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CHAMPUS/TRICARE  A Pretense Of Coverage 
 

Stand up and be counted
 

Maybe it is all HMOs in general. 
 Another Good Health Care Watchdog Site Focuses On Foundation Health 

A Courageous And Remorseful Ex-HMO Doctor  
Tells The TRUTH About HMO Game-Playing  
http://www.sepp.net/  
http://www.sepp.net/Peeno.html  
http://www.sepp.net/Peenox.html  
http://www.sepp.net/Peeno1097.html 


This was a guest book entry,   for the  website above,     my plan for reinvigorating the CHAMPUS/TRICARE HMO organization.    As I realize more information that would be helpful here,   I will edit this.

Feel free to mirror,   or clone and edit it.

Other Struggles I Am Involved In
http://www.snowcrest.net/soza/ThingsNO.htm

My New Ongoing Newsletter About Gardening And Journaling,
If you want to be really healthy,   you have to keep a garden.
http://www.snowcrest.net/soza/herbs/NewsLetr.htm


My Plan For CHAMPUS


Name: Shari Soza 
Url Address: http://www.snowcrest.net/soza/ThingsNO.htm 
Email Address: soza@snowcrest.net 
Website: The New Inquisition 
Referred by: Net Search 
From: I live in Yreka, California, originally from SE Texas. 
Time: 26-Mar-98 

Comments: I am an unremarried widow of a 100% disabled veteran, who was retired on disability, and I have had good service from CHAMPUS since 1976. For whatever reason, when it changed to TRICARE, they seem to have more fun just finding some way to say NO.  

It costs more in manpower time and expenses, to have all these delaying tactics, lies, dys-organization, and appeals (to the same personnel that doesn't have enough education to ADJUDICATE anything anyway).  

It is a SHAM, a pretense of coverage.  
It is not just CHAMPUS/TRICARE, but HMOs in general.   
Of course, CHAMPUS/TRICARE is the HMO we worry about.  

They are obviously not operating it in our best interests, and yes, it is a breach of contract.  
I believe that if they are more interested in saying NO than in paying our bills on time, as we have a right to expect, the program should just be abolished, and the government can pay us a little more each month, and let us buy some real health insurance.  

That limits the liability of the government, and keeps costs to the taxpayers in line.  

I have a plan.  

1. Before you get any medical services, except for an emergency, send in a fax asking for pre-authorization, to your CHAMPUS/TRICARE pre-authorization office.  

2. Keep a copy of every phone call on cassette tape.  

3. For every lab work, or doctor's visit, you do the billing, so that you can get the forms right.  

Send a copy of the claim form and the original receipts, to your health care provider.  
Keep copies for yourself in a binder.  

4. Send the official copy of the claim form, and the original receipts, with 3 copies of all this, to your CHAMPUS/TRICARE claims process, by certified mail, return receipt requested.  

Fill out a PROOF OF SERVICE form, every time.  

5. If you don't obtain payment within 30 days, resubmit the claims again, to CHAMPUS/ TRICARE claims processor, again with a PROOF OF SERVICE, and a Notice of Resubmission to your Senators and Congressmen in Washington.  

6. Always, keep in touch with your health care providers, and let them know you are not avoiding the bills, just trying to get CHAMPUS/TRICARE straightened out.  

7. If you don't obtain payment within 60 days, resubmit the claims again, to CHAMPUS/ TRICARE claims processor, again with a PROOF OF SERVICE, and a Notice of Resubmission to your Senators and Congressmen in Washington.  

8. If you don't obtain payment within 90 days, resubmit the claims again, to CHAMPUS/ TRICARE claims processor, again with a PROOF OF SERVICE, and a Notice of Resubmission to your Senators and Congressmen in Washington.  

9. At 90 days, file a lawsuit in your local Small Claims Court, against both Department of Defense, CHAMPUS, and your CHAMPUS/TRICARE contract claims processor, for the full amount of the bill, for BREACH OF CONTRACT, FRAUD, and/or other possible causes of action, plus 25% of the amount, for wasted time and emotional distress, and 300% of the amount for punitive damages.  

When you win, split the punitive damages award with your doctor. CHAMPUS has been stealing their time, too.  

10. Small claims court is not too hard to navigate.  

11. The main thing is keeping copies of everything, and those PROOFS OF SERVICE, plus the return receipts from certified or registered mail.