Hello all,
I have a general question about billing, and I am not sure what to do in this case. I have Tricare Prime. Anyone who knows Tricare, knows under Prime you can't see specialist without a referral from PCM. My PCM who we had been with for years after retirement at this time, obviously the practice knew this. Never an issue. But, in 2021, wife had a small injection. PCM was supposed to submit referral to specialist to give the shot. We thought all was well. However, two years later in later half of 2023, we get a bill from the provider saying we owe just under $400. When we talked with them and dug in to why, we found out that Tricare never paid the specialist(who at the time was with a Tricare network clinic). This was because the PCM's office never sent in the referral, and Tricare considered it a POS. Well we tried to work with provider, and Tricare. I think the clinic tried to submit a back dated referral, but I don't think at this time now, Tricare is allowing it. Keep hitting road blocks. This has gone back and forth with us to the office for the past 3 or 4 months. They keep saying Tricare says it's not a problem with the bill. I finally told them, it's not the bill that's the problem...it was the PCM's office didn't submit a referral so that is why Tricare didn't pay. So, I guess my question is; is there anything I can do possibly, or am I just going to eat it?
Thanks for any info.
