I’m feeling a little crankly this morning. This whole Tricare open season has me stressed about whether to switch to Tricare Select, and I’ve been spending a ton of time comparing the costs and benefits and trying to figure it all out. Which is ridiculous, because this is already my full-time job and I should already know every single in an out of this, except I can’t because NO ONE ACTUALLY KNOWS ANYTHING.
Now, this has been a year of dramatic change for Tricare. Standard became Select, the regions and contractors changed, co-pays jumped dramatically, the fiscal year changed, retirees were no longer default enrolled in Tricare Select, and the Open Season system has gone into effect. It’s understandable that there were some hiccups along the way.
But it’s November. Why is this stuff still so messed up?
Here’s an example: we have a child on Tricare Prime, because she’s not eligible for the US Family Health Plan like the rest of us because of her location at college. She has a specialist she sees every couple of months. Last fall, she found a doctor that took Tricare Prime and we set her up for an appointment in January of 2018. I verified with the provider and with the contractor that this doctor was in-network. She shows up at the doctor’s office in January and is told that Humana is having some problem and that while they did all the paperwork to be in-network with Tricare under Humana, Humana couldn’t find it and no one knew what was going on. I paid for the visit out of pocket, a couple of hundred dollars, and the doctor’s insurance person said she would continue to try to figure out what was going on. My daughter had another visit in March, which I again paid out of pocket. Then, the Humana website said that they’d paid both those bills. Whoohoo – finally the doctor had gotten in-network. My daughter went to the doctor in May, and there was no payment due, and we got reimbursed for the previous visits. All sorted, right?
She shows up in August for another visit, and is asked to pay a $72 co-pay. I called and talked to the insurance specialist, who said that due to all the hassles with Humana, they were never in the network. Now I have my child established with a specialist, who she likes, who is not in the network.
Which is why I am looking at Tricare Select for her, and as long as I’m moving one person to Select, maybe I should move the whole family?
So then, trying to figure out the best plan for 2019, I pull up the 2019 Tricare Costs and Fees document, and there’s a lot of stuff there that doesn’t make sense. In particular, there is what appears to be a significant error in how the catastrophic cap is applied to those with a family member on Tricare Young Adult. I’d call and ask, but the Tricare/contractor reps never give the same answer twice. So I went to the Tricare Facebook page, and I asked a question, and am getting a ridiculous run-around of mis-information from someone who clearly doesn’t understand anything about Tricare Young Adult and catastrophic caps. (I’m seriously considering adding the screen shots here. Eh, I’ll just link… my really frustrating Facebook conversation with Tricare, in which they admit that their published 2019 Costs and Fees have an important mistake.)
I’m not the only person who is having trouble with Tricare and its contractors. Military family members across the country are taking to social media to express their frustration with denied claims, incorrect provider directories, customer service reps giving inconsistent information, all sorts of problems. It is ridiculous, and it is costing military families money paying for things that should be covered by Tricare, and Tricare beneficiaries are not getting care that they need.
Health care benefits are an important recruiting and retention tool, particularly because Tricare is arguably the best health coverage available in the United States. But being the best isn’t worth much if it doesn’t work the way it is supposed to work. More frustrating, I don’t see anyone in military or civilian leadership doing anything to try to fix the situation. I go to these military families events, and listen to high-level Department of Defense officials talking about the importance of family programs to ensuring that we can sustain an all-volunteer force into the future.
How about we fix the important program that we already have?
If you’ve had problems with Tricare, Humana, or Health Net Federal Services, please consider filing a complaint with Tricare and/or your federal legislators. I used to hate it when people said, “Call your congressman!” but it is becoming clear that this problem is not going to fix itself.
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