Thursday, July 3, 2008

Tricare Prime Preference Question

Ok, this has long been on my mind, so I'm just going to throw it out there because I'm a curious gal. Why do you military wives avoid using Tricare Prime when you have the option? I mean, when you can use an MTF, but you choose instead to use a provider in town. I used civilian doctors before I was married (not for anything like birth, though), and didn't really think the care was much different from that I receive now. (Except my doctor never deployed to Iraq or PCSd on me, of course!) Since being married, I've only had Tricare Prime and used the Naval Hospital here. I delivered both babies, one with a husband at sea, and have nothing but good to say about it. There are definitely things that didn't work out too well, but nothing I would say is particular to military care or that hospital. What has me really curious about it is the negative impression some people seem to have about military care. We see family practice doctors. They are split between the military providers and a few civilian ones on another floor. The only really negative experiences I've had there have been with the civilians. I avoid them at all costs. It does seem like there are a lot of residents, which is definitely an issue at times. They are hard to get an appointment with which messes up consistent care, and there is the experience factor. The doctor that delivered Wyatt was a resident, though, and she was the best one I've had here yet. I was so sad when she moved to Guam! I'm just really curious why people choose to not use an MTF and avoid the insurance hassles in the civilian world. Unless something horrible happens or it's unavailable, I will not be using in-town care while we are active duty. I just don't see the value of doing that.

9 sonar pings:

Mrs. Staff Sergeant said...
This comment has been removed by the author.
Mrs. Staff Sergeant said...

I was just going to write you back via Email about your last comment on my doctor/insurance post. But seeing as you posted about it here, I'll just answer you here :)

We have Tricare Prime and have never used any other insurance since J joined the military. I have no complaints what-so-ever about them and have been as mystified as you about why so many military families seem to gripe about it so often.

When Dillon was diagnosed with cancer we had moved to NY to be closer to family while J was in Korea for a year. That forced us to switch to Tricare Standard for a bit (until we moved here to Jersey) but even then all we ever paid was $1000 for the entire year he was on treatment. (His bills have easily topped a million dollars by now- no lie). I feel unbelievably blessed to have such good health insurance! Many other families we know who have dealt with similar situations in the civilian world have had to file for bankruptcy.

As I've been trudging through my latest problem with referrals and specialists it's become clear that the problems are NOT stemming from Tricare, but from my doctors office. Long story short, they never submitted a referral for me to be seen by a specialist at all and that was what caused the problem. Tricare has assured me several times that they will have no problem approving the appointment and covering costs if only the doctor would send the correct forms for the request.

I finally got the doctor to do what they were supposed to do yesterday and, lo and behold, I had my approval number from Tricare by the end of the day!

Bottom line is- this office screwed up big time. It wasn't the insurances fault. And I already have a request in to Tricare to be moved to a different OB provider. I'm done dealing with the ones who cant seem to get their facts straight.

Just to clarify, I do see a civilian OB here in Jersey, but not because I chose to. There isn't an OB practice on base here and everyone gets referred off base after the initial confirmation of a pregnancy.

As far as I know, the only other thing they don't provide here is An ER. We need to go to a civilian hospital for that too, but the base ambulance will take you if you call 911.

We see the military doctors for everything else under the sun right on base and again I've never had a complaint about them that wouldn't be something you'd deal with in a civilian practice too. At the very least it's extremely convenient to be able to walk across the street for all of you medical care, lol.

So that's that. I don't get it either.

Ana said...

Ah, ok. Your story did make me think about this again; I wondered if you just didn't have access where you guys were stationed. I hope you're new doctor is a whole lot better than the old one!

Anonymous said...

Well, I use the MTF for myself, but for my children I have chosen a provider in my town. It is 2 minutes from my house and I can get in and out of there much faster than the MTF. Plus, they get to see the same doctor every time.

My youngest has some minor medical issues and I knew that being out in town would make it easier for him to get quality care, and I have been right. I don't struggle with insurance issues. The doctors' offices handle them all and, believe me, we have lots and lot of referals. I haven't had one problem. It is actually unreal how easy it is.

I don't think that the care is significanly better in town. Except for my son's physical therapist. He is awesome, and I know I wouldn't get that at a MTF. The one complaint I have about the MTF is that you have to see someone different all the time. Sure, they assign you a provider, but you never get to see them. You see everyone but them. If I want to see my provider I have to wait to see her. I also found that it is much easier to get appointments to outside doctors. It gets a little old waiting 2 weeks for something that isn't urgent to them.

I think that it is great that they give us a choice. When I first married my husband, we didn't get a choice. Then, we had a choice but we had co-pays if we wanted to exercise that choice. Now, we truly get the choice with no co-pays.

Overall, I don't have many complaints about Tricare. They have covered all of my son's issues with not one hiccup. I wish we had a little more choice in certain specialties, but that is not Tricare's fault. Well, unless you factor in that Tricare doesn't pay well.

Anyway, this got long. It is something close to my heart because I don't think that the rules of Tricare are understood by many families. I have even caught the Tricare office not exactly telling the whole truth to people and it bothers me. So, I try to talk about it a lot. :)

sues2u2 said...

Ok, I'll add my two cents too. Hubby is retired & we still use tricare prime! For one it's cheaper & for another being in Army town we get to see civilian drs with a $12 copay. For that I am thrilled. We still can use the post pharmacy however but with the war civilians are shuttled off post which is fine with me!

Military Drs. Some of the best doctors we've ever had were military although I'm not too fond of Army OBs. You see they made me stay in labor for 36 hrs on pitocin with 32 of that being "hard" labor to the point of me passing out in between contractions. My son ended up being born by emergency c-section & was in the NICU for a month with a life flight transfer to Mannheim. (for that month we only paid $90! Definitely a "bargain")

In the states we were seen @ the National Naval Medical Center & we had the best care! They truly were wonderful. As a matter of fact my son had the same pcm for the 9 years that we were there & I never had any real problems getting in to see them. We did however have some problems with civilian specialists (getting in to see them!) & getting dermatology (army dr) to forward the right forms to tricare.

So while I don't think too much of regular Army Dr's (loved the Dr's we had with N in the NICU) we have had some truly wonderful care with the military.

Ana said...

I hadn't thought about consistency of care too much (although it has annoyed me greatly to have had two good docs and lost both of them - one to a PCS, one to Iraq). We've been lucky to have no one with any real healthcare problems, so we are really only going in for the odd issue here and there and well-baby checkups. If anyone ever did have a serious issue, I can totally see going into town just to use one doctor all the time.

And that appointment line, eh, that could be a whole post in itself...I do miss being able to schedule appointments the same day you were told to get one. All this playing phone tag is REALLY irritating.

trying said...

I've had some iffy military doctors (most have been OB's and the base were at isnt really used to providing that service. They see mostly cadets and retirees at our hospital). I prefer to use MTF whenever possible.

My oldest see's an civilian GI b/c there isnt one around and he's fantastic but for the first year the insurance was a nightmare. So when they asked if I wanted an outside allergist for him I told them Id rather drive six hours to Walter Reed.

As long as the standard of care is what I feel it should be I'll stick with MTF and work within the system that we have.

Laura said...

I have also been mystified by people opting to change to Tricare Standard, rather than use a MTF.

We have had good experiences. I had a home birth with a midwife...Tricare paid for most of that.

We lived in a remote area without access to a MTF...and were able to find an awesome doctor there, completely covered through Tricare Prime Remote.

Here, I have already changed my children from their assigned civilian provider back to the MTF...because Tricare wouldn't cover services thru the civilian that I could get done at the MTF. The only problem I have had here have been with the civilian providers at the MTF...especially the ones who barely speak English. However, there is no problem in saying that I do not want to see him, and they give me appointments with another provider. We've had no problems getting necessary referrals...allergists, ENT, audiology, neurology....yeah, we've gotten referrals for them all in the last 2 months....

Emily Snow said...

Since we are living overseas as military civilians, we have access to the military medical clinic. We don't have Tricare, but we use our Bluecross Blueshield insurance, we do have to deal with a lot of paperwork and hassle but all the same, I am so glad to have the option of seeing an American doctor.

Going in, I had a bad impression about military medicine, and although it is a little different, I have felt that we have received quality care with very little complaint...yes, there is complaint about sometimes not being able to get in for a sick visit, but that happens everywhere. Military can start calling at 6:30 AM and civilians at 7:30 AM and there was one day this spring where I called and they were already full... The only difference is that we don't have a instacare to go to if that is the case, like I am assuming you would if your military doctor couldn't see you in the States or my doctor in MD couldn't see me.

Some of the other nearby military bases are closing down this summer and moving to our area, which will mean as a civilian, it will be harder and harder to get a sick appointment, which means that we will have to go out "on the economy" and see German docs...I am not looking forward to the even bigger hassle the insurance will be and having to pay upfront with a wad of euros in my wallet! I know for me, I will always try to go to the clinic first!

Also, this spring I went to a military OBGYN for my yearly visit. No one, absolutely no one in my ward goes there, they all go to one german OB...I am baffled. So, I gave it a try and you know what, it was one of the most respectful, careful (as in it didn't hurt too much!) exams and appointments I have had! I'm still baffled!