Tricare For Life and OHI
 

Has anyone with TFL and OHI had problems with medical billing not submitting to TFL after submitting to Medicare and then billing you for the balance.
For some reason this often happens with one hospital system I have access to and not the other.

HHave had TFL for 14 years, Maryland and here. Numerous medical procedures for me and wife, including major operations . Never had a blip on billings. My understanding is that Medicare automatically pays their portion and then forwards to TFL.

Here in Cleveland we use Cleveland Clinic and University Hospital. No problems with CC. Problems with UH billing are recurring even after calling their billing service and providing TFL information repeated times assuming someone in billing answers the phone. I’m trying to figure out who to contact at UH that has the power to get the UH billing service to clean up their act.

Some Medical facilities send you a bill after medicare pays the primary without "waiting" for the seconday insurance to kick in (TFL). You have to be your own advocate and be aware if TFL has yet paid. Then call the Medical facility and ask them why are you sending me a bill without waiting for my secondary insurance to pay. They stutter a lot when you call them on this.

If you have Medicare, TFL does not want to be billed. Medicare will take care of that. I try not to tell them I have TFL but, of course, some insist on knowing who is secondary. In any event, I never pay the secondary amount when billed and, once I get the TFL summary notice, just attach a copy of that to the bill for secondary payment and return it to the provider. There's not much they can say when you send them proof they have already been paid.

The flow is supposed to be Medicare first, then the balance is submitted to TFL.This is per the Tricare website. Anyway, I always tell my providers at the time of service that I have two insurances. The occasional billing problem is always resolved. When I retired in 1997 I never realized how much I would not have to pay out of pocket when Tricare was secondary to Medicare. As you know prescription costs are 0 per month.