Category: Tricare

My personal Tricare experience: I have received several years of harmful care, after decades of inadequate care, from Tricare.

Recently, my soon-to-be-former PCM defended his negligent/health-threatening care by telling me that I had not been aggressive enough in managing my own care.  I countered that aggressively managing one’s own healthcare is very difficult when one has a chronic debilitating condition (especially a condition that affects one’s cognitive abilities).

But today I’m having a good day, abilities-wise, so let’s talk about fighting fire with fire.  You want me to aggressively manage my own healthcare?  Look out, buddy, you just summoned a pissed-off veteran, and you’re about to regret it very, very much.

A friend of mine has a saying about dealing with others, especially those who work in any area interacting with clients/customers.  When encountering roadblocks in daily life having to do with the ignorance, apathy, or incompetence of others, my friend asks exasperatedly, “How many people’s jobs do *I* have to know how to do???”  (Meaning, since you can’t do your job correctly and give me the information and assistance I need, I will have to learn all of the information, procedures, laws, regulations, etc. myself in order to get the result I need.)

We have decided that the answer to this question is “ALL of them.”

ALL of the People.  ALL of the Jobs.

To be fair, there are some *awesome* people in this word who like their jobs, know how to do their jobs well, and like helping others.  When these magical unicorns cross your path, you do whatever you can to make them stay in your life, and you let them know how appreciated they are.

For the Non-magical-unicorn days, which is most of them, you learn how to do ALL the jobs.

Alright, soon-to-be-former PCM, you want me to aggressively manage my healthcare?  You got it.

Today I visited a Tricare Patient Advocate.  I walked in to the largest MTF near me, went to the information desk, and asked for the Tricare Patient Advocate and they hunted around until they found one, who came out and spoke to me face-to-face.

[I had previously located a Tricare Patient Advocate email address for a local advocate.  I emailed in November, and am still waiting for a response over five months later.  (Not the same advocate as the one I spoke to today.)]

The Patient Advocate gave me the contact information for the DoD’s Interactive Customer Evaluation (ICE).  I am going to contact ICE and provide “customer evaluation” on the negligent care I have been receiving, such as waiting 27 months for an MRI/Arthrogram of my wrist, even after I specifically told my soon-to-be-former PCM that my shoulder orthopedic surgeon suspected that I could have a torn ligament in my wrist, and then requested that my PCM submit a referral for an MRI and Arthrogram, which he did not do.

I will tell them that I gave up on ever receiving the care I needed from Tricare, and instead requested an MRI/Arthrogram from the VA, which I received within 6 weeks and which confirmed that I have *two* torn ligaments in my hand/wrist.

There are a few other things I will discuss with ICE about the inadequate care I received from this PCM…

But, next, after speaking to the Patient Advocate and confirming that my PCM did submit a request for referral to a wrist orthopedic surgeon after I confronted him with the results of my (VA) MRI/Arthrogram, I went home to aggressively manage my referral.

I called my Tricare region’s customer service number.  I never reached a human being. (ALL of the People. ALL of the Jobs. ALL of the Computers?)  I chased menu options long enough (15-20 minutes) to figure out that I would not get the level of information I needed from a machine.

So I bit the bullet and created an account on my region’s Tricare website.  I had been avoiding creating an online Tricare account, given the government’s track record on protecting personal information.  I don’t want my health information compromised.

But I needed access to the information, which I got after I created my account.  I was able to see the referral letter and, most importantly, the authorization number.

There are several useful pieces of information on Tricare referral letters.  If you keep reading past the name and contact information of the healthcare specialist to whom you have been referred, you will see this sentence: “This authorization is valid for the dates and service codes that follow on the back page.”  Keep reading until you reach the dates and service codes.  Make sure that your treatment takes place with the date range, and that you do not receive any treatments that were not authorized, or you will have billing problems with Tricare (as in, they may refuse to pay).

If you keep reading past that section, you will see a section titled “If You Would Like to Choose a Different Provider.”

Did you know that if you are not referred to an MTF, but are instead deferred to network, you can choose to see *any* in-network provider of the same specialty?

Also, as per the referral letter, “if your authorization number begins with a 7, you do not need to notify us of a change in provider.”

[Authorization numbers can also begin with a 4, in which case, you *do* have to get prior authorization to switch providers.]

***CAUTION: “You may not switch providers if you have already begun seeing a provider for the service authorized in this letter.”

Armed with that information, and all of the research I had done on orthopedic wrist and hand surgeons since my (very-belated) diagnosis, I called the office of the in-network surgeon I had selected, and scheduled an appointment for later this week.

This probably shaved several weeks off my wait-time, instead of waiting for the referral letter to come in the mail and then trying to figure out how to change providers.

The Patient Advocate also gave me advice on how to switch to a different PCM, given the current constraints of the system (patients being forced to use PCMs at MTFs only; no network PCMs; MTFs not accepting new patients due to being over-capacity).  We decided it would be best to remain with my soon-to-be-former PCM until the wrist/hand surgery is complete, so as not to cause hiccups in the system.  But I will be switching to a different PCM and a different MTF as soon as that is complete.

Meanwhile, I continue to receive excellent care for my other health issues from the local VA facility.

As far as resolving my issues with Tricare, I followed the chain-of-command, as well as rules of common decency.  I tried resolving my inadequate healthcare issues first with my PCM, who got defensive and hostile.  Then I went to the Patient Advocate.  Next I will file an evaluation with ICE.  I will also be completing an Army Provider Level Satisfaction Survey (APLSS).  If I still don’t receive a satisfactory resolution, I will continue to pursue the matter (on the days my health permits me to battle).

I have no illusions that my PCM will change his methods as a result of these actions.  He is impervious to feedback, and I’ve seen much worse healthcare providers remain in the military healthcare system, sadly.

The best I can hope for is:

1.  To insist I get the care I need for my health conditions and injuries
2. To insist the providers of this care are highly competent
3. To hold this PCM accountable for his negligent care by reporting it
4. To provide helpful information to others who are dealing with similar situations

I suspect by the time I am done, my soon-to-be-former PCM will regret having ever told a pissed-off veteran to be more aggressive about their healthcare.  Mischief, I mean Healthcare, Managed!

Another good reason to embrace preventive health and self-care: retiree health care benefits continue to erode.  Recent proposals would make health care significantly more expensive for retirees and their families.

According to this article in Military Times, the Pentagon’s proposed 2017 budget includes several changes to the existing Tricare system and to the fee structure.  The most significant price change is the proposed implementation of an annual healthcare fee for “working-age retirees” – retirees (and family members) who are not yet eligible for Medicare.

Under the proposed plan, Tricare would be re-structured into two choices: Tricare Select, which provides care through military treatment facilities (MTFs) and is similar to the current Tricare Prime option, and Tricare Choice, which provides care through civilian providers and is a hybrid of the current Tricare Extra and Tricare Standard options.  Tricare Select would cost $350 for an individual or $700 for a family (per year).  Tricare Choice would cost $450 for an individual or $900 for a family (per year).  Please see the Military Times article for proposed co-payment rates and other proposed fees, which would be in addition to the annual enrollment fee.  What’s the bottom line?  According to MOAA’s president, retired Air Force Lt. Gen. Dana Atkins, “the full array of fee changes would mean about a $500 to $600 annual increase for retired families under 65 who use in-network providers and an increase of more than $1,000 a year for those using out-of-network providers” (MOAA article on the proposed changes here).

The proposed budget also includes increases to the catastrophic caps for beneficiaries.  For retirees, the cap would increase from $3,000 to $4,000, and participation fees would not count toward the caps.

Military Times states, “According to budget documents, the changes are designed to entice more beneficiaries to use military hospitals and clinics by continuing to offer care at these facilities at no cost to patients and curb the rising costs to DoD of private care.”  As has previously been pointed out on this blog, this places patients in a very difficult position when MTFs in their area are at capacity and not accepting new patients.

Furthermore, MOAA is concerned about the robustness of the non-military network of providers.  In the MOAA article, Lt. Gen. Atkins asserts, “One of the main access problems is that many doctors don’t want to be in the current network.  We’d like some assurance that will be fixed.”

The new system would require annual enrollment, and families who fail to enroll and pay the enrollment fee will forfeit coverage for the plan year – in other words, coverage would no longer be automatic, and if you don’t sign-up during the enrollment period, or fail to pay the fee, you would have no military healthcare for that year.  While it is suggested that requiring annual enrollment would bring Tricare in line with civilian heath plans, one wonders about ulterior motives.  Research has repeatedly shown that individuals are more likely to participate in benefit plans that are opt-out, rather than opt-in (read more here, here, or here).

These proposed changes are intended to change beneficiary health care behaviors.  In other words, if it costs more to see doctors and specialists, and it costs more to have prescriptions filled, maybe you won’t use them as often.  (Of course, if you miss the sign-up window, you won’t be using them at all that year.)

There are many ways to respond to these proposed changes.  I choose to respond to a future that most-likely includes increased healthcare fees by taking actions to improve my health.  How about you? Why not take control of your health and your finances by practicing informed preventive health and avoiding increasingly more expensive co-pays?  You may find that managing your health through diet, exercise, meditation, or other self-care practices could reduce your need for medications and reduce the frequency of your visits to the doctor.  Why not focus on the part of the equation you can control?