Recently I have been gettings claims with a code of 004 which says the drug is considered to be a Over-The-Counter drug and Tricare will NOT reimburse these drugs. I questioned these and now they did an audit on all of my last 4 years of claims where they paid for these drugs.
Now I have started receiving letters from Tricare saying that I need to return the amount that they have paid in error. THEIR ERROR AND I HAVE TO PAY THEM BACK…
The other day I received another letter requesting another repayment and in the same mail there was a rebursement check for a claim I had submitted. The funny thing is that on this claim were 2 of the drugs that they are now claiming to be Over-The-Counter and they were reimbursed.
Whoever is processing these claims sure DO NOT KNOW WHAT THEY ARE DOING!!! AND I HAVE TO PAY FOR THEIR ERRORS!!!
I have called Tricare numerous times with no results.
My advice is that if on your claims they claim some items are now considered Over-The-Counter, DO NOT QUESTION THEM or they will also be asking you for repayment too.
GOOD LUCK ON SUBMITTING YOUR CLAIMS TO TRICARE