Healthcare Resolutions

About

The Healthcare Resolutions Program can help resolve clinically complex issues in a private and neutral setting. 

Patient Issues

Healthcare Resolutions can help resolve issues with health care, such as:

• Dissatisfaction with treatment results or quality of care
• Unexpected/adverse outcomes of care
• Sentinel events
• Medical errors
• Misdiagnosis or delays in diagnosis
• Unexpected death
• Inability to communicate well with providers

Goals 

The goals of Healthcare Resolutions are to:

• Resolve complex health care disputes, issues, and concerns at the lowest level, directly and at the earliest opportunity.
• Ensure a fair resolution process for all parties - patients, health care providers, and the military treatment facility.
• Combine patient, family, and provider input into process improvement initiatives and enhance patient-provider partnership in care delivery.
• Promote organizational clarity and integrity, including training providers in disclosure techniques.
• Share any unexpected outcomes of care openly and honestly, including system weaknesses, with patients and families.
• If weaknesses are found, we will change and improve processes and functions. This is consistent with our role as a high-reliability organization.

Guiding Principles 

• Confidentiality. Your identity is never shared without your permission.
• Neutrality and Impartiality. We do not take sides in a dispute. Healthcare Resolutions aims to achieve the best possible outcome for all.
• Independence. We operate across all levels of the MTF and will address any party about issues needing their attention.
• Informality. We use candid and direct problem-solving processes to resolve disputes. Using the Healthcare Resolutions Program does not limit your right to pursue formal or legal processes.

How does the Healthcare Resolutions Program help resolve issues?

• Conducts informal fact-finding, facilitates open communication between parties, and offers fair and equitable solutions
• Communicates with patients and providers about quality of care issues; may enable mediation sessions with patients and providers
• Negotiates and reasons to analyze situations; recommends appropriate actions for solutions, while ensuring that all parties understand their options and the processes involved

In some cases, the MTF leadership is informed about developing issues, while staying confidential and neutral. 

Who can use the Healthcare Resolutions Program?

The Healthcare Resolutions Program is available to all patients, beneficiaries, next of kin, and health care personnel assigned to the facility. We accept referrals from any beneficiary or staff member experiencing clinically complex patient care issues. For more information or to schedule an appointment, contact our office. 
 

We are committed to providing you and your family with the best possible health care. Helping you understand the referral process and your financial responsibility is part of our duty in providing your health care.

Our health benefits advisor can provide information and assistance to:

• Active Duty members, retirees, and family members about various programs and services and explanation of benefits
• Individuals transitioning to the TRICARE for Life Program.

Resolving Your Medical Bills

Just a few tips to help you get that bill paid!

• Call ahead to ensure the office bills TRICARE - Have you called the doctor's office or the clinic where the services were performed to ask if they billed TRICARE?  It should show up on the bill when TRICARE pays.
• Get prior authorization - TRICARE requires prior authorization for all care outside of your Primary Care Physician's office. The authorization letter from TRICARE states specifically who you can see and for what date range.  Did the visit require prior authorization; did you get a referral from your Primary Care Physician?
• Check the billing information - Is the bill in the wrong name?  Did they use the DoD number instead of the Sponsor's social security number?  Is the date of birth correct? Is the date of service correct? 

Many times you will resolve your own bill when you have answers to the above questions. If there are still problems after taking the above steps, our Health Benefits Advisor can help you.  Be sure to bring all pertinent information to help resolve your bill.

Did You Know?

Many of your billing issues can be resolved by contacting HUMANA Military! Prior to visiting the health benefits advisor, try reaching out to HUMANA to assist you in resolving some of the most common billing issues. Call 1-800-444-5445.