Does anyone know who the gov't representative is for the Humana Military East contract? I had medical services at an in-network provider that was pre-approved and authorized. They denied the claim on the basis that I had other health insurance, which ended at the beginning of this year. I sent in the required form to say that we have no other health insurance as of 1/1/18. I called Humana, they confirmed that they received the form and that the system is updated, and that the denied claims will be re-processed. However, the provider is asking for payment which is of course a lot higher than the allowable charges. To add insult to injury, I received a letter from TRICARE to say that I may need refund them for the other claims they processed and paid because I have other health insurance. This is after I went through the entire process to prove I don't have other health insurance (I filled out the form and sent them a copy of the letter from the other health insurance showing the other coverage termination date).

Anonymous wrote:we are in the process of doing exactly that. they cautioned us that Tricare does not even have to reply to their inquiry on my behalf. Seriously. They said they'd try to help us, but Tricare didn't have to cooperate with the congressman's staff.

That's appalling. Are you local or at a duty station outside of the DMV?

If you are at a duty station outside of the DMV then you might have cause to see if there are others in similar positions, and then take it up the chain of command at the duty station. Post/Base commandants and commanders are usually very receptive and responsive when they hear of mistreatment of families in their care. I'm not sure how much you would be able to do at a place like the Pentagon but you could try a similar tactic.

If you are in the DC area then you might want to try contacting one of the television stations that runs special programming aimed at helping consumers who are being ripped off or mistreated. Also, perhaps you could contact one of the Metro journalists at WaPo and see if any of them would write about your problems and maybe that would apply enough pressure on Tricare that you get help.

Good luck.

I am so frustrated with their claims processing. The representative I speak with are very polite on the phone but unable to resolve the claims issues.

we are in the process of doing exactly that. they cautioned us that Tricare does not even have to reply to their inquiry on my behalf. Seriously. They said they'd try to help us, but Tricare didn't have to cooperate with the congressman's staff.

OP -- when you are sure you are correct and you have tried every avenue... this is when you document it all and send it to your local congressional representative. They have people on staff who can get the attention of Humana a lot faster than you can. Document everything and start pulling some strings.