Maybe it is all HMOs in general.
A Courageous And Remorseful Ex-HMO Doctor
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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
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.
They are obviously not operating it in our
best interests, and yes, it is a breach of contract.
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.
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.
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