If you have Tricare, did you know......

Guest · Post by **Guest** » Tue Sep 26, 2006 1:33 pm

I have Tricare Standard. This is what I was told today.

I was told Tricare will buy our machines after they rent them for a period of time to see if we still need them, or maybe just to see if we will use them.

I called several people at Tricare today, they said Tricare will buy the machines. They all said they will send us a bill for our copay.

If your machine breaks under warranty, no one knows how that is handled. I have a spare, as do many of us, but I don't know if Tricare will pay for a rental, and none of the insurance people seemed to know. Since it is a medical issue, I would hope they would cover a rental.

If your machine breaks after it is out of warranty, the whole cycle starts all over again. New machine.....you pay your copay to buy it and so on.

Does this sound anything like what you have been told about renting versus buying?

One question they could not answer, and I am still searching, is if you buy it after it has been rented six months...is your copay any less? If you buy it the first month, your copay might be $500, I don't know, but using that number...would your copay be $400 after renting for 3 months? And maybe your copay would be $200 after renting for 6 months?

My bacterial filters we talked about...Tricare and Apria now have me set up on a monthly filter, unless I need to change more often. they will pay for it.
Again, it is a medical issue for me. My autoimmune system has been lowered on purpose, so I can breathe ambient air at least part of the time.
I am now on oxygen more than I want to be, but they can't seem to keep me osygenated. I go up to 98% and if I don't keep using oxygen, I will be back in the high 80s within 2-3 hours. Anyone else have this problem??

dllfo · Post by **dllfo** » Tue Sep 26, 2006 1:43 pm

Rats..thought I was logged in...that was me......dllfo

Sorry about that...can I go back and change the author of a post???

OwlCreekObserver · Post by **OwlCreekObserver** » Tue Sep 26, 2006 3:28 pm

dllfo, I'm Tricare Prime and I was told that my category doesn't get a purchased machine and that they will rent them forever. That makes no sense to me so I just left them an inquiry at their website to verify that.

By the way, I was also told that I have to have a prescription to get a replacement mask, regardless of how long I've had the one I've got. I asked them again today about that as well. A script for a non-script item?? Sheesh!

Anyway, at least I'll have something in writing from them. I'll have to say that they've been really good in the past about getting back to me on my inquiries.

OCO

Arkanoid · Post by **Arkanoid** » Tue Sep 26, 2006 3:40 pm

I'm Tricare Prime also, and when I asked a few weeks ago, the person I talked to looked it up (or claimed to, it did take a while) and came back and said I didn't need anything to get a replacement mask. Needless to say I haven't tried it though. I know when I wanted a full face mask after I had started, they told me to get a letter of medical necessity that my Primary Care Dr gave me with no trouble (just in case). As of 1 April, they said we don't even need pre-approval for CPAP machine, but we are still supposed to get it from a "Authorized DME provider"

OwlCreekObserver · Post by **OwlCreekObserver** » Tue Sep 26, 2006 3:51 pm

Arkanoid wrote:I'm Tricare Prime also, and when I asked a few weeks ago, the person I talked to looked it up (or claimed to, it did take a while) and came back and said I didn't need anything to get a replacement mask. Needless to say I haven't tried it though. I know when I wanted a full face mask after I had started, they told me to get a letter of medical necessity that my Primary Care Dr gave me with no trouble (just in case). As of 1 April, they said we don't even need pre-approval for CPAP machine, but we are still supposed to get it from a "Authorized DME provider"

Good grief!

I take back all the nice things I said earlier about them.

I'll post again here when I receive their reply to my inquiry this afternoon. Doesn't seem to me like this is rocket science. All they need to do is make a rule and then make sure that all the customer service people get the memo.

OCO

SelfSeeker · Post by **SelfSeeker** » Tue Sep 26, 2006 4:35 pm

I do not have Tricare.

My insurance is good about letting me get a machine on line at the same coverage as a DME etc.

But when it comes to masksm as I found out today when I called them, I will also need a prescrition for each replacement. Even if it has been a year. There is no standard replacement policy. Wonderful.

I thought that in the USA, masks are replaced every 6 months, anything that goes in the nose every 3 months. As some kind of medical thing.

OwlCreekObserver wrote:dllfo, I'm Tricare Prime and I was told that my category doesn't get a purchased machine and that they will rent them forever. That makes no sense to me so I just left them an inquiry at their website to verify that.

By the way, I was also told that I have to have a prescription to get a replacement mask, regardless of how long I've had the one I've got. I asked them again today about that as well. A script for a non-script item?? Sheesh!

Anyway, at least I'll have something in writing from them. I'll have to say that they've been really good in the past about getting back to me on my inquiries.

OCO

Snoredog · Post by **Snoredog** » Tue Sep 26, 2006 6:30 pm

you should:

1. be able to request a hardcopy of their policy or
2. be able to download said policy from the internet.

What circumstances and how they pay for DME equipment should be spelled out in that policy.

For example:

If you go to google.com and search for: Aetna +CPAP it will display the Aetna website with the policy on cpap. There should also be links for the complete policy:

http://www.aetna.com/cpb/data/CPBA0004.html

Guest · Post by **Guest** » Tue Sep 26, 2006 7:39 pm

I was dealing with a guy who told me he was in Washington DC and he KNEW
it all. In spite of some things, he really was a fairly nice guy.

I asked him WHY Tricare doesn't put our rules and regs on the internet, it would save them a hundred thousand calls a year. He fed me some party line about security and how it was too expensive and did I know most people couldn't understand it anyway (now he was getting personal

So who knows. I want it on the internet so we can read it.

Stay tuned for Tricare by the Sea, part II.

Dave

Linda3032 · Post by **Linda3032** » Tue Sep 26, 2006 9:40 pm

Tricare Info. There are one or two topics on Tricare. Here is one of them:

viewtopic.php?t=9232&postdays=0&postorder=asc&start=15

The confusion lies in the fact that there are 3 levels of Tricare. Add to that, is that each Region (there are 4 of them), has it's own set of rules and regs. Kinda like the military and we've all been there and done that in one form or another.

Talk to your area Rep. -- not claims dept. And, if he/she tells you something unbelieveable (in a good way), have her put it in an email to you. At least that way, you have it in writing.

Also, if you join the Tricare internet site, you can put your questions in writing, and they will respond to you in writing. That covers your u-know-what.

Linda3032 · Post by **Linda3032** » Tue Sep 26, 2006 9:46 pm

All that said, my experience has been:

I've purchased two machines over the internet. I paid for them and submitted my claim to Tricare - Standard. Tricare paid 75%.

I bought my two machines 3 years apart - Tricare said they purchase machines "as needed". I did have to get a new prescription and a letter of necessity for the 2nd machine.

My Southern Region of Tricare Standard requires a new prescription for masks and accessories every year. I can get two masks per year - no more often than 6 months.

jeepdoctor · Post by **jeepdoctor** » Tue Sep 26, 2006 9:59 pm

I am Tricare standard also (South Region). Here are some of my observations.

First of all, sign up for mytricare. Then you can ask questions in writing and receive written answers. This is much better than telephone conversations.

According to a letter I received last week from Tricare, they will pay for 11 months of rental payments, at which time I will own the CPAP machine.

If you are renting and decide to buy a machine and submit for reimbursement, there are several things you need to know. First, you must purchase from a Tricare-approved vendor. U.S. Expediters is on the Tricare approved list. Second, your cost share is calculated by taking the purchase price of the machine and subtracting the sum of rental payments made to date. Your cost share is then 25% of the difference. Since the monthly rental on a machine I can buy for $ 550 is $ 120 per month, my cost share will be the entire purchase price if I wait too long to act. In my case, every month of rental adds $ 79 to my cost share, should I decide to purchase a CPAP machine and turn the rental machine in to the DME.

If your machine breaks under warranty, call the seller. Several folks on this forum have stated that they have called U.S. Expediters and that U.S.E. has sent out a new machine immediately for use while their machine is in for warranty repair. If my machine breaks, warranty or not, I will use it as a good excuse to get a Goodnight 420G to use as a travel machine and as a backup.

Linda3032 · Post by **Linda3032** » Tue Sep 26, 2006 10:05 pm

Jeep - would it be possible to copy the letter and either post it here or send it in an email?

Since we are in the same region and both Standard, this has to be a latest revision to Tricare rules - yet another one.

The last revision lasted from Jan. 1, 2006 until April 31, 2006 --- a whole 3 months.

I wish they would make up their dang minds.

Did they make you "rent" instead of buy?

Linda3032 · Post by **Linda3032** » Tue Sep 26, 2006 10:08 pm

And then we can add another problem into the mix --- Medicare. Once you hit 65 (which I've got another year + to go), then Medicare becomes your Primary and Tricare becomes your Secondary. Yuk.

dllfo · Post by **dllfo** » Tue Sep 26, 2006 10:13 pm

I was the guest again...not sure why I am not being logged in, this happened awhile back....sorry about that...

I belong to MyTricare or whatever they call it. I did send in a couple of questions and got "see pamplet 555-Z-415X" type answers. I gave up on them at that point. Same with social security.

BUT...maybe tricare west is catching up, I will see. I agree, an email is much better, but not guaranteed to bail us out.

I asked about the copay thing today and didn't really get a good answer, the tricare lady I was asking questions of sent me to claims.....who was not pleased at her...but still tried to answer my questions.

They were so bad a few years ago, my file was locked and only one person in the USA was allowed to process it. It was a real mess. That was when it was in South Carolina.

I really don't understand why we can't get them to put the regs on the internet.

Let's see if this logs me in as dllfo.......Dave...it says I am logged in up at the top of the page......

jeepdoctor · Post by **jeepdoctor** » Tue Sep 26, 2006 10:34 pm

I had Aetna when I worked for a living. Now I am retired and have Tricare. I have found that Tricare is better than Aetna was. One of my medicine men, who is network Tricare, told me that he prefers Tricare over Aetna. So there!