Tag: TFL

Sunda’s Wandering Political Thoughts

This is about me. As my posts often are.

I’ve been undergoing treatment for lymphedema. It’s been going well. As part of that process, after the swelling in my lower legs, ankles, and feet were reduced, tailored-made compression socks to help me maintain my lymph fluid flow were ordered. Because the left side was ordered first, it was received first. I’ve been wearing it, and I’ve been happy with it.

My right side has taken longer. Part of that is because I was recovering from surgery on that side for a ruptured tendon. The surgery area ballooned up and fought against going down. Hence the therapy prescried for me to deal with the lymphedemia.

The right side has responded to it all and is much better after a month of special bandages, strict dieting, and a bevy of special exercises. The surgery is healed. I’m awaiting my special compression sock for it. It was supposed to arrived last week. We thought it’d be here by last Friday at the latest. It still hasn’t arrived.

It occured to me last night that my sock might be trapped somwhere as part of the Great Undoing. See, Medicare A&B cover me, backed up by the insurance from my twenty-year military career, Tricare For Life (TFL). But the socks ordered by my therapist through my hospital go through Medicare and paid for by Medicare and TFL. That’s done through an organization in Portland, Oregon, which outsources the sock production from a Germany company. The German company ships it directly to moi.

It leaves me in limbo at this point. I wonder, why hasn’t the second sock arrived yet?

Has it been affected by the Great Undoing and the PINO Trusk cuts, chaos, freezes, and tariffs?

Is it just standard logistical issues caused by weather and life?

Was or is it just a bureaucratic snafu?

Time will reveal all in the long run. In the meantime, like many Americans, I’m trapped in a loop of ‘wait and see’.

It’s a frustrating place to be.

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Friday’s Wandering Health Thoughts

Went to see my PCP earlier this year. 68 yo, I was dealing with my prostate (on meds for it), edema, hypertension, and mild IBS. Those had been ongoing since I was 65 or so. IBS is gone now, hypertension is responding well to meds and diet. The prostate is the prostate, enlarged but benign.

The appointment was an annual. My PCP is monitoring these things. She ordered blood panels in conjunction with the visit. Give us something to talk about. Well, as a retired military over the age of 68, my healthcare coverage is all gov: Medicare A & B, which I pay for, and Tricare-for-Life. Medicare happily paid their part of the lab work.

Not TFL. They balked. Yes, denied it. Didn’t see the need for it.

Second time I’ve gone through this with TFL. Honestly, they’re as bad as United Healthcare. What’s their motto again? Oh yeah, “Delay, deny, depose.” Guess it’s really the motto for that entire industry. I don’t expect it to get any better under PINO Trump.

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Coffee Powr

I’m a retired military veteran and over sixty-five years old. That combo means my health insurance is through a hybrid product that requires me to sign up for Medicare A & B when I turned 65. Mediacare provides primary coverage to me and my wife; TriCare for Life (TFL, officially known on the web as TriCare4Life) gives us secondary coverage. It’s not a bad deal. It isn’t free; my wife and I both pay for Part B.

What made my coffee taste more bitter than usual was a bill from my provider received this month. They said I owed them over a hundred dollars for lab work and that TFL hadn’t paid anything. Egged on by my other, that sent me into a tizzy of indignation. A website I found said, yep, TFL doesn’t pay for preventive lab work. This made no friggin’ sense and only urged me to greater outrage.

I logged into the various systems this week to find answers. Not finding satisfaction there, I was forced to *gag* call them and speak to people. I have nothing against people or talking but I dislike phones and bureaucracies. Girding myself with a mug of stout dark goodness, I called T4L. After providing evidence of who I am and waiting a few minutes, I was connected to Derek.

I explained it all to him and proved who I am to him. Derek began ferreting through the systems for more about my grievance. I logged into my provider portal and dug out more details. Shame on me, but only then did I realize that this bill was for services from May of 2022. That just seemed wild that I’m dealing with that over eighteen months later.

Derek looked into it and discovered that T4L didn’t pay it because Asante, who did the work, didn’t send an EOB for the Medicare part that was paid. “Have more coffee and call the provider,” Derek advised.

Thanking him for his assistance and wishing him a good day and Merry New Year, I did so. After providing evidence about who I am and a short wait, Karen heard my tale. “Interesting,” she said. “We show that T4L denied the claim.”

What?

She went on to tell me it’d been rejected three times and that’s why they were now billing me. “Let me contact the insurance section and confirm they sent the needed EOB,” she went on. “I’m going to email them now.” She typed away while I listened to keyboard clickety-clack. “There,” she said. “Now we’ll see what happens. Your bill is due next week but ignore that. If you get another bill or notice asking for payment, give us a call to check on the status, okay?”

Sure. I thanked Karen, wished her good day and Happy New Year, hung up and wrote up my notes. Now I wait, but I feel optimistic about the outcome. The whole thing only took one hour.

I couldn’t have done it without coffee, though.

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Friday’s Wandering Thought

Since retiring from the military in the 1990s, I’ve had health insurance through various Tricare programs, which replaced CHAMPUS. Most recently, my coverage was mandated to be Tricare for Life. It worked well. Of course, to continue using TFL, I was required to sign up for and start paying for Medicare once I became 65 years of age, which happened two years ago. This is a vein of the product called ‘Tricare for Life Medicare’.

I was recently hit with a bill for lab work done earlier this year. The lab bill was $300 and I had to pay $108 of that.

That surprised me. Investigating my benefits, I found that Medicare paid part. I thought TFL would cover the rest, but no; Tricare for Life Medicare doesn’t cover preventative lab work, only such work for life-threatening issues.

After a life of being pushed to be proactive and take preventative measures to find and treat health conditions in early stages, it seems like an odd turn of coverage. Makes me re-think what they were thinking when they called the program ‘Tricare for Life’.

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