Help please!

[gamecockinnc]

Hi,

 

We were on the 8 night CCL Valor and returned September 23rd 201/. While on board I had to visit the ships doctor and had 1 test down and I was prescribed 2 medications one being an antibiotic. I had to go back a few days later and was given another antibiotic.

 

I have Medicare as my primary and Tricare for life as my secondary. We also purchased cruise insurance through Carnival.

 

I have called Medicare and Tricare and have not gotten anywhere. How do I get reimbursed? I am lost and need to get this done quickly. The bill is less than $200 but who can't use $200. Please advise what to do.

 

Thank you in advance for your help!

[cruiseco]

Hi,

 

We were on the 8 night CCL Valor and returned September 23rd 201/. While on board I had to visit the ships doctor and had 1 test down and I was prescribed 2 medications one being an antibiotic. I had to go back a few days later and was given another antibiotic.

 

I have Medicare as my primary and Tricare for life as my secondary. We also purchased cruise insurance through Carnival.

 

I have called Medicare and Tricare and have not gotten anywhere. How do I get reimbursed? I am lost and need to get this done quickly. The bill is less than $200 but who can't use $200. Please advise what to do.

 

Thank you in advance for your help!

 

The order in which things will have to happen is:

 

Submit claim to Medicare (primary insurer)

Get denial of coverage from Medicare

Submit claim to Tricare (secondary insurer)

If Tricare won't pay or only pays a portion of the claim then --

Submit claim to BerkleyCare/Carnival (tertiary insurer)

 

Where exactly are you in this process? I can't believe that Medicare has already notified you of the claim denial so I'd guess you're still at step one. You said you've called Medicare. What did they tell you? Have they received your claim? Has it been assigned to a claims person? Are they sending you some documentation of the denial that you can then submit to Tricare and if necessary BerkleyCare? Calling Tricare at this point is probably a waste of time.

[6rugrats]

Agree. There is no way a claim with Medicare was processed this quickly. Cruiseco has listed the correct sequence of event. You can't call to get payment, you must file a paper claim. Hopefully, you have the itemized receipt from the ship for your treatment, because you'll need this. Also, don't assume you'll get 100% of your payment back.

 

You don't state if you have regular Medicare, a Medicare HMO, Tricare, Tricare For Life, and if your insurance through Carnival was possibly primary (I know nothing about Carnival insurance).

 

You need to file a claim yourself first with Medicare. Instructions here:

 

http://www.medicare.gov/claims-and-appeals/file-a-claim/file-a-claim.html

 

Then you need to file a claim with Tricare, including Medicare's Explanation of Benefits (the paper where they deny your claim; don't send the original, send a copy). Instructions here:

 

http://www.tricare.mil/mybenefit/ProfileFilter.do;jsessionid=Q13fNLYhtRn4Jg3B2qyXwRTYvv8tSMgBQ72bhNKGLsgLKQLW9qBM!1787486194?puri=%2Fhome%2FMedical%2FClaims

 

If you have Tricare For Life, go here for a claim form:

http://www.tricare4u.com/apps-portal/tricareapps-app/static/beneficiaries/claims/

 

Then, if anything is still owed, you'll have to file a claim with Carnival, and provide them with copies of payments/denials from both Medicare and Tricare with your claim.

 

This is going to take a while; you will be lucky to get anything back within four weeks with a paper claim.

 

You may want to read this publication:

 

http://www.medicare.gov/publications/pubs/pdf/02179.pdf