A Navy veteran and his wife said they had been blinded when Tricare, the military health program, canceled over $ 100,000 medical allegations that he approved and paid a few years ago.
71-year-old Harve Smith received a $ 470 bill in January for a 2020 dermatologist visits.
TRICARE also turned approval for at least 10 requests, for a total value of about $ 100,400, for his wife Janice in the same period of time, while nine other claims that were once marked, were re-processed, according to records of her TRICARE portal, who browned NBC News.
“We don’t know where this ends,” says 67 -year -old Janice Smith, who has multiple sclerosis and worries that stress will worsen autoimmune disorder.
Harve Smith, pictured in 1983, served at the Navy for 15 years to 1994.
The Falon couple, Nevada, said they would have to use their retirement funds or repair their home, which they completely possess to clear the debt. The anxiety kept Harve Smith, who served at the Navy for 15 years to 1994, from sleeping at night.
“He just woke me up,” said Harve Smith, a former lieutenant commander. “Did I do anything wrong?”
It is unclear what prompted the cancellation, which seem legal under federal law, according to two healthcare laws.
In Nevada, recovery terms are usually determined by contracts between private health insurers and suppliers, said Las Vegas -based lawyer Ayesha Mehdi. Contracts often allow insurers to refund payments within a year or two, and sometimes four years, she said.
But since the federal law is stronger than the state legislation, said Mehdi, TRICARE, a federal program, is allowed to cancel payments in accordance with its provisions, which allows refund up to 10 years in cases of overpayment or errors.
The Defense Health Agency, which runs TRICARE, did not say whether it paid or made a mistake or whether the couple’s case was unique. Spokesman Brenda Campbell said he could not comment publicly on individual health cases, but would work with Smiths to investigate further.
The Federal Services Health Net, the former contractor of the TRICARE West region, also said he could not comment on specific cases, citing health confidentiality laws, but said he “actively addresses the issue.”
The Triwest Healthcare Alliance, which took the contract this year, postponed a comment to Health Net, which he said was responsible for the processing and payment of claims before January 1. Triwest said he had not reimbursed or did not try to repay payments from Smiths and was not allowed to take such actions under his contract with the defense health agency.
After spending weeks calling the agencies and being bounced between departments, Smiths said, they did not get clarity.
Meanwhile, the $ 470 account from the dermatologist has already gone to collections. The notice of collections on February 7, which was reviewed by NBC News, instructed Harve Smith to pay the balance within the next 30 days or to face an unfavorable credit report.
Smiths said they did not plan to pay the bills in the pocket until they confirm that it was their responsibility to do so.
The documents in the TRICARE portal of Harve Smith, which also reviewed the NBC News, show that TRICARE has issued payments to the dermatologist in 2020.
Janice Smith said, “It was so stressful and so scary. We cannot be the only ones in this position. “
Millions of employees, retirees, their families and networks suppliers across the country have felt cascading interruptions since the changes in the TRICARE contract this year.
About 16,000 healthcare providers on the east coast alone have not been paid this year, staff said, forcing many to release patients with tricks, reduce their hours, or consider closing their clinics. On the west coast, federal officials said the beneficiaries are fighting many problems, including a long time of waiting in call centers and restrained referrals and permits.
On January 1, Triwest began managing TRICARE benefits on the west coast and in six eastern states that were redirected to the western region. The Defense Health Agency said the new contract would “improve the provision of health care, quality and access” to US beneficiaries. But he acknowledged that several challenges have since emerged across the country.
Smiths said it took weeks to call TRICARE before someone picked up the phone. During one attempt, they said, they were waiting for more than two hours.
“I was so exhausted. I just started crying, ”said Janice Smith.
Janice and Harve Smith in 2023
She said they called TRICARE for Life, which is the Medicare program of TRICARE, but they are diverted to at least three other numbers. When they finally came to a representative for the admissibility database of military records, which possesses information for each member of the service, Janice Smith told them, they were told that officials should manually fix their husband’s records.
Smiths said the database system did not develop what was wrong with its records or what caused the obvious mistake. They were told to complete a TRICARE form asking them to restore their recording, although they did not know if they had been removed.
In the meantime, they do not know if they are currently having a health cover and whether they are on the hook to pay all the claims outside their pocket.
Janice Smith said TRICARE initially approved her services to the spouse and her husband, who include brain scans to monitor her condition, surgery to replace the hip joint, physical therapy and annual examinations.
“We will not pay. We are not wrong, “she said. “We were covered. We had insurance. “
Smiths, who have been married for 42 years, enjoyed their retirement and spent their time visiting their daughters in Hawaii and Virginia.
They said that the reverse claims, which have so far caused at least two medical bills, made them live more savage, limiting the trip and even the dates of lunch.
“We were the embodiment of Footloose and without fantasy,” said Janice Smith. “Now we have this over us.”
This article was originally published on nbcnews.com