DoD proposes doubling out of pocket medical costs

[Spekkio]

In order to "save" $2.25 billion/year, or 0.35% of the DoD budget.

Proposed changes would take effect for all military personnel in 2015 if it gets through Congress.

This circle-jerking is getting old. Supposedly the DoD is making 'tough choices,' except when it comes to reconsidering bloated acquisition programs that are bleeding it dry.

 

[KilroyUSN]

In order to "save" $2.25 billion/year, or 0.35% of the DoD budget.

Proposed changes would take effect for all military personnel in 2015 if it gets through Congress.

This circle-jerking is getting old. Supposedly the DoD is making 'tough choices,' except when it comes to reconsidering bloated acquisition programs that are bleeding it dry.

I feel like Navy supervisors and the CFS's jobs are about to get a bit harder if they get rid of Tricare Prime and start forcing active duty family members to pay out of pocket for health care...

 

[Renegade One]

I need an education…my "data" is obviously dated…need/want to know today's "ground truth":
1. While I was AD…medical care was free…for a family of 4. No matter how much…free. ER visits, childbirth, hospitalization, surgeries, prescriptions, yadda yadda yadda. No charge for anything…ever.
2. After I retired, yes there was/is an "annual enrollment fee" for Tricare Prime. Hardly onerous, and it has continued to go up, but not yet onerous. Occasional "co-pays" for non-Navy-provided services (from civilian suppliers…)…yeah, but always less than a week's worth of coffee at 7-Eleven or Starbucks. E.g.: Not onerous.
3. My wife and I will turn age 65 this summer, and much of that will now change…Medicare Parts A & B along with "Tricare for Life". I gather my costs will NOW go up, and we're still trying to figure all of that out. Unfortunately, "Tricare Extra" is now apparently closed…which means that we can no longer see our Navy PCP's and must seek new civilian Docs who will accept Medicare. All "clinical services" at the local NRMC are still avail…ER, Breast health, Dermatology, ortho, etc.

For the most of you who are not in my situation, what's the real impact on "all military personnel"?

 

[lowflier03]

There are locations where family members are not able to be on prime because of limited military facilities. Also from personal experience, base facilities/doctors/prime are shit for actually allowing family members to get care they need. There is a lot of the typical, "take this motrin or antibiotic for a month or 5 and then maybe I'll think about getting you a recommendation to actually see someone who can help you."

edit: Additionally I have already seen some of the cost cutting with my family. Procedures/specialists that are clearly covered as per Tricare's website and brochures consistently get denied. I've had to resubmit claims and/or call numerous times before something gets paid for. Also there are some procedures they are denying outright with no explanations, again despite it being listed on the site. Most people I've talked to are under the impression that they are trying to cut some costs, and get by with this method because of the bullshit confusion of bureaucracy that is military healthcare.

 

[KilroyUSN]

I need an education…my "data" is obviously dated…need/want to know today's "ground truth":
1. While I was AD…medical care was free…for a family of 4. No matter how much…free. ER visits, childbirth, hospitalization, surgeries, prescriptions, yadda yadda yadda. No charge for anything…ever.
2. After I retired, yes there was/is an "annual enrollment fee" for Tricare Prime. Hardly onerous, and it has continued to go up, but not yet onerous. Occasional "co-pays" for non-Navy-provided services (from civilian suppliers…)…yeah, but always less than a week's worth of coffee at 7-Eleven or Starbucks. E.g.: Not onerous.
3. My wife and I will turn age 65 this summer, and much of that will now change…Medicare Parts A & B along with "Tricare for Life". I gather my costs will NOW go up, and we're still trying to figure all of that out. Unfortunately, "Tricare Extra" is now apparently closed…which means that we can no longer see our Navy PCP's and must seek new civilian Docs who will accept Medicare. All "clinical services" at the local NRMC are still avail…ER, Breast health, Dermatology, ortho, etc.

For the most of you who are not in my situation, what's the real impact on "all military personnel"?

I think it is kind of hard to tell, from the posted article, especially since there is not a whole lot out of it, but from the article, it seems to be that Prime will no longer exist. In essence the medical care for free would no longer exist. It would for the AD member, but not for their family.

I myself have a family of five and have never used Standard or Extra, so I am not sure what people are paying out of pocket, although I am sure it is generous compared to the civilian world. That being said, the article suggests that they everyone would be charged approximately double what those who are on Standard pay. I know what too many E's with families who barely scrape by (for whatever reason) and can only imagine that, having to pay for the doctors bill of their kids, spouse, etc, while they are out to sea, will (at least in the short term of the average enlistment, before they all get out) give extra hardship, that they normally do not have to worry about, to those who should be focused on their job.

I guess we will see, when they release more information about their proposed plan, and if it gets approved

 

[Renegade One]

There are locations where family members are not able to be on prime because of limited military facilities. Also from personal experience, base facilities/doctors/prime are shit for actually allowing family members to get care they need. There is a lot of the typical, "take this motrin or antibiotic for a month or 5 and then maybe I'll think about getting you a recommendation to actually see someone who can help you."

edit: Additionally I have already seen some of the cost cutting with my family. Procedures/specialists that are clearly covered as per Tricare's website and brochures consistently get denied. I've had to resubmit claims and/or call numerous times before something gets paid for. Also there are some procedures they are denying outright with no explanations, again despite it being listed on the site. Most people I've talked to are under the impression that they are trying to cut some costs, and get by with this method because of the bullshit confusion of bureaucracy that is military healthcare.

Good informative post. Thanks for the time it took to "nug it out". I guess I was less than sensitive to those folks living outside of a major military catchment area with a major Medical Facility.

 

[Spekkio]

I think it is kind of hard to tell, from the posted article, especially since there is not a whole lot out of it, but from the article, it seems to be that Prime will no longer exist. In essence the medical care for free would no longer exist. It would for the AD member, but not for their family.

I myself have a family of five and have never used Standard or Extra, so I am not sure what people are paying out of pocket, although I am sure it is generous compared to the civilian world. That being said, the article suggests that they everyone would be charged approximately double what those who are on Standard pay. I know what too many E's with families who barely scrape by (for whatever reason) and can only imagine that, having to pay for the doctors bill of their kids, spouse, etc, while they are out to sea, will (at least in the short term of the average enlistment, before they all get out) give extra hardship, that they normally do not have to worry about, to those who should be focused on their job.

I guess we will see, when they release more information about their proposed plan, and if it gets approved

What I got out of the article is that you won't enroll in Prime or Standard. The spouse will either choose to continue utilizing MTFs for free, or will utilize doctors out in town for double the out of pocket expenses with no admin circle-jerk to 'declare' which option you want to use.

It sounds like they are trying to deter people from using non-MTF physicians. But spouses aren't choosing civilian doctors just because Tricare Standard is so cheap -- it's the myriad of stories they hear of PCMs brushing off patients to avoid the cost of sending them to specialists until it's too late, just like lowflier said. Also, they don't want to sit in a waiting room for 3 hours to see a physician for acute illness.

I suppose if you are not married or if you are married and your spouse has her own healthcare plan, this won't affect you at all. But if you have a spouse/child who uses Tricare Standard as their primary insurance then it will double your costs.

edit: Additionally I have already seen some of the cost cutting with my family. Procedures/specialists that are clearly covered as per Tricare's website and brochures consistently get denied. I've had to resubmit claims and/or call numerous times before something gets paid for. Also there are some procedures they are denying outright with no explanations, again despite it being listed on the site. Most people I've talked to are under the impression that they are trying to cut some costs, and get by with this method because of the bullshit confusion of bureaucracy that is military healthcare.

Any time that I've ran into insurance payment trouble with tricare, the healthcare provider has been at fault for screwing something up. From talking to people in the healthcare industry, tricare is actually easier to work with than a lot of other insurance companies as long as you follow their rules and provide the appropriate documentation (ie, that your PCM or primary physician submitted the referral for specialized treatment to tricare and the specialist office used the proper corresponding billing code). That's really hard for a fat lazy person behind the desk to do sometimes and they tend to want to point the finger at your insurance company because they don't want to admit they made a mistake or bother to even look into it. The fact that *you* are submitting anything is an indication that someone in the doctor/hospital billing office isn't doing their job correctly. The shitty thing is that once they screw up and the claim gets denied, it's not their credit on the line.

I actually dealt with this fairly recently on top of the fact the office never answer the phone and didn't respond to emails, and submitted a complaint to one of the CA healthcare advocate groups. I expected that to go nowhere but 48 hours later they were eating out of my wife's hand like a puppy and the claim got resolved.

There are locations where family members are not able to be on prime because of limited military facilities.

Actually, when this happens the spouse gets the good deal. You can go on prime and see a civilian physician of your choice as if you were on standard. No out of pocket costs, and no dealing with PCMs who think it's more important to save the MTF a few bucks on a referral than to get you the healthcare attention that you need.

 

[KilroyUSN]

What I got out of the article is that you won't enroll in Prime or Standard. The spouse will either choose to continue utilizing MTFs for free, or will utilize doctors out in town for double the out of pocket expenses with no admin circle-jerk to 'declare' which option you want to use.

It sounds like they are trying to deter people from using non-MTF physicians. But spouses aren't choosing civilian doctors just because Tricare Standard is so cheap -- it's the myriad of stories they hear of PCMs brushing off patients to avoid the cost of sending them to specialists until it's too late.

I suppose if you are not married or if you are married and your spouse has her own healthcare plan, this won't affect you at all. But if you have a spouse/child who uses Tricare Standard as their primary insurance then it will double your costs.


Any time that I've ran into insurance payment trouble with tricare, the healthcare provider has been at fault for screwing something up. From talking to people in the healthcare industry, tricare is actually easier to work with than a lot of other insurance companies as long as you follow their rules and provide the appropriate documentation. That's really hard for a fat lazy person behind the desk to do sometimes and they tend to want to point the finger at your insurance company because they don't want to admit they made a mistake or bother to even look into it. The fact that *you* are submitting anything is an indication that someone in the doctor/hospital billing office isn't doing their job correctly.

Yea it was hard to tell how/if it would affect Prime, I just don't understand why they wouldn't just keep Prime and Standard separate and charge double for Standard, unless there are some changes that would also affect Prime in this merger and I can't imagine any changes to Prime, that wouldn't involve increasing out of pocket expenses.

It would be interesting to see what percentage of sailors even use Standard or Extra, seeing how most people enjoy the "free" aspect of Prime.

 

[Spekkio]

I don't know. What I do know is that the biggest driver in healthcare costs are wounded/disabled servicemembers missing appointments. When that happens, the treatment period is exponentially longer as is the period that they have to stay on a cocktail of expensive drugs, but the member does not incur any cost for failing to keep up with his treatment or missing appointments. The other driver is increased costs for retirees who are living longer.

They are reforming the wrong part of military healthcare to subsidize what's actually broken.

 

[lowflier03]

Any time that I've ran into insurance payment trouble with tricare, the healthcare provider has been at fault for screwing something up. From talking to people in the healthcare industry, tricare is actually easier to work with than a lot of other insurance companies as long as you follow their rules and provide the appropriate documentation. That's really hard for a fat lazy person behind the desk to do sometimes and they tend to want to point the finger at your insurance company because they don't want to admit they made a mistake or bother to even look into it. The fact that *you* are submitting anything is an indication that someone in the doctor/hospital billing office isn't doing their job correctly. The shitty thing is that once they screw up and the claim gets denied, it's not their credit on the line.

I actually dealt with this fairly recently on top of the fact the office never answer the phone and didn't respond to emails, and submitted a complaint to one of the CA healthcare advocate groups. I expected that to go nowhere but 48 hours later they were eating out of my wife's hand like a puppy and the claim got resolved.

Actually, when this happens the spouse gets the good deal. You can go on prime and see a civilian physician of your choice as if you were on standard. No out of pocket costs, and no dealing with PCMs who think it's more important to save the MTF a few bucks on a referral than to get you the healthcare attention that you need.

While I would have agreed with you the first time, or maybe 2. This has happened to me consistently, from multiple healthcare offices. And on more than 1 phone call with tricare I've had them tell me "no, that service/procedure isn't covered under Standard" Only for me to finally get to talk to a supervisor, be told the same thing, then point out where exactly on their website and in their benefits package it defines said procedure as covered.

Also that includes a doctors office that has had claims for a specific procedure for children denied for the last year, (Which previously there was no problem) and certain ages of adults its still getting covered.

 

[Spekkio]

That is strange that they would tell you something was not covered under standard. I was under the understanding that prime/standard covered the exact same medical procedures, it's just a matter of whether or not you owe a percentage of the cost and whether or not you are obligated to maximize the use of MTFs.

 

[Recovering LSO]

SECNAV told a packed house at Naval War College this morning that there is only one over budget / behind timeline program in the Navy... CVN-78.

We also must remember that there's more to service than money - he thinks there's a patriotism piece to it....

Seriously, he said both of those things.

 

[BigRed389]

SECNAV told a packed house at Naval War College this morning that there is only one over budget / behind timeline program in the Navy... CVN-78.

We also must remember that there's more to service than money - he thinks there's a patriotism piece to it....

Seriously, he said both of those things.

I think his last ASN (Bob Work) was better informed than him.

 

[lowflier03]

SECNAV told a packed house at Naval War College this morning that there is only one over budget / behind timeline program in the Navy... CVN-78.

We also must remember that there's more to service than money - he thinks there's a patriotism piece to it....

Seriously, he said both of those things.

Seems sadly similar to VCNO when he told NPS students that the american people had been "very generous" with military compensation and that we can expect to take the hits. Oh and that we should take every hard deal that BUPERS throws at us because it will be "career enhancing" and good for us in the long run.

Funny how detached that level is from the realities of what the last 10+ years has meant for servicemembers. I honestly wonder if anyone at that level has any sense of the discontent and dissastifaction with how personnel have been managed?

 

[Spekkio]

I think that they should tour some enlisted base housing to recalibrate themselves to the fact that not all servicemembers pull O-7+ pay and don't have mansions before they start making across the board cuts to pay and benefits. And those servicemembers deal with whatever they get because E4-E6 BAH is often not enough to get a house in town, and Balfour Beatty et al knows it.

Pay increased so much in the last decade because it needed to, so quoting the 90% increase contained in the FY13 budget report is misleading. Do we really want to go back to the days where an E5 with kids qualified for food stamps and needed it to get by?