Tricare and WPS

emilynewhomeJuly 23, 2011

We are retired military, last year at age age 65 we enrolled in Medicare part B. Medicare is now our primary insurance and Tricare second payer.

We've had Tricare for over 30 years. We recently moved to TX which is covered by WPS insurance (Tricare South region). I had a double surgery in January. Tricare WPS was paying claims until March then suddenly 'denied payments'.

I went to our online account to see the explanation, which was "has other insurance". Since we've never had anything but Tricare, decided to check my onlone profile. Well lo and behold it had been changed! It now showed AETNA as my insurer, not only that but it gave a patient policy number and a 2007 start date for the policy.

I called the consumer number and asked for explanation. I was told it was an office "error", and that they would correct it. They would not explain how an employee could alter my profile without sending verification of a change (since that is their usual procedure).

They beleived they saved $$ by denying 8 medical claims, now they all have to be resubmitted and paid.

Does Wisconsin health insurance company think by following this practice that patients will just pay out of pocket, leaving them with fatter profits from Tricare!

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vala55

I would call your state's insurance office. I have forgotten the term for it. They can look into it.

    Bookmark   July 28, 2011 at 7:22PM
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wantoretire_did

Emily, I know this is after the fact, but have you enrolled in DEERS? We have Medicare and Tricare for Life and that's it. Meds are through our local Navy Clinic, Express Scripts or, rarely, Rite Aid. Go to your nearest military facility and get this straightened out.

    Bookmark   September 1, 2011 at 6:38PM
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maifleur01

Something similar happened when I retired and I found out that it was changed because my husband forgot/did not know that he had to advise his doctors of the change to Medicare being primary rather than secondary. Since all of the claims were being sent as if Medicare was secondary and not primary Medicare had no way to know that the supplier was submitting the claimms wrong. Check with the places that have been declined to see if they have Medicare as primary and have them resubmit the claims.

    Bookmark   September 3, 2011 at 9:28PM
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emilynewhome

wantoretire, yes I am enrolled in DEERS. WPS is the payer for Tricare For Life Southern Region. Medicare (over 65)only pays a portion of the bill, Tricare (which uses WPS insurance pays as secondary payer), we pay the remaining balance!
It is quite a convoluted shell game of who will pay for which services.
All the claims that were denied were due to WPS putting false information in my file!
I did complain to Tricare who say they are now investigating! We are still sorting it all out and most of the claims have now been paid by WPS.

    Bookmark   November 13, 2011 at 8:36PM
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