Monday, December 31, 2012

Open Letter to Medicare (and Tricare)

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

Dear Sirs:

1. Your web “service” is totally inadequate. For all the millions of tax dollars
spent on your hideously complex web sites there is no easy way or indeed
no way (period) to send you an email and get a response. So we'll do it the
old fashioned way: with a letter.

2. I do not want to sit on HOLD for hours to talk to some inexperienced call
bank operator who hasn't a clue. Please fix this. Give the customer (that is
we the people) a way of sending an email for some educated person at your
end to research and resolve the problem.

Now to the real business:

a. You and Tricare are in a Mexican standoff over my account. You pay about 30
cents on the dollar (I can prove that) on the claims submitted by providers. The
rest is shuttled to Tricare, who then adjudicate the claim and pay some more, but
not all, to the provider. You call this process “cross over”.

b. The provider puts up with this nonsense because it is too hard to fight it.

For better or worse, I have the time to fight it (due to more Governmental
incompetence, specifically the current budget impasse) so I shall. Hence this

c. The process of shuttling your responsibility to Tricare (you call it “cross over”)
works with a number of different providers. All except one:

Provider & Billing Address: QUEST DIAGNOSTICS INC

d. The following provider has acknowledged this issue and has called me and
asked me to fix it. I cannot. You MUST:

Provider & Billing Address: ABENA A ADDO MD 62

e. I contacted you before and you stated that only Tricare can correct this.

f. I then contacted Tricare, but they say:
If we are receiving claims via the electronic cross over between Medicare and TRICARE For Life
for all other provider except the one you have referenced in your message, there is nothing
wrong with our system, nor is fix I can complete to fix the issue.
Since Medicare if the party who is supposed to send us the claim electronically, I would suggest
contacting Medicare to discus the issue with them.
So we are at an impasse.

This is totally unsatisfactory.

I do not require an immediate reply, but I do require that someone with
experience, e.g., a supervisor, investigate this impasse and find a resolution.

Again, it is working for all except this one provider Quest Labs. So it is either your
problem or Tricare's.

1. If it is your problem then please fix it.

2. If it is Tricare's problem then explain to me why it is their problem, not yours,
so that I can then tell them.

Or even better, since you are both in the same business and both a lot smarter on
these matters than I, why doesn't someone from your organization contact Tricare
and sort it out and then write me back?

That is what any true professional would do. I am the customer, I have paid
thousands of dollars for a service I am not not presently receiving.

Oh, and include the Honorable John Boehner on your reply, as I am including him
on this request.

Tell me how I can help, but do not tell me to call a phone number. I want a letter
in reply so I can hold your feet to the fire.

Fix your system: both for email access and the crossover process.

Best regards,

C. Andrews (Claude A.) Lavarre,
Captain, USN (Ret.)
SSN: 408-72-5175
15 Willow Street
Newport, RI 02840

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