Jump to content
Using an Ad Blocker? Consider adding HadIt.com as an exception. Hadit.com is funded through advertising, ad free memberships, contributions and out of pocket. ×
  • 0

Tricare -- Reneging On Previous Commitment To Pay.


vaf

Question

This involves a service-connected back surgery that my husband chose to have performed in a civilian hospital locally. I would like to hear of anyone's experiences suing Tricare for first committing to a hospital or physician to pay for services, and then reneging on that commitment. Were you successful, did they pay the charges, plus any attorney and court costs? Who was your attorney?

I can briefly discuss details, if needed. Tricare authorized the surgery with both me and the hospital, and then reneged after the surgery, saying its rep made an error, for which Tricare is not responsible, and they're now refusing to pay. We're looking at suing Humana Military Health Services as the administrator of the DOD sponsored Tricare medical insurance plan.

I initially posted this elsewhere, and apologize for putting it here, but this is the area where the board receives the most traffic, and I'm dealing with a time deadline. Thank you for your patience, and any information you can give me.

Link to comment
Share on other sites

  • Answers 3
  • Created
  • Last Reply

Top Posters For This Question

Top Posters For This Question

3 answers to this question

Recommended Posts

  • HadIt.com Elder

I am sure that there are provisions that would allow a review. Its really pretty stupid for them to say an agent made a mistake as most law is pretty clear that an Agent acting for the Company locks the Company in mistake or not.

Good Luck

Link to comment
Share on other sites

I am sure that there are provisions that would allow a review. Its really pretty stupid for them to say an agent made a mistake as most law is pretty clear that an Agent acting for the Company locks the Company in mistake or not.

Good Luck

The trick is finding an attorney who will take this on. Otherwise, we're stuck. I don't mind approaching the VA without an attorney, at least initially. I understand what I'm dealing with there.

This particular issue involves breach of contract, and of course, the hospital finds it easier to look to us for payment vs. taking on Tricare.

So yes, it should be pretty easy to prove, but we need formal representation.

Link to comment
Share on other sites

If you can prove what you contend by way of a signed contract between the VA and the hospital and you, they don't have a case against you at all.

It's all about the substance of and the signatures on.

Usually, a formal letter from your attorney attesting to the contested nature of this business and his representation of you is enough to quell the collection agencies.

What's in the signed contract is the key to the whole thing.

The buck stops at the top.

In this case it looks like the Secretary and the HMO get to fight it out.

But, I don't know anything about state or federal law.

sledge

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Answer this question...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

  • Ads

  • Ads

  • Ads

  • Our picks

  • Ads

  • Popular Contributors

  • Ad

  • Latest News
  • veteranscrisisline-badge-chat-1.gif

  • Advertisemnt

  • How to get your questions answered...

    question-001.jpeg

    All VA Claims questions should be posted on our forums. Read the forums without registering, to post you must register it’s free. Register for a free account.

    Tips on posting on the forums.

    1. Post a clear title like ‘Need help preparing PTSD claim’ or “VA med center won’t schedule my surgery” instead of ‘I have a question’.
    2. Knowledgable people who don’t have time to read all posts may skip yours if your need isn’t clear in the title. I don’t read all posts every login and will gravitate towards those I have more info on.
    3. Use paragraphs instead of one huge, rambling introduction or story. Again – You want to make it easy for others to help. If your question is buried in a monster paragraph there are fewer who will investigate to dig it out.

    Leading to:

    Post clear questions and then give background info on them.

    Examples:

    • A. I was previously denied for apnea – Should I refile a claim?
      • was diagnosed with apnea in service and received a CPAP machine but claim was denied in 2008. Should I refile?
    • B. I may have PTSD- how can I be sure?
      • I was involved in traumatic incident on base in 1974 and have had nightmares ever since, but I did not go to mental health while enlisted. How can I get help?

    This gives members a starting point to ask clarifying questions like “Can you post the Reasons for Denial from your claim?” etc.

    Note:

    Your firsts posts on the board may be delayed before they show up, as they are reviewed, this process does not take long and the review requirement will be removed usually by the 6th post, though we reserve the right to keep anyone on moderator preview.

    This process allows us to remove spam and other junk posts before they hit the board. We want to keep the focus on VA Claims and this helps us do that.

  • Most Common VA Disabilities Claimed for Compensation:   

    tinnitus-005.pngptsd-005.pnglumbosacral-005.pngscars-005.pnglimitation-flexion-knee-005.pngdiabetes-005.pnglimitation-motion-ankle-005.pngparalysis-005.pngdegenerative-arthitis-spine-005.pngtbi-traumatic-brain-injury-005.png

  • Advertisemnt

  • VA Watchdog

  • Advertisemnt

  • Ads

  • Can a 100 percent Disabled Veteran Work and Earn an Income?

    employment 2.jpeg

    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

×
×
  • Create New...

Important Information

{terms] and Guidelines