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THE SILENT HEROES Through the history of world aviation Many names have come to the fore, Great deeds in the past in our memory will last As they're joined by more and more. When man first started his labor In his quest to conquer the sky, He was the designer, mechanic and pilot, And he built a machine that would fly. But somehow orders got twisted, And then in the public's eye The only men that could be seen Were the men that knew how to fly. The pilot was everyone's hero, He was brave, he was bold, he was grand. As he stood by his battered old airplane With his goggles and helmet in hand. To be sure, these pilots have earned it, To fly you have to have guts And they blazed their names in the Hall of Fame On wings with baling wire struts. But for each of these flying heroes There were thousands of little reknown, And these were the men who worked on the planes And kept their feet on the ground. We all know the name of Lindbergh, And we've read of his flight into fame But think, if you can, of his maintenance man, Can you remember his name? And think of our wartime heroes, McConnell, Jabara, and Ritchie. Can you tell me the names of their crew chiefs? A thousand to one you cannot. Now pilots are highly trained people And wings are not easily won, But without the work of the maintenance man, Our pilots would march with a gun. So when you see mighty jet aircraft, As they mark their way through the air, The grease stained mechanic with wrench in hand, Is the person who put them there. From John Wolter, 483rd BG (H),
1992
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[ After many, many long years without federal coverage, long term, length of service retirees have become eligible for TFL (Tricare-for-Life) medical coverage in addition to Medicare. The new paper shuffling process has generated a tad of confusion in some cases.We hope the following Billing explanation will help. ] The TFL billing process in CONUS is as follows: The health care provider (Doctor's office) submits a claim to Medicare. Medicare will send you an explanation of benefits (EOB) when they process/pay the claim. From Medicare, the claims are forwarded electronically to the secondary insurance carrier that is either TFL or any Other Health Insurance (OHI) carrier. If the beneficiary has an OHI they pay their share and provide the health care provider and the beneficiary an EOB. After receipt of the EOB from the beneficiary's OHI, health care provider may submit a claim to TFL for any additional payments. In these cases, the beneficiary will also receive an EOB from TFL reflecting fact it made no payment to the health care provider. When no other health insurance is involved, the EOB from TFL will reflect the amount it paid to the health care provider. However, there are always problems with claims processing. When Medicare simultaneously sends a claim to both the OHI and TFL, sometimes parts of the information may be lost. Consequently, TFL may not recognize an OHI is involved and this could result in a dual payment. In these cases, it is the health care provider's responsibility to return the TFL payment, accompanied with a copy of the OHI EOB. That will alert TFL to make and correct the beneficiary's file. Any changes made to the system always take time before they are recognized. Since there are up to three computer systems involved, the process making changes do not happen overnight. If you have any questions regarding TFL, the only viable source of information for a beneficiary's individual account is the TRICARE for Life Program Call Center. The toll free number is 1-888-363-5433. [Source: NAUS Update 18 JAN 02] TFL Billing Problems: If you received medical care in CONUS after October 1, 2001, and the doctor or hospital filed a claim with Medicare, Medicare will send you an explanation of benefits when they process/pay the claim. Medicare sends TRICARE the claim they received from your doctor when they mail you the Medicare Explanation of Benefits. Within 30 days of receiving the Medicare explanation of benefits, you will receive a TRICARE explanation of benefits (EOB) explaining how much TRICARE paid. You do not have a problem if you receive the TRICARE EOB. If you have not received a TRICARE explanation of benefits after 30 days since receiving your Medicare EOB its time to follow-up. Call your TRICARE claims processor. DO NOT call Medicare - they can't help. Your TRICARE contractor will tell you if they received the claim from Medicare and when it will be processed. If Tricare didn't receive the claim, your TRICARE claims processor should ask you for the information necessary for Medicare to send TRICARE your claims. Even if TRICARE didn't receive your claim from Medicare you are still entitled to TRICARE benefits. While not as convenient, the TRICARE claims processor will ask you to send a copy of the doctor's bill, the Medicare EOB and a claim form (Most doctor's offices will do this for you). This information is necessary for TRICARE to pay the rest of the bill. You may have to send claims for up to 60 days after calling the TRICARE claims processor to allow time for Medicare to receive you information and start sending claims directly to TRICARE, but once things are working there should be no more problems. [Source: B/Gen Bob Clements USAF (Ret) Msg 11 JAN 02] |
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