Health & Safety

August 29, 2014

Ask the Doc

99th Medical Group

doctor
 
Q: How do I file a medical appeal?
 
A: To file a medical appeal, follow the instructions on your explanation of benefits or determination letter for your denied claim. Send your appeal to your regional contractor. See below for the address.
Claims Appeals:
North Region
Health Net Federal Services, LLC.
TRICARE Claim Appeals
P.O. Box 105266
Atlanta, GA 30348
South Region
TRICARE South Region Appeals
P.O. Box 202002
Florence, SC  29502
West Region
TRICARE West Region
Appeals Department
P.O. Box 105493
Atlanta, GA  30348
TRICARE For Life
WPS TRICARE For Life
P.O. Box 7890
Madison, WI 53707-7890
Authorization Appeals:
North Region
Health Net Federal Services, LLC.
TRICARE Authorization Appeals
P.O. Box 105087
Atlanta, GA  30348
South Region
Humana Military
ATTN: Utilization Management
P.O. Box 740044
Louisville, KY  40201
West Region
TRICARE West Region
Appeals Department
P.O. Box 105493
Atlanta, GA 30348
TRICARE Overseas Program
TRICARE Overseas Program
Claims Appeals
P.O. Box 7992
Madison, WI  53707
TRICARE For Life
WPS TRICARE For Life
P.O. Box 7890
Madison, WI 53707-7890
Your appeal must be postmarked or received by your regional contractor within 90-calendar days from the date on your EOB or determination letter. For more information, download the TRICARE Appeals Fact Sheet on from the http://www.tricare.mil/faqs
For issues that can’t be appealed such as concerns with the quality of health care you received, complaints about a provider or facility behaving inappropriately, etc. you may file a grievance.
Mail written notice of your grievance to the appropriate contractor and be sure to include the following:
• Your name, address and telephone number
• Your Sponsor’s Social Security number
• Your date of birth
• Your signature
• A description of the issue or concern that must include:
•  Date and time of the event
•  Name of the provider(s) and/or person(s) involved
•  Location of the event [address]
•  The nature of the concern or complaint
•   Details describing the event or issue
•  Any appropriate supporting documents
Note: If you are filing a grievance on behalf of a dependent, provide the dependent’s information, as well as your own in the grievance.
Contact Information
North Region Contractor, Health Net
1-877-TRICARE, 1-877-874-2273
www.hnfs.com
South Region Contractor, Humana Military
1-800-444-5445
Humana-Military.com
West Region Contractor, UnitedHealthcare
1-877-988-WEST, 1-877-988-9378
www.uhcmilitarywest.com
TRICARE Eurasia-Africa Regional Call Center
Commercial: +44-20-8762-8384
Toll-free from the U.S.: 1-877-678-1207
www.tricare-overseas.com
TRICARE Latin America & Canada Regional Call Center
Commercial: 1-214-942-8393
Toll-free from the U.S.: 1-877-451-8659
www.tricare-overseas.com
TRICARE Pacific Regional Call Center
Commercial: Singapore: +65-6339-2676; Sidney: +61-2-9273-2710
Toll-free from the U.S.: Singapore: 1-877-678-1208; Sidney: 1-877-678-1209
www.tricare-overseas.com
TFL Overseas Contractor, International SOS
Country-Specific Toll-Free Numbers

www.tricare-overseas.com
TFL Contractor, Wisconsin Physicians Service
1-866-773-0404
www.tricare4u.com
US Family Health Plan
1-800-74-USFHP, 1-800-748-7347
www.usfhp.com

Send your questions to askthedoc@nellis.af.mil.

 

Send your questions to askthedoc@nellis.af.mil




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