Aug 16 2013
Effective October 1, 2013 Tricare will only reimburse VA 20% of the allowable charge vice the past practice of paying 80% for non-service connected care received in the VA for Tricare for Life (TFL) beneficiaries rated at less than 50% disabled. While this is not a new law, it has not been enforced.
The rationale that supports this change follows:
- Although VA Facilities are Tricare-authorized, they are not Medicare-certified.
- Medicare, by statute, cannot reimburse for care provided by a Government facility.
- Simply put, the VA can’t bill Medicare and Medicare can’t reimburse the VA for care.
- Since the VA can’t be Medicare-certified, it presents as an opt-out Medicare provider.
- Therefore, Tricare reimburses the VA what it would have paid if Medicare had been primary – which is 20% leaving you with a bill for the remaining 80%.
- For less than 50% VA rated, use your TFL benefit in the community for non-service connected TFL care to prevent being billed for 80% of the allowable charge.
The Tricare News Release of August 14, 2013 states:
As part of the intake process at VA facilities after October 1, 2013, TFL beneficiaries will be asked if they’re using their VA or TFL benefit or if they have other health insurance (OHI). When electing to use their TFL benefit at the VA, they will also be informed they must pay the remained bill after Tricare pays its portion of the Tricare-allowable charge. They may be asked to sign a form indicating they understand their responsibility……. Call the TFL support contractor Wisconsin Physicians Service (WPS) 866-773-0404 or visit www.tricare.mil/tfl for more information.
32 Responses to “BEWARE – Non Service Connected VA/TFL Healthcare Users”