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Tricare -- Reneging On Previous Commitment To Pay.

vaf

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vaf Mentor

vaf

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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.

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Pete53 Grand Master

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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

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vaf Mentor

vaf

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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.

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SLEDGE Mentor

SLEDGE

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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

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