patient has already been seen by a network provider without pre-approved authorization.
"A way patients can avoid the problem of medical bill debt collection is to bring their medical statement to the TRICARE Service Center so they can take a look at it before it goes to collections," Brown said. "It could be a minor problem that can easily be taken care of."
For more information, call 255-7731 or 255-7472.