Medical care for Reservists - Brief Article

Knowing what to do in advance saves time, grief later

If a soldier gets hurt or becomes ill while performing IDT (Drill) or Annual Training, do you know who is going to pay for the medical care? Unless your unit trains on an active duty installation with a Military Medical Treatment Facility (MTF), or Troop Medical Clinic (TMC) or has medical support for the Annual Training site, chances are the soldier will be seeing a civilian provider.

When properly authorized, most care will be covered under the Tricare Supplemental Health Care Program. The Supplemental Health Care for soldiers remotely located from a MTF or TMC requires coordination with the unit, the Military Medical Support Office (MMSO), and the TRICARE Contractor to ensure medical claims are paid. Care by a civilian provider does not have to turn into a financial nightmare for the individual soldier. In order to make sure that the provider gets paid, there are a few easy steps that the unit leadership team can take.

In an emergency situation, the soldier should be directed to the nearest civilian or military hospital with an emergency room. It is easy for the paperwork to get overlooked, but not necessary.

Before training begins, the commander or first sergeant may want to create a few "triage" kits to have on hand for situations when soldiers may need medical care during training. These kits should consist of a two-pocket folder filled with a locally created instruction sheet and MMSO RC Medical Cover Sheet (checklist), DA 2173 for determination of Line of Duty Status, DD Form 2527 for Third Party Liability recoupment action. The Third Party Liability form is only required when the soldier was injured by a third party (i.e. a POV causes an accident with a government vehicle, a soldier is injured in a POV accident with another POV while traveling to or from military duty, etc). If a third party causes the soldier's injury, the third party's automobile insurance will be billed for recoupment of the soldier's medical care by the TRICARE Contractor.

It is important to understand that the unit claim payment will not be delayed if the TRICARE Contractor is awaiting information for third party liability recoupment action. TRICARE is first payer if the soldier is covered by private health insurance. Do not submit TPL form (DD2527) for the soldier's private health insurance. The Reserve Component Cover Sheet, forms, and more detailed information for submitting medical claims are at the MMSO website:

http://navymedicine.med.navy.mil/mmso

The Local Instruction sheet might include such basics as name and phone number of the designated urgent care facility; name and number of the full-time POC at the unit who will be responsible for following up on the medical claim; complete unit designation, UIC, address and other key information; MMSO contact information and checklist for assembling claim packet

Whoever makes the determination at the unit to send the soldier for medical treatment should initiateinitiates this necessary paperwork and ensures that medical personnel complete required data at the time the soldier is treated. After the soldier has received medical care, the unit leadership team follows up by reviewing the documents for completeness and forwarding the required packet to the MMSO for action.

Units should also follow Regional Support Command guidance regarding disposition of LOD when an injury might result in profile or disability. The claim should normally be submitted within a week of the soldier's treatment. For more information on LOD processing, check with your unit RSC personnel or see the LOD Regulation (AR 600-8-1, 1986) which is located on the MMSO website under NG/Reserve References.

In addition to the documentation required for the initial visit, all follow-up visits after the duty period require the unit to obtain a preauthorization number from the MMSO. If the soldier obtains care without a preauthorization, the soldier's unit will need to submit an appeal to get payment authorized.

On a monthly basis the MMSO, located at Great Lakes Naval Training Center, Great Lakes, IL, reviews approximately 2,600 denied active duty claims, verifies eligibility of 8,100 Reserve Medical Claims, and authorizes payment of 6,280 Dental Claims. Due to this high volume, it is critical that unit personnel become familiar with the proper procedures for submitting medical claims. The MMSO website provides detailed instructions and required forms for downloading to be used by the unit in submission of claims. For more information, check the MMSO website or contact the Reserve Liaison at MMSO, 888-647-6676.

(Master Sgt. Bein is the Patient Administration NCO at Military Medical Support Office, Great Lakes, Ill.)

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