it's TRICARE week... another question

shan87

I have a Tricare question and coverage with TriCare Standard. I would have FI call Tricare but he is super busy right now, when he gets a chance he is going to also check on this question, until then I thought I'd ask it here.

Backstory:
March, 2008 my Dad at age 50 goes in for his routine Colonoscopy, no other reason to get it besides for his age. Well they found Stage 4 Colon Cancer that had spread to his liver, lymph nods and pancreas. The cancer specialist estimated the cancer had been growing for 12 years. They judge by the previous and current rate of growth that he has 2 good years left.

June 2008: I go in for my yearly female exam with my Primary Care Physician. I tell her the news and her opinion is that based on family history that I should start getting yearly colonoscopies at age 24.

Dec. 2009: Dad's cancer spreads to Brain and two weeks later he passes away.

Present: My 24th birthday is in July. David and I will be married by then and we are pretty sure we have picked Tricare Standard for me.

I am wondering if this insurance will cover these yearly "preventive" exams. (My sister was not covered and my mom's current insurance plan also does not cover it, so it can run a couple grand if you are put under) After having my dad die in my arms there is no way I will not be getting these exams and I will willing to plead my case to Tricare:) I just don't know if I will need to have my current doctor speak with someone/send a referral or make sure it is documented in my file. Or if I am doomed to spending the $$ every year.

(also I am really involved in a couple Colon Cancer organizations so I know there is some help out there emotionally and financically but it adds up!)

greeneke2

This is what I found on Tricare's website for Tricare Standard.  

For individuals with hereditary non-polyposis colon rectal cancer syndrome, exams are available every two years beginning at age 25 (or five years younger than the earliest age of diagnosis of colorectal cancer, whichever is earlier), and then annually after age 40;For individuals who have first-degree relative diagnosed with sporadic colon rectal cancer or adenomas before the age of 60 or multiple first-degree relatives with colon rectal cancer or adenomas, exams are available every three to five years beginning 10 years earlier than the youngest affected relative.Once every 10 years beginning at age 50 for individuals at average risk for colon cancer.

If you have any questions you can always go to www.tricare.mil

greeneke2

For more specific info, I might message Ilumine because she know A LOT about Tricare!

shan87

Thanks, I should have done some more digging before posting.

ETA: Green what part of the site did you find that under?

greeneke2

http://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Colonoscopy

If you use the drop down menu you can check out some other things you have questions about!

SamiJoeB

Isn't FI AD? if he is, you should be able to enroll in Tricare Prime, which I believe is at least a little bit better about coverage...

SarahP787

I'm sorry to hear about your dad

If Tricare won't cover you (and based on green's post, it looks like they might not since 24 is earlier than 10 years prior to your fathers diagnosis) your doctors can write you a letter of medical nesesity or even call Tricare to argue your case. I have zero experience with Tricare specifically, but if your doctors have good medical reasoning to back them up it's always worth a shot.

*Professional Plug* Have you ever thought about seeing a genetic counselor about your family history of colon cancer? It sounds like your dad's cancer may have started when he was very young, and a GC might be able to help you figure out your chances of developing cancer based on your family history, or even the chances of a cancer suseptibility syndrome being passed down in your family (like hereditary non-polyposis colorectal cancer syndrome.)

shan87

In Response to <a href="http://forums.theknot.com/Sites/theknot/Pages/Main.aspx/special-topic-wedding-boards_military-brides_its-tricare-week-another-question?plckFindPostKey=Cat:Special Topic Wedding BoardsForum:13Discussion:69b1e35d-da46-439b-bdbb-59c849972026Post:96f5182e-18cf-4c39-a866-784363c1a045">Re: it's TRICARE week... another question</a>:
[QUOTE]I'm sorry to hear about your dad :( If Tricare won't cover you (and based on green's post, it looks like they might not since 24 is earlier than 10 years prior to your fathers diagnosis) your doctors can write you a letter of medical nesesity or even call Tricare to argue your case. I have zero experience with Tricare specifically, but if your doctors have good medical reasoning to back them up it's always worth a shot. *Professional Plug* Have you ever thought about seeing a genetic counselor about your family history of colon cancer? It sounds like your dad's cancer may have started when he was very young, and a GC might be able to help you figure out your chances of developing cancer based on your family history, or even the chances of a cancer suseptibility syndrome being passed down in your family (like hereditary non-polyposis colorectal cancer syndrome.)
Posted by SarahP787[/QUOTE]

I have thought about the genetic testing, and my dad did get tested, I believe. But if I get tested and they match the Gene its a "pre-existing condition" and thus insurance wont cover it.


ETA: I am super scared to see what my Genes say about me, as my Dad's brother was just diagnosed with Stage 2 Throat Cancer - the same cancer his dad (my Grandpa) died from ages ago. To put it lightly my genes suck haha.

shan87

In Response to <a href="http://forums.theknot.com/Sites/theknot/Pages/Main.aspx/special-topic-wedding-boards_military-brides_its-tricare-week-another-question?plckFindPostKey=Cat:Special Topic Wedding BoardsForum:13Discussion:69b1e35d-da46-439b-bdbb-59c849972026Post:d42741fe-d71a-4368-bdf3-7dc0c42684c1">Re: it's TRICARE week... another question</a>:
[QUOTE]Isn't FI AD? if he is, you should be able to enroll in Tricare Prime, which I believe is at least a little bit better about coverage...
Posted by SamiJoeB[/QUOTE]

Yes, David is Active Duty. He didn't even know there were different levels of TriCare. So he was just planning on leaving it up to the DEERS office. I may need to ask more about it when we get my Mil ID and all that jazz.

SarahP787

In Response to <a href="http://forums.theknot.com/Sites/theknot/Pages/Main.aspx/special-topic-wedding-boards_military-brides_its-tricare-week-another-question?plckFindPostKey=Cat:Special%20Topic%20Wedding%20BoardsForum:13Discussion:69b1e35d-da46-439b-bdbb-59c849972026Post:8b59a148-9766-4bb6-8c4a-a2487f0133db">Re: it's TRICARE week... another question</a>:
[QUOTE]In Response to Re: it's TRICARE week... another question : I have thought about the genetic testing, and my dad did get tested, I believe. But if I get tested and they match the Gene its a "pre-existing condition" and thus insurance wont cover it. ETA: I am super scared to see what my Genes say about me, as my Dad's brother was just diagnosed with Stage 2 Throat Cancer - the same cancer his dad (my Grandpa) died from ages ago. To put it lightly my genes suck haha.
Posted by shan87[/QUOTE]

Genetic testing isn't for everyone - not everyone wants to know! And it can be a very scary thing, especially when you have so much personal experience with people who have had cancer.

But if insurance is really a barrier for you, my understanding is that the Genetic Information Nondiscrimination Act of 2008 should make it illegal for  insurance companies to use predictive genetic testing against you as far as coverage. (Once you actually have symtoms, in this case cancer, then they get to treat you like any other patient.) And it sounds like Tricare might cover more extensive screening for people with an HNPCC mutation (although there *are* other hereditary colon cancer syndromes, I don't know which your dad may have been tested for.)

But like I said, some people prefer not to know and that's enough reason all by itself :)

LuluP82

I have Prime and I like it. The biggest issue with Prime is you have to see your PCM for referrals, I think (as far as I can tell, that's the biggest obstacle). However, after talking to other wives, I learned that your PCM doesn't have to be at a military facility. Nothing against military facilities-- I actually have received great care at them when I've gone-- but we live a bit far from base, so the thought of having to go on base every time I need a dr was annoying! But, if you live far from base, you can see whoever you want on the PCM list. I found someone I LOVE, and she's been actually super helpful in navigating the system.

I have civilian health insurance through my job, which we keep since it's great insurance and for both of us under $50 a month for medical, vision AND dental...but here where we are, Tricare is accepted more places than my civilian insurance. I thought about switching to Standard until I realized Prime is better (you'll be put on Standard automatically I believe, you have to enroll in Prime, but Prime is free/cheaper)

shan87

Thank you so much ladies! David was unaware that there was different levels and he was really confused about the varying coverage. Wedding is next week so we can talk it over at that time, then in August when I get set up with my Mil ID and such I'll make sure to ask the DEERS people.