Potential Tricare

[Jay Johnson]

the value of the health benefit has improved greatly. For retirees, the promise of “space available care” first made in the 1950s has been replaced with “universal access” to care on base or, more often, through a network of civilian physicians. Adams called it a “highest-quality” benefit having few limitations.

What a joke. I had to take my 9yr old daughter to shriners because tricare won't cover a SINGLE specialist in the Portland area (we're talking an area of 1 million people or so) for a bone growth on her left ring finger. Time and time again tricare refuses to pay for services and when one finally does find a doctor stupid enough to accept tricare, one quickly finds that said doctor is really a PA or among the worst doctors in town. Hell, my wife is 100% SC for PTSD and they won't cover a SINGLE psychiatrist in the Portland area (but they'll cover some wanna-be nurse practitioner). So, I'm forced to pay out of pocket for her to recieve psychiatric care for a condition THEY caused.

I can't believe congress, and the American public, is letting them cut an already terrible program with next to NO benefits at all.....finding a doctor that accepts tricare is like the current administration finding Bin Laden:-)

[huskerfanfl]

What a joke. I had to take my 9yr old daughter to shriners because tricare won't cover a SINGLE specialist in the Portland area (we're talking an area of 1 million people or so) for a bone growth on her left ring finger. Time and time again tricare refuses to pay for services and when one finally does find a doctor stupid enough to accept tricare, one quickly finds that said doctor is really a PA or among the worst doctors in town. Hell, my wife is 100% SC for PTSD and they won't cover a SINGLE psychiatrist in the Portland area (but they'll cover some wanna-be nurse practitioner). So, I'm forced to pay out of pocket for her to recieve psychiatric care for a condition THEY caused.

I can't believe congress, and the American public, is letting them cut an already terrible program with next to NO benefits at all.....finding a doctor that accepts tricare is like the current administration finding Bin Laden:-)

I did a search of the Portalnd TRICARE and there is a list of 186 psychiatrists that are supposed to accept it, are you saying that all of these are not?

[Jay Johnson]

I did a search of the Portalnd TRICARE and there is a list of 186 psychiatrists that are supposed to accept it, are you saying that all of these are not?

Not a single one. Tricare is a joke and no doctor that actually wants to support his/her family would accept it. My son broke his arm a couple of years ago and the bill for the emergency room was around $5000....tricare paid them around $75, which, by law, they have to accept in that situation.

Tricare pays fractions of pennies on the dollar...they are horrible.

Edited May 25, 2007 by Jay Johnson (see edit history)

[huskerfanfl]

Jay,

It sounds like you have a terrible company in charge of TriCare out there. I can only comment based on my own expereince, but I live in a whopping city of 56,000, and have never had trouble getting service and while they do not pay 100% of any bill submitted they certainloy pay more than your company pays.

[Jay Johnson]

Jay,

It sounds like you have a terrible company in charge of TriCare out there. I can only comment based on my own expereince, but I live in a whopping city of 56,000, and have never had trouble getting service and while they do not pay 100% of any bill submitted they certainloy pay more than your company pays.

Tricare is run by Tricare and the problem really has nothing to do with the company itself. The problem with Tricare is that not only do they pay pennies on the dollar for claims, they also force "providers" to certify with them EVERY year in training courses in order for Tricare to even work with them. So, if a company comes to you and says, "we're not going to pay you anything and you'll have to work really hard to get next to no reimbursement", would you agree to those terms?

The list of Tricare "approved" psychiatrists was about as long as when I looked 2 years ago, but when I called all of those providers they said they weren't taking "new" patients from "TRICARE" or they were no longer "certified" (because they were tired of the BS)...keep in mind that they weren't accepting new TRICARE patients, but they were accepting new patients (from any other medical insurance).

When Tricare decided to send my daughter to a sports medicine doctor (that was as close as they could get to a bone specialist), the doctor just laughed and said why the hell did tricare send you to me? We discussed how horrible tricare was and he said, "the only reason I take tricare is because I feel obligated to help the military.....they are the worst insurance in the country".

Do yourself a favor and ask your doctor about it the next time you see him/her. Tricare is absolutely HATED in the medical community and the only reason most doctors accept it is because they feel some sense of obligation to military families....and this panel wants to charge more and claims the benefits are unmatched???? They're out of their friggin minds....

Edited May 25, 2007 by Jay Johnson (see edit history)

[huskerfanfl]

Tricare is run by Tricare and the problem really has nothing to do with the company itself. The problem with Tricare is that not only do they pay pennies on the dollar for claims, they also force "providers" to certify with them EVERY year in training courses in order for Tricare to even work with them. So, if a company comes to you and says, "we're not going to pay you anything and you'll have to work really hard to get next to no reimbursement", would you agree to those terms?

The list of Tricare "approved" psychiatrists was about as long as when I looked 2 years ago, but when I called all of those providers they said they weren't taking "new" patients from "TRICARE" or they were no longer "certified" (because they were tired of the BS)...keep in mind that they weren't accepting new TRICARE patients, but they were accepting new patients (from any other medical insurance).

When Tricare decided to send my daughter to a sports medicine doctor (that was as close as they could get to a bone specialist), the doctor just laughed and said why the hell did tricare send you to me? We discussed how horrible tricare was and he said, "the only reason I take tricare is because I feel obligated to help the military.....they are the worst insurance in the country".

Do yourself a favor and ask your doctor about it the next time you see him/her. Tricare is absolutely HATED in the medical community and the only reason most doctors accept it is because they feel some sense of obligation to military families....and this panel wants to charge more and claims the benefits are unmatched???? They're out of their friggin minds....

Again, I can only speak about my own experience. I have not had trouble with TriCare, the claims that have been submitted have been settled in a timely manner, I have had no doctor indicate that they do not like TriCare (other than the codes), nor have I had trouble finding a provider. I will have to disagree that TriCare is run by TriCare, it is in fact contracted out in each region.

[Chuck75]

Seems that an additional clause needs to be added to Tricare.

Under any conditions, Tricare shall pay providers at least the amount paid for the same services as Medicare & Medicaid combined.

Or even better, Tricare shall pay providers the same amounts paid by insurance plans that are offered/available to govt employees and members of the US Senate and House.

[free_spirit_etc]

I was amazed at how little Tri-Care paid on some of the charges my husband had --The doctor told us that Tri-Care paid less for the chemo than it cost the doctor - but they made up the difference on office fees etc.

When we were ordering home medical equipment - the provider told us that Tri-Care pays the same rate that Medicare does for equipment. That might be true for most of their payments - they run pretty close to Medicare.

We have Tri-Care Prime, which might make a difference. With that you have to go to a Military Provider if one is available -and have to get authorizations for things. But we never had a problem with those.

In fact -- my husband needed something that Tri_care and medicare usually don't cover - but I called Tri-Care and they said they could pre-authorize it if he had a letter of medical neccessity.

Both the doctor's office and medical equipment supplier kept telling me they woudn't cover it -- but they did.

Just because they won't AUTOMATICALLY cover something - no questions asked -- does not mean they will not cover it. You just have to jump through more hoops to show you need it.

When I told the nurse we needed a letter of medical neccessity - She said that was what the precription was. NOT! No wonder they never get those things approved --if they don't understand that a precription is not a letter explaining WHY something is medically neccessary.

In fact the first time they told me that Tri_care had DENIED the claim. She showed me the letter. It didn't say the claim was denied. It said it wasn't approved yet - as they needed more information.

So I think sometimes the providers themselves cause the problems that they balme on Tri-Care.

I did have some problems with some physicians trying to charge above the copay amount after my husband's death. Tri-care has a daily rate for being in the hospital. And everything is covered. But several doctor's, technicians, etc sent me bills - showing my husband still owed money. Rather than fighting each one of the about it - I just called Tri-care and told them the providers were trying to charge us fees that were not allowable. Tri_care handled it. They sent the providers a letter and sent me a copy - telling them they could not do that.

Had I not known my husband's coverage - I would have just paid the bills. I imagine a lot of people do.

I was reading an article where some retiree's tried to sue because they were promised FREE medical care for themselves and their dependents. The lawsuit was about TriCare requiring 65+ retirees to purchase medicare. They did not win the suit. The Supreme Court said the promises for free medical care were backed by statute - not contract.

http://www.ll.georgetown.edu/federal/judic...ns/99-1402.html

I think that is also one of the reasons vets are denied things with the VA. Like equitable tolling in many cases. Anything that is considered an "entitlement" isn't as protected by law as you would think.

For instance, if you file a claim within one year of complete disability -- they can go back one year. But if you wait over a year -- it only goes by te filing date.

My husband did not file within a year of his cancer diagnosis because he was misinformed about the type of cancer. He was treated at the Air Force Base - but had his surgery at a civilian hospital. For a whole year the Air Force Docs kept telling him it was small cell lung cancer..which grows pretty quickly. It is in all his medical records at the Base (post service records).

After a year - they read the biopsy reports and told him that it was NONsmall cell lung cancer - and due to the slow growth rate of pulmonary adenocarcinoma - that it had most likely started 12 - 15 years before he retired from the service.

The doctor even noted in the records that the records had been wrong and the patient had been misinformed as to the type of cancer. (But he still just noted "Important differences explained to the patient") and gave him a handwritten note of the growth rates and doubling times).

Anyway -- in a civil court - this would be a case for equitable tolling. Or as my husband explained in his inital letter of claim - he did not file sooner because he had been misinformed. So a civil court would equitably toll the 1 year filing deadline.

But from the cases I have read at the VA -- that wouldn't fly at the VA. 1 year is 1 year. It was not the VA that misinformed him (thought it WAS military doctors) - and VA benefits are an "entitlement" -- not a "right." etc. etc. etc.

Free

Free

Seems that an additional clause needs to be added to Tricare.

Under any conditions, Tricare shall pay providers at least the amount paid for the same services as Medicare & Medicaid combined.

Or even better, Tricare shall pay providers the same amounts paid by insurance plans that are offered/available to govt employees and members of the US Senate and House.

[Jay Johnson]

Again, I can only speak about my own experience. I have not had trouble with TriCare, the claims that have been submitted have been settled in a timely manner, I have had no doctor indicate that they do not like TriCare (other than the codes), nor have I had trouble finding a provider. I will have to disagree that TriCare is run by TriCare, it is in fact contracted out in each region.

I've been in Tricare east, Tricare south and, now, Tricare west....these are the three Tricare areas in this country and all were equally horrible.

The problem with many folks, in this regard, is that a lot of veterans have been in the military health care system for their entire lives and have NO clue how health care *should* work. They only seem to consider that the health care is cheap and, therefore, good. Try a good civilian health provider that covers dental, medical and eye......see how much less red tape there is and just how many more doctors actually accept said insurance (as compared to tricare).

We are the richest nation on earth and we shouldn't have to beg for services from some pencil pusher sitting behind a desk.....be it civilians or military.

Yes, tricare will eventually cover most things if you go to their crappy doctors and jump through a ridiculous amount of hoops, but it's simply not worth it to me and it's designed, just like the VA system, to discourage folks from seeking benefits. Could I go to some idiot nurse practitioner for my wife's psych meds? Sure, if I was willing to travel for 1.5 hrs, get on a 5 month waiting list and fill out 25 forms that need to go to 10 different departments ONLY after getting authorization from her PCM. Personally, I'd rather pay out of pocket and get a REAL psychiatrist that is GOOD at his job and can actually HELP her.

Part of the reason that she has been so bad over the last 5 years is because we were stuck using tricare's list of providers....the instant we decided to pay out of pocket we found a psych that specializes in anxiety disorders and has been very open with her in the med process. Because of this, she is more stable than she's ever been on the best set of meds she's had thus far.

So, if you like bad doctors that are willing to accept pennies on the dollar then go for it....I would rather have a qualified doctor that actually has a medical degree and not a glorified nurse and/or some idiot with a general bachelor’s degree with 2 years of wanna-be med school (IE - a PA).

P.S. - Despite the nonsense the media tries to feed the average American, military health care (for active duty) is among the worst health care in the world. They have the least qualified doctors with the least experience and the least educated and trained staff of any health care system on the planet.....3rd world nations get better health care. But it's free, so I guess that means it's good /sigh.

[Ricky]

We see a military doctor on base. Referrals are quick and we have never had a problem finding a doc. If our primary puts in a referral we usually get a letter from the local tricare office providing that the referral is approved and we have an appoint with doctor x on x date which is usually within two weeks. If it is a hurry up kind of thing our doc usually calls a civilian doc and gets us in within 48 hours and then he takes care of tricare.

So for me and my family tricare is wonderful. We can call in at 8 am and get a same day appointment for minor things such as colds etc...... So I am one happy camper and I hate to see the rates increase. I will write as many letters as I can to my congress and senate idiots asking that they step on DoD an stomp hard when they do. If DoD is having a hard time maybe they should cut a few cost items themselves.

[Jay Johnson]

On base care is typically quick and tricare is quick to pay because it's VERY cheap for them. The reason it's cheap is that most military doctors aren't even licensed to practice medicine and/or they are undereducated PAs and NPs. Quick + cheap doesn't always mean good.....

The military needs to do away with stateside military hospitals as does the VA....they are costly and useless.