Back pay for medical related expenses

cld6gc

Registered Member
Good Morning All,

I just submitted my PDBR and know that I have a long time until a decision is made but I read that if I am awarded retroactive medical retirement that I may be able to recoup past medical expenses. Is this true and if so does this include past insurance premiums? Also how do they calculate, do I need to track down all my past premiums and expenses from past insurance providers?

Thank you
 

chaplaincharlie

Staff Member
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PEB Forum Veteran
Registered Member
I would call and ask Tricare about the process. That way you will have saved the right documentation, should your case be approved.
 

chaplaincharlie

Staff Member
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You are welcome. Please post what you find out. This questions has come up before.
 

cld6gc

Registered Member
Update

Called and spoke to Tricare and DEERS. They could not give out any details of information they would need for reimbursement for prior healthcare costs until I was awarded a medical retirement in the system.

But they did suggest to have billing records of past healthcare expenses in the event I am awarded retro retirement.
 

Perci75

PEB Forum Veteran
Registered Member
I contacted Tricare regarding this and have recently been medically retired under the PDBR. Tricare stated to fill out a DD Form 2652, include a letter explaining what to be reimbursed with the history of the payments/charges. I don't have any medical bills so this will only be the premiums I have paid over the years.

Also will include the PDBR letter explaining the situation. Tricare stated this will then go to a board to determine payment.
 

cld6gc

Registered Member
Good to know, thank you for the information. Please let me know how it goes. I am going to gather all the payment information I can from previous medical care.
 

Matt80

Registered Member
Hello everyone, this is my first post to this forum although I have been reading posts here for almost 2 years. You are right cld6gc, it is a long process (too long IMO!!) and I wish you well in your endeavor. I am AF as well and it does seem to take longer for us to receive a final decision than the other branches. I started the PDBR process in Aug 2016 and just received my updated DD214 today. Luckily I was upgraded from 10% to 40%. I also received a letter from Tricare earlier this week stating I was eligible to enroll in a plan. Due to work, I have not been able to call them yet. I too have been wondering if Tricare will reimburse me for past insurance premiums which would be a substantial amount (I was discharged in 2004). I will get a chance to call late next week and will let you know what I find out. I am not sure what to do now that I'm officially retired but I figure Tricare is a good place to start. If anyone else has any info on what comes next I would greatly appreciate it.
 

cld6gc

Registered Member
Hello everyone, this is my first post to this forum although I have been reading posts here for almost 2 years. You are right cld6gc, it is a long process (too long IMO!!) and I wish you well in your endeavor. I am AF as well and it does seem to take longer for us to receive a final decision than the other branches. I started the PDBR process in Aug 2016 and just received my updated DD214 today. Luckily I was upgraded from 10% to 40%. I also received a letter from Tricare earlier this week stating I was eligible to enroll in a plan. Due to work, I have not been able to call them yet. I too have been wondering if Tricare will reimburse me for past insurance premiums which would be a substantial amount (I was discharged in 2004). I will get a chance to call late next week and will let you know what I find out. I am not sure what to do now that I'm officially retired but I figure Tricare is a good place to start. If anyone else has any info on what comes next I would greatly appreciate it.
Thank you for the information and glad you received a favorable decision. Yes please keep me updated on what Tricare has to say.
 

chaplaincharlie

Staff Member
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@Matt80
Congrats on a positive, albeit long decision. It would be a great service to others when you post the process. Congrats again.
 

Matt80

Registered Member
Good Morning Matt,

Any updates from Tricare yet?
Hello. Hope everyone had a Merry Christmas and a happy New Year! Sorry for the delayed response. I work in healthcare and have long hours, the holidays didn't help either. I have called Tricare several times over the last few weeks and all I got accomplished was getting enrolled for coverage. If open enrollment hadn't been extended I think I would have had a hard time even accomplishing this. No one I spoke to has heard of the PDBR. Apparently my records were updated to show that I have been eligible for Tricare since '04. I have to explain that their information is misleading and in reality I just became eligible for coverage in December. I had many people tell me that my situation was a first for them. They don't know how to help me and just transfer me from department to department. It has been frustrating explaining my situation to multiple people. Everyone keeps assuring me that can I can get reimbursed for past medical expenses but this does not interest me. I have great coverage from my employer and have had very little out of pocket expenses over the years. My premiums however are another story. I have paid $7000-$8000 a year in premiums to have medical insurance when I should have been covered under Tricare. I did speak to a supervisor the last time I called and he said that Tricare is not responsible for reimbursing me for premiums paid to another insurance provider. I don't have high hopes that this can be done. I am just grateful that I have Tricare now and can save money moving forward. I plan to consult a lawyer when things settle down here to see if I have any other options but I will keep my expectations low. If anyone has had a different experience or has further info I think a lot of people here would be grateful.
 

cld6gc

Registered Member
Hello. Hope everyone had a Merry Christmas and a happy New Year! Sorry for the delayed response. I work in healthcare and have long hours, the holidays didn't help either. I have called Tricare several times over the last few weeks and all I got accomplished was getting enrolled for coverage. If open enrollment hadn't been extended I think I would have had a hard time even accomplishing this. No one I spoke to has heard of the PDBR. Apparently my records were updated to show that I have been eligible for Tricare since '04. I have to explain that their information is misleading and in reality I just became eligible for coverage in December. I had many people tell me that my situation was a first for them. They don't know how to help me and just transfer me from department to department. It has been frustrating explaining my situation to multiple people. Everyone keeps assuring me that can I can get reimbursed for past medical expenses but this does not interest me. I have great coverage from my employer and have had very little out of pocket expenses over the years. My premiums however are another story. I have paid $7000-$8000 a year in premiums to have medical insurance when I should have been covered under Tricare. I did speak to a supervisor the last time I called and he said that Tricare is not responsible for reimbursing me for premiums paid to another insurance provider. I don't have high hopes that this can be done. I am just grateful that I have Tricare now and can save money moving forward. I plan to consult a lawyer when things settle down here to see if I have any other options but I will keep my expectations low. If anyone has had a different experience or has further info I think a lot of people here would be grateful.
Good Afternoon Matt,

Any good news on back pay for insurance premiums?

Thanks for the update
 

Perci75

PEB Forum Veteran
Registered Member
What about out of pocket expenses?
I never had any out of pocket medical bills. Both my wife and I are disabled vets and use(d) VA over the years. I chose to keep my employer insurance over the last 10 years, it was cheap and for the occasional urgent care visits. Once I was retired mil I obviously dropped my employer insurance. I don’t have any medical claims to submit for Tricare.
 

cld6gc

Registered Member
Thanks, this if unfortunate for my family. I have paid quite a bit in out of pocket and premiums, I was hoping if I am granted retro retirement that I could recoup my previous medical expenses. I am not going to worry to much right now seeing I have not been awarded retro medical retirement yet.
 

Perci75

PEB Forum Veteran
Registered Member
Thanks, this if unfortunate for my family. I have paid quite a bit in out of pocket and premiums, I was hoping if I am granted retro retirement that I could recoup my previous medical expenses. I am not going to worry to much right now seeing I have not been awarded retro medical retirement yet.
Well the premiums don’t get paid back, the out of pocket medical bills from my understanding can be claimed. I think there is some threads on here of people working on getting reimbursed for these.

Quoting this from Heath.mil: You may request to have TRICARE retroactively reimburse your previous medical expenditures
 
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