drugs and dollars

I owe someone an apology.  And because I am an American, I will apologize for almost anything -- even if I have had no personal responsibility for whatever trendy fad cries out for an apology.

And then there are other times.  When I really am responsible.  This is one of those times.  Well, in part.

Last May, while I was gesticulating madly atop my moral high horse in opposition to extending Medicare's bureaucracy to Mexico's American expatriates, I told you about a crazy example imposed by my military retirement medical insurance -- Tricare.  I had just filled out a claim form requesting reimbursement for my rather expensive prescription medication.

Tricare will reimburse 75% of my out-of-pocket expenses less my deductible, co-pay, and other deductions that seem to fall in the "sleeping with the window shut" fees.  After sending in my May claim form, I noticed a rather unsettling warning:

Prescription claims require the name of the patient; the name, strength, date filled, days supply, quantity dispensed, and price of each drug; NDC for each drug if available; the prescription number of each drug; the name and address of the pharmacy; and the name and address of the prescribing physician. Billing statements showing only total charges, or canceled checks, or cash register and similar type receipts are not acceptable as itemized statements, unless the receipt provides detailed information required above.

I thought I would never see a penny of drug reimbursement.  Drugs are not dispensed with that type of detail here.  Until I requested it, my local pharmacy didn't even provide a receipt.  There is no cash register.  We are talking small town here.

My discussion caused distress from other Tricare patients in Mexico.  Like me, they had not been submitting documentation even close to the requirement for prescription claims.

About a month after I wrote that essay, Tricare sent my claim form back to me.  I was not surprised to see it in my postal box.  But I was surprised at the contents of the letter I received.

Tricare noted that I had not included the address and telephone number of the pharmacy.  It actually was on the hand-written receipt I had submitted.  But, never mind.  I could easily write both on the letter.  Back the form went to Tricare with heightened hopes that I may actually see some bucks.

And two reimbursement checks showed up here early this month.  I told you about them in my piece about using my mobile telephone to make bank deposits -- dialing for dollars.  From submission to payment took about three months.  Not really a stellar response time.  But it is the government.

Then, Saturday morning, I had a real shock.  There was another Tricare envelope in my postal box.  Since I had just asked a friend, a week ago, to mule my most recent claim form north, I was shocked to see such a short turnaround.  In fact, I was about to laud Tricare for its administrative professionalism.

But that would have been premature.  The envelope did contain a check (denominated in pesos) -- but for services in June.  Still, that was just a two month turnaround.

Thus my half apology.  It turns out that Tricare is far more flexible in its reimbursement process than its form would indicate.  And that is good.  I suspect Mexico is not the only country where detailed receipts are rare.  Sheedy's Rexall in Powers during the 1950s probably fell into that same category.

So, I will continue to pay for my drugs out of my pocket knowing that I will eventually get some reimbursement.  At some point.

It is better than a poke in the eye with a sharp crocodile.