Avoid the Bite of Double Damages (Part 4)

Rafael Gonzalez, Esq., Cattie & Gonzalez, PLLC

Tricare

Tricare is the United States Department of Defense (DOD) health insurance program for almost 10 million active-duty personnel, retirees, and select National Guard/Reserve members, along with their eligible family dependents.

When the DOD replaced CHAMPUS (the Civilian Health and Medical Program of the Uniformed Services) with Tricare in the 1990s, there were only three types of plans. However, the program has since evolved. Plan variations such as Tricare Extra and Tricare Standard have come and gone. Today, there are more than a dozen health and dental plan options to cover the needs of active-duty military service members, Guard/Reserves, retired service members, and their families around the world, depending on their status, location, and medical provider preferences.

Tricare Eligible Individuals and Insurance Type

There are two main categories of Tricare beneficiaries with different sets of health care benefits and plans available to them: 1) Sponsors—active duty, retired, and Guard/Reserves; 2) Family members—dependents registered in the Defense Enrollment Eligibility Reporting System (DEERS). 

There are two basic types of plans: HMO-type managed care plans in which all care and referrals are coordinated by a Primary Care Manager or Provider with relatively low (or no) out-of-pocket costs; and PPO-type plans, which let enrollees see a wide range of Tricare-authorized providers, but at a higher cost. 

VA Health Care Benefits Eligibility

If the plaintiff served in the armed military, naval, or air service and didn’t receive a dishonorable discharge, he/she may be eligible for Veterans Administration (VA) health care benefits. VA directs a health care system with an annual budget of approximately $68 billion, overseeing the delivery of care to more than 9 million enrolled veterans. VA, the nation's largest health care system, employs more than 371,000 health care professionals and support staff at 1,298 health care facilities, including 171 VA Medical Centers and 1,113 outpatient sites.

If the member enlisted after September 7, 1980, or entered active duty after October 16, 1981, he/she must have served 24 continuous months or the full period for which he/she was called to active duty in order to be eligible for VA health care benefits, unless the member was discharged for a disability that was caused or made worse by his/her active-duty service, or the member was discharged for a hardship or “early out,” or the member served prior to September 7, 1980.

If the individual is a current or former member of the Reserves or National Guard, he/she must have been called to active duty by a federal order and completed the full period for which he/she was called or ordered to active duty in order to become eligible for VA health care benefits. In addition, if the member served in certain locations and time periods during the Vietnam War era, he/she may be eligible for VA health care. 

VA Medical Care and Services Coverage

Once qualified for VA health care, all veterans receive coverage for most care and services, while some will qualify for added benefits like long term care, dental care, and vision care. Such covered benefits depend on the member’s priority group, the advice of the VA primary care provider, and the medical standards for treating any health conditions he/she may have.

VA covers inpatient hospital services, like surgeries, medical treatment, kidney dialysis, acute care, specialized care (including organ transplants, intensive care for mental and physical conditions, and care for traumatic injuries), as well as urgent and emergency care services. VA also covers diagnostic testing, blood work, X-rays, ultrasounds, therapy and rehabilitation services, and prosthetic items, audiology, and radiation oncology.

VA also covers other services and needs, like mental health services to treat certain issues like posttraumatic stress disorder (PTSD), military sexual trauma (MST), depression, and substance use problems, assisted living, residential, and home health care (depending on the member’s needs and income as well as space in the programs), and medications for prescriptions written or approved by a VA doctor. 

Our Verification of Entitlement Service

If you don't know that the plaintiff in an auto accident, liability matter, medical malpractice incident, no-fault situation, or workers compensation claim is a Tricare or VA health care recipient, how can you properly protect the claimant, your organization, or Tricare and VA’s interests? How can you make sure everyone involved in the claim has done what's legally necessary?

The Cattie & Gonzalez Verification of Entitlement (VOE) service allows you and your organization to have eyes wide open as to what benefits the plaintiff is entitled to and therefore what liens or reimbursement obligations may exist, as well as what future steps may be necessary to protect his/her future entitlement to these benefits.

Cattie & Gonzalez provides clients with detailed information as to whether the plaintiff is on Medicare Part A (hospital) and Part B (physician), or whether he/she may have switched to Medicare Part C (advantage) or Part D (prescription) plan.

We are also able to provide our clients with information about state Medicaid, CHIP, or Managed Care Organization entitlement, as well as Tricare and VA military benefits eligibility, allowing you the opportunity to make plans to fully comply with federal reimbursement obligations that may exist in your mass tort, nursing home, products liability, slip and fall, or wrongful death case.

Verification of Entitlement to Medicare, Medicaid, and Military Coverage

Over the next several weeks, we will provide a comprehensive and detailed sequential evaluation analysis of our VOE services, including details pertaining to our Medicare (hospital, physician, advantage, and prescription), Medicaid (state agency, chip, and managed care organization), and Military (Tricare and VA) verification of entitlement services.

Our VOE service allows you and your organization to minimize these federal liens exposure more easily, consistently, and comprehensively. This service will simplify the early components of securing accurate and timely information regarding the plaintiff’s entitlement to these federal benefits. We do the research and then provide you with simple and understandable reports delineating the type of coverage, the dates of coverage, and the specific plan providing such coverage to the plaintiff.

We conclude our VOE service by making recommendations regarding any changes necessary to the client’s state or federal mandatory reporting program, by outlining recommended resolution of any pending or outstanding liens, as well as by providing detailed steps to take into consideration in order to protect ongoing entitlement to Medicare, Medicaid, and/or Military benefits.

Conclusion

Would love the opportunity to speak with you and your organization about our firm, our people, our services, and our results, and very specifically the benefits of using Cattie & Gonzalez to verify entitlement to Medicare, Medicaid, and Military benefits and assist with resolution of any related liens, as well as steps necessary to protect such future coverage. To learn more, please feel free to visit us at www.cattielaw.com, email us at info@cattielaw.com, or call us at 844.546.3500.

About Rafael Gonzalez 

Rafael earned his Bachelors of Science degree from the University of Florida, and his Jurisprudence Doctorate degree from the Florida State University. 

Rafael has over 35 years experience in the legal and insurance industries. He is currently a partner in Cattie & Gonzalez, PLLC, a national law firm serving clients in all 50 states, focused on Medicare and Medicaid secondary payer law and compliance in auto, bodily injury, liability, mass tort, medical malpractice, nursing home, no-fault, products, workers compensation, and wrongful death claims and litigated cases. 

Rafael writes and speaks about workers compensation, social security, medicare, medicaid, marketplace, mandatory insurer reporting, conditional payments resolution, set aside allocations, msa and snt administration, social determinants of health, and diversity, equity, and inclusion throughout the country. 

Rafael can be reached at 844.546.3500 or at rgonzalez@cattielaw.com. You may also reach out to him on social media, as he is active on linkedin, twitter, facebook, instagram, and youtube.