Military Brides

TRICARE FACTS vs incorrect information being provided to Kendall

I was reading the reply posts to Kendall and just had to point out some incorrect information.  I actually WORKED as a Patient Advocate for a military association.  My job was to help benes navigate the program, so I have NO HIDDEN LOVE for TRICARE, but I dont want people to have WRONG information either. 

That means they wont get the care they need.

1) TRICARE does have a Dental Option.  Just like civilian health care, it is purchased through a secondary network company, UNITED CONCORDIA  - http://www.tricaredentalprogram.com/tdptws/home.jsp  The costs are $12.69 per single dependent and $31.72 for a family plan.  The benefits covered and out-of-pocket costs (ie procedures) are comparable to the civilian world (ie TRICARE bought the UCCA plan that they were already offering up).

2) TRICARE IS NOT BASED ON RANK.  At least not for the Dependents (though a General's wife may have better access...but its not a legal offering). 

TRICARE has two basic Plans, PRIME and STANDARD. 

Prime is their HMO plan, very controlled, red tape (though Kaiser Permanente has more hoops that TRICARE), and full of referrals...but free (as in no co-pays or premiums). 

STANDARD is a PPO, where you will pay a cost share of 20% if you see a doc outside fo the MTF network or 15% if your doc is in the network. HOWEVER, your fiscal year Catastrophic Cap is only $1000. 

There are a few additional plans, TRICARE PRIME REMOTE for Active Duty personnel stationed outside of an MTF catchment area, such as recruiters or Coasties, or the Reserve Select for the G&R or TRICARE FOR LIFE for those recieving Medicare. 

RANK does not come into play until you are retired and have to pay premiums...but THE BENEFIT COVERAGE is the same for everyone. 

3) TRICARE ACTUALLY HAS THE BEST BENEFIT COVERAGE IN THE US right now.  That is to say, TRICARE will cover almost every DX, without a financial cap, using every universally (american that is0 accepted procedure out there. This is not true for most civilian insurances, that actually disallow certain diseases, procedures or drugs for care (ie very restrictive formularies) and CAP how much they will pay out in a year or a lifetime.  

4) TRICARE DOES NOT HAVE A PRE-EXISTINT COVERAGE constraint. You cannot say that for almost any other Insurance out there. 

5) TRICARE DOES NOT HAVE AN UNDERWRITTER, THE DOD and its yearly BUDGET underwrites TRICARE.  There are THREE regional companies that provide for (ie contract) the civilian providers and hospitals, with additional contractors that process the claims.  However, those companies get their money directly from US Government Contracts.

Their benefits coverage and formulary are decided upon by TRICARE itself.  TRICARE bases its coverage on the Standard of Practice in the civilian world.  So, if you are pregnant, you will only get 2 U/S covered, LIKE THE REST OF THE CIVILIAN WORLD.   However, if your at risk, they will cover more, LIKE THE CIVILIAN WORLD. 

As for the DRUG.  Their formulary is actually one of the most robust, since BY LAW, TRICARE MUST PROVIDE EVERY APPROVED DRUG TO ITS BENEFICIARIES.  While they DO have a Generic First and Step Program Policy, they WILL give you a Third TIer Drug at the Second Tier cost if its Medically Neccessary - OR FREE if the drug is on the Core Formulary for the MTF. 

That means that if you get CANCER, your out-of-pocket costs for everything will never ever ever be more than $1000 a fiscal year.  Can you say that about any other CIVILIAN policy? 

Now, I am not saying that TRICARE is the most wonderful program ever.  They do have issues, like following their legally mandaged Access Standards, providing referrals, over crowding visits and I coudl go on and on about the care overseas.....

But it is NOT the cesspool we make it out to be. The best way to make it work is to KNOW The TRUTH about how it works and demand your rights.
 
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Re: TRICARE FACTS vs incorrect information being provided to Kendall

  • calindicalindi
    5000 Comments Second Anniversary Combo Breaker
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    edited December 2011
    Thanks for that! Insurance in general isn't what we'd hope, but it is an industry issue, not a military one. TriCare is one of the better options, though still has a lot of hoops to jump through.

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  • edited December 2011
    I think the biggest thing that sucks about tricare is having to use their doctors/dentists. Sorry if I offend anyone but I have had to get tested several times at the doctors, and been misdiagonosed before. And Just had to deal with a TON of dental work all because themilitary dentist could do it right the first time around... pita... ok that's my rant I'm done now.

    Thanks for posting thing, I'm sure a lot of people will read and appreciate it :)
  • edited December 2011
    firsttimer-you might what to look into tricare standard when you get married.  You'll be able to go to civilian doctors
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  • edited December 2011
    Oh no I know that. I have tricare right now as well as a bluecross. All that stuff was done when I lived in Germany; and it's really hard to get a referral to a civilian doc/dentist there since that means she/he wouldn't be American.
  • edited December 2011
    OHhhh I see.  Yea I don't like military doctors.  I won't let them anywhere near me.  I'm convinced they have NO idea what they are doing.
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  • Sammy0709Sammy0709
    Fifth Anniversary 500 Comments 25 Love Its
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    edited December 2011

    I always get unreasonably offended when people cut on the military providers as my husband is one eventhough I know no one means anything by it. 

    That aside.  I'm fortunate that I have never had to deal with any bad military providers because I have only been to one base and the majority seem to be pretty good here.  However, I have worked will a lot of pretty terrible providers when I was training to be a respiratory therapist at a civillian hospital.  Because of that, I think I have the exact opposite opinion as most people.  I always try to keep in mind that DH IS NOT paying top dollar for my healthcare (about $20) I think so I can't really expect much. 

    I'm also probably a little more positive about it and give some docs the benefit of the doubt because I was in the student position once and a lot of the doctors are fresh out of med school so I don't expect much.

    Now, all of that being said, I would trust DH before ANY provider at the hospital for most of the procedures I will have in my life (excluding any major surgery).

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  • edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    I always get unreasonably offended when people cut on the military providers as my husband is one eventhough I know no one means anything by it.  That aside.  I'm fortunate that I have never had to deal with any bad military providers because I have only been to one base and the majority seem to be pretty good here.  However, I have worked will a lot of pretty terrible providers when I was training to be a respiratory therapist at a civillian hospital.  Because of that, I think I have the exact opposite opinion as most people.  I always try to keep in mind that DH IS NOT paying top dollar for my healthcare (about $20) I think so I can't really expect much.  I'm also probably a little more positive about it and give some docs the benefit of the doubt because I was in the student position once and a lot of the doctors are fresh out of med school so I don't expect much. Now, all of that being said, I would trust DH before ANY provider at the hospital for most of the procedures I will have in my life (excluding any major surgery).
    Posted by Sammy0709

    I'm sorry I didn't mean to offend you.  I know that there are good military doctors and there are obviously some bad civilian doctors as well.  I've just had way more bad experiences with military doctors than with civilian ones.  I like the fact that I can research and choose what doctor I'd like to see.  That is just me though!

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  • Beachy730Beachy730
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    edited December 2011
    Thanks for posting.  I think the main reason most of us were just giving the negative aspects ot Kendall is because she is getting married early and young just to get better insurance than she says she has on her parents' plan.  I don't think that's any reason to get married, and was trying to point out that Tricare isn't going to be the easy insurance she wants, where she just tells a doctor she wants this script and they cover it.  I don't think she truly understands how it works at 19.  I know I sure as hell didn't. 

    Also, my comment about depending on rank was more referring to United Concordia, but I was just speaking of military insurance in general.  Once you get higher in rank (I think like E-5 but I can't remember for sure) the percentage they cover gets better.  

    Also, we have had to deal with Tricare Remote and it was a giant PITA.  I was just praying that I didn't need to go to any doctors or anything in the few months before we PCS'ed.
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  • edited December 2011
    Sammy- That's exactly why the second thing I said was apologizing if I offended anyone. I know that there are some great docs, great hospitals, etc. Dentist-wise hands down I will never ever go to one again. You have no clue the amount of pain my mouth has been in the past year, fixing all the stuff that they messed up. (I say they, because I have never been to one dentist more than once, due to moving so much.)
    Doctor-wise, I've heard horror stories about gyno's that perscribe too high of estrogen and cause an incredible weight gain, I personally dealt with a skin care issue for 7 years because every one of them thought it was eczema and told me to just live with it (the first civilian doc I went to see when I went to college perscribed me something that took care of it in a MONTH and has been gone ever since.)
     The nurses that would come to our school and do a weight/height check were horribly rude. (I remember I was a couple pounds under weight for my height one year and was like oh yay. and the nurse replied, "yeah but don't be too happy because remember in ten years you still need to weight that much, so think about that at lunchtime" ... really? is that appropriate to snap at a 14 year old that way? )
     I had a nurse give me the wrong tb test, that was increidbly painful, so I had to get it redone (btw I'm needle-phobic). lol yeah. not the best experience at military hospitals.
    I do understand that most come straight from college which has a lot to do with the lack of experience or tact/empathy when dealing with patients; and I definitely understand that they could be making waaaay more money in the private sector than what they are doing with the  military (my FI is in the same position with what he does and what he could be doing with his degree). I know many people that LOVE their doctors on certain bases, I personally am pretty scarred. :P
  • KendallR10KendallR10
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    edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    Thanks for posting.  I think the main reason most of us were just giving the negative aspects ot Kendall is because she is getting married early and young just to get better insurance than she says she has on her parents' plan.  I don't think that's any reason to get married, and was trying to point out that Tricare isn't going to be the easy insurance she wants, where she just tells a doctor she wants this script and they cover it.  I don't think she truly understands how it works at 19.  I know I sure as hell didn't.  Also, my comment about depending on rank was more referring to United Concordia, but I was just speaking of military insurance in general.  Once you get higher in rank (I think like E-5 but I can't remember for sure) the percentage they cover gets better.   Also, we have had to deal with Tricare Remote and it was a giant PITA.  I was just praying that I didn't need to go to any doctors or anything in the few months before we PCS'ed.
    Posted by dnbeach12

    I'm aware that it isn't going to be like that but having a DR tell you "No I won't give you more birth control because you don't need it and insurance won't cover it." Is not okay. My FI is PISSED. I gave up fighting and stopped going to the dr.

    Military Brides December 2011 Siggy. Holiday picture with your SO. We suck and don't have one :/ Those who matter don't mind and those who mind don't matter.
  • Beachy730Beachy730
    5000 Comments Fourth Anniversary Combo Breaker
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    edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall : I'm aware that it isn't going to be like that but having a DR tell you "No I won't give you more birth control because you don't need it and insurance won't cover it." Is not okay. My FI is PISSED. I gave up fighting and stopped going to the dr.
    Posted by KendallR10
    But that's not your insurance, that's the doctor.
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  • edited December 2011
    well tricare isnt perfect either kendell i had a friend who had to wait months to get an appt with the gyno on base and when she asked about birth control he told her she didnt need it because she was preggo it sure sucked for her considering she didnt want kids and it wouldnt have happened before on her old insurance bc it wouldnt have taken so long to get an appt. so just be prepared for tricare to suck at times its not always rainbows and butterflies like some people make it out to be
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  • KendallR10KendallR10
    1000 Comments
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    edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    well tricare isnt perfect either kendell i had a friend who had to wait months to get an appt with the gyno on base and when she asked about birth control he told her she didnt need it because she was preggo it sure sucked for her considering she didnt want kids and it wouldnt have happened before on her old insurance bc it wouldnt have taken so long to get an appt. so just be prepared for tricare to suck at times its not always rainbows and butterflies like some people make it out to be
    Posted by greeneke2
    My name is KendAll. (Sorry major pet peeve.) 

    I'm aware of that. but its got to be better than what I have now. an insurance Co who won't help me at all
    Military Brides December 2011 Siggy. Holiday picture with your SO. We suck and don't have one :/ Those who matter don't mind and those who mind don't matter.
  • Beachy730Beachy730
    5000 Comments Fourth Anniversary Combo Breaker
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    edited December 2011
    Like I said though, unless your insurance is INSISTING you go to that doctor to get covered, you have a Dr. problem not an insurance problem.  And insisting you go to certain doctors to receive coverage is something that Tricare will do.
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  • edited December 2011
    sorry about messing up your name. out of curiosity what insurance do you currently have?i dont see why insurance wouldnt let you have bc i would be seeing a different doctor
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  • KendallR10KendallR10
    1000 Comments
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    edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    sorry about messing up your name. out of curiosity what insurance do you currently have?i dont see why insurance wouldnt let you have bc i would be seeing a different doctor
    Posted by greeneke2
    Medco does my Precriptions and I'm covered my cigna. 

    Its med co that won't do sh!t
    Military Brides December 2011 Siggy. Holiday picture with your SO. We suck and don't have one :/ Those who matter don't mind and those who mind don't matter.
  • edited December 2011
    id be heading over to planned parenthood personally lol
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  • Beachy730Beachy730
    5000 Comments Fourth Anniversary Combo Breaker
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    edited December 2011
    Have you thought about just going to Planned Parenthood then if that's all this is about?
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  • KendallR10KendallR10
    1000 Comments
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    edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    Have you thought about just going to Planned Parenthood then if that's all this is about?
    Posted by dnbeach12
    Thats only one of the issues. They won't cover my ADHD meds either or my depression
    Military Brides December 2011 Siggy. Holiday picture with your SO. We suck and don't have one :/ Those who matter don't mind and those who mind don't matter.
  • edited December 2011
    doesnt walmart do some deal on scripts? or do you have to have insuraance for that? anyone know?
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  • kyrgyzstankyrgyzstan
    Eighth Anniversary 1000 Comments 100 Love Its Name Dropper
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    edited December 2011
    Anyone who whines about not having bc because their wait for an appointment was too long should have quit whining and marched on down to Planned Parenthood. They would have had to pay a token amount, but they'd have bc for a year. People cant blame tricare for getting KU, im sans insurance completely and I manage to be  bc and buy condoms. All this criticism of medical personnel is offensive, and anecdotal. My tiny and rolling veins have been poked too many times by a baby Corpsman,but it could be a heck of a worse, I could've paid for a baby civilian provider to do the exact same thing. Mil medical personnel, despite the apparent flauting of the UCMJ by one on this board, dont have to join. They are members of one of the only fields where they could get a job elsewhere in this economy. Even if some of them do join for loan forgiveness, they're still volunteering to deploy and give service members the best medical care possible. if we don't like the medical care they provide (which I did and will), we are all free to get jobs and/or buy our own health insurance plans. The moment any of your spouses need medical care in theater, I hope the pendulum of your anecdotal evidence swings to the other side.
    I hate Dave Ramsey
  • KendallR10KendallR10
    1000 Comments
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    edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    doesnt walmart do some deal on scripts? or do you have to have insuraance for that? anyone know?
    Posted by greeneke2
    even there it is like 200 dollars for the generic 
    Military Brides December 2011 Siggy. Holiday picture with your SO. We suck and don't have one :/ Those who matter don't mind and those who mind don't matter.
  • edited December 2011
    wishicould i wasnt saying she blamed the military personell for her getting preggo and i most certainly wasnt putting them down so im sorry it came off that way and im sorry i offended you. i was just trying to point out that tricares system at times can be flawed or just difficult to deal with and its not perfect i have bad personal experiences w military doctors but i also havent seen one in probably around fifteen years since ive switched to tricare standard im really am sorry you took it that i meant it like that it wasnt my intention
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  • edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall : Thats only one of the issues. They won't cover my ADHD meds either or my depression
    Posted by KendallR10

    You can just go to PP for your BC, and still see your primary physician/therapist/psychiatrist, then you could get ADHD meds and antidepressants. :)
  • KendallR10KendallR10
    1000 Comments
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    edited December 2011
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall:
    In Response to Re: TRICARE FACTS vs incorrect information being provided to Kendall : You can just go to PP for your BC, and still see your primary physician/therapist/psychiatrist, then you could get ADHD meds and antidepressants. :)
    Posted by MissAnnThropee
    The DR won't give me my ADHD meds :[ 

    I am going to pp soon
    Military Brides December 2011 Siggy. Holiday picture with your SO. We suck and don't have one :/ Those who matter don't mind and those who mind don't matter.
  • edited December 2011
    Greeneke, you're nicer than I . I'm not sorry. I can bitch about whatever I want. :P
    Tricare does what it can for military families and I think a lot of us understand and appreciate that. The medical staff does what they can, and many of us appreciate that as well. I'm extremely thankful that we do have active duty that are doctors, nurses, etc.(my FI loves his squadron's new doc. plus she is just really cool to hang out with)

     That doesn't change that bad experiences happen [military or not]. I absolutely appreciate all who serve and what they do; and that does include the medical staff. That doesn't mean that I need to go to them if I don't want to or have had bad experiences. The only thing I use med insurance now is for bc anyway, so I won't need to deal much with them thankfully (Thankfully meaning that I don't have to deal with any hospitals, not just the military ones! haha) Dental, however, I will be avoiding on base. My FI hates the base dentist and that's reason enough for me to stay away!
  • edited December 2011
    Ilumine- I saw that you were a patient advocate and know a lot about tricare and the dental provider.  I am newly married and just signed up for health care however, i am living in a different state due to my job and husbands station. i am totally confused by all things health care Smile.  since i am now moving from my health care to his.  would you mind me sending you a private message with some questions that maybe you could help clear up?  thanks!
  • edited December 2011
    Haha welll, although I did find her post a little bit harsh and somewhat taken out of context, it is never my intention to purposefully offend anyone.  I understand that sometimes since the conversation is not face to face things can be misunderstood or construed in the wrong way, so I like to apologize when I may have made something to seem to be taken as when way when those weren't my intentions.  But that is just me!

    But the military does have a stigma of having a lot of "bad" doctors.  Of course this isn't always true and there are some great military doctors, the stigma wouldn't be there if there wasn't a smidge of truth to it.  I respect every military service member.  I've been a military dependent my whole entire life and I really appreciate everything and all of the opportunities that have been given to me because of my affiliation to the military. But, that doesn't mean I have to like military doctors and I have had to many bad experiences. I switched to Tricare standard! I really don't have one single bad thing to say about it! I love being able to choose my doctors and get appointments with who I need when I need them.  So for me I'm happy!
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  • edited December 2011
    well put! Yeah tell me about it.. the college I'm at is my 14th school. I've lived in about 27 different houses (not including those hotels you get stuck at for two months while looking for housing :P ) and pretty much know all the AFN commercials by heart. :P
    I'll be doing standard as well. Although the new rules allow me to stay on my mom insurance (for health anyway.. not dental that was lost at 22) until I'm 26 even if married, so yay there!
  • Sammy0709Sammy0709
    Fifth Anniversary 500 Comments 25 Love Its
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    edited December 2011
    I had to get my facts straight before I asked this question.  Am I misunderstanding the definition of an underwriter because I thought it would be an agency contracted to write insurance policies for an entitity?

    When OP said there was no underwriter I asked DH because he happens to work down the hall from the tricare office at the hospital and I know we have had the underwriter conversation with friends before.  His response was that Tricare is not an insurance policy.  It is a system for providing Triforce Healthcare and it covers the Navy Army and Airforce.  The Marines are covered under the Navy.  The health and life insurance policies that outline how the care is provided are written by the Hartford Life and Accident Insurance Company.  They began writing the policies only recently.  Wouldn't the Hartford be the underwriter?

    Not that this is extremely significant when understanding your health insurance coverage but I'm confused.
    I just want to know where my misinterpretation is.
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