Doctor in England blames Tricare for claims issue
European edition, Monday, April 30, 2007
RAF MILDENHALL, England — The sole pain management doctor within the Tricare system in England temporarily stopped seeing American patients earlier this year due to more than $25,000 in unpaid claims.
The payment issue left six American patients without an insured treatment option and prevented others from scheduling appointments with Dr. Rajesh Munglani, who sees Americans in nearby Cambridge.
While claims have started to be reprocessed and paid in the past few weeks, Munglani said he had outstanding invoices for more than 30 patients, with some claims going back to May 2006. He stopped seeing Americans in February.
At their peak, the outstanding invoices totaled 15,800 pounds, more than $30,000.
“We’ve had to discontinue treatment,” Munglani said in March. “It goes totally against my own principles.”
Munglani stressed that his problem is with the Tricare system and its contracted bill processor, Wisconsin Physicians Services — WPS — not with his American patients or the Air Force intermediaries at RAF Lakenheath, who he said have been helpful. Citing medical privacy laws, base officials did not provide the names of affected patients.
“It’s not the patients’ fault,” said Munglani, who has been a provider in the Tricare system for about eight years. The affected patients were military dependents and retirees.
No American patients of Munglani’s returned to the Lakenheath medical authorities for treatment after Munglani suspended services, Lt. Col. Rex Langston, commander of the 48th Medical Support Squadron at Lakenheath, said in an e-mail.
“Dr. Munglani is now seeing all patients referred to him and as far as we know today the billing issues have been or will soon be resolved,” he wrote last week.
Munglani is the only doctor to suspend treatment as a result of payment issues, Langston said.
Air Force officials, Munglani and Tricare representatives in Europe agreed there was a problem, but they could not agree on why the claims weren’t paid on time. Munglani and his staff said that WPS ignored their concerns. Air Force and Tricare officials said it was paperwork confusion and not indicative of a larger issue. WPS did not return requests for comment.
Wendy Newell, an office administrator for Munglani, said in an e-mail that base officials offered a one-time credit-card payment to clear up the outstanding invoices, but the doctor was unable to accept credit-card payments at the time, and a wire transfer was apparently not an option.
Langston said such an offer was never made. “There’s not been any offer of lump sum payment to Dr. Munglani,” he said.
While things have started improving, Newell said in an e-mail that the WPS system seems “very complicated.”
“The issue of late/nonpayment from WPS is unacceptable and causes much frustration for us,” she wrote. “WPS appear unable to provide us with explanations as to why payments are not forthcoming, even when reminder invoices have been sent. Some form of communication from them would be extremely helpful.”
Munglani said his office normally starts to “chase” delinquent bills after about a month.
“My secretaries didn’t mention the problem to me until most bills are six months (late) or usually much longer,” Munglani said in an e-mail. He said he realized eventually that the only way he could get anyone to listen was to stop treatment.
Claims confusionAir Force officials said the problem lies with Munglani and how his staff files medical claims.
The slightest clerical error can delay processing, Langston said.
“Filing claims in many respects is somewhat foreign,” he said. “They’re not used to doing it like we do in the United States. That can make it onerous on their part. We can’t file the claims for them.”
Munglani said patients fill out the forms, and that there are only problems with dependents or retirees, not active-duty airmen. According to Newell, Munglani’s assistant, claims are sent within a week of the appointment.
In fiscal 2006, more than 270,000 claims were filed on behalf of Tricare — Europe beneficiaries, according to Tricare representatives. Of that total, 1.6 percent were denied for payment.
WPS had five different addresses for Munglani at one point, he said, something that Air Force officials at Lakenheath say has since been corrected.
Providers denying access to patients means there is a repetitive claims problem, said Navy Capt. Mark Copenhaver, of Tricare Europe.
“Normally, Lakenheath or any other [military treatment facility] is in continuous contact with the provider,” he said. “Normally, the provider will go to the Tricare service center and say, ‘I’m having claims issues.’ Normally, these will be taken care of.”
“This is not a normal situation.”