Thursday, December 9, 2010

Tricare

Tricare how you annoy me! Don't get me wrong I'm thankful you are free and for the most part a pretty good insurance but you are a pain to deal with

When the hubs and I first were married I kept my govt insurance which I paid for. When we moved to NC and I got my job I need to enroll in tricare since my job didn't provide insurance. When I enrolled since there was an influx of beneficiaries, I got pushed to a clinic off post since I lived off post.

A few weeks ago I had to go to my off post primary care manager for a referral. Since there were some concerns I had to have some tests done before the referral was made. Once the tests came back ok the referral was put in the system

This past weekend I got my paperwork saying the referral had been approved and I was being referred to the clinic and main hospital on post. Perfect! I called to make my first apt only to be told that my PcM put in the referral for the wrong thing. So I couldn't make an apt. And my PcM when I called said it had been done correctly. My mom who is a nurse back home told me to call and demand to speak to the director of the clinic. My PCM is only a PA and my
Mom said every PA has to have a dr above them. So I called and the director reviewed my charts and saw where my referral was wrong. He promised to change it. That was Tuesday. It still hasn't been changed. I've spent every day on the phone with my PcM, tricares local office here in town and Healthnet. I keep getting told three different things and no one will give me a dr. It's getting to the point where I need to see a dr and soon and I'm not able to. I'm so frustrated. Again this morning tricare had no updated referral even though yesterday my PcM said she corrected it and submitted a new one. I am at a loss. It should not be this hard to see a dr. Especially when its medically necessary. If nothing is changed by tomorrow I told the hubs he better step up to the plate and do something about it as my sponser. He deploys soon and this needs to get taken care of now. Any advice on dealing with tricare?


- Posted using BlogPress from my iPhone

15 comments:

  1. Urgh this happened to me too as my referral got put in for ONE visit when I needed multiple ones! I simply called Tricare though and pointed out the situation and got a letter within about a week stating that it had been corrected. I hope it all works out for you hun that is soooo frsutrating!

    ReplyDelete
  2. HealthNet/Tricare can be very particular about how the referrals come in. I had to get a referral for an OB appointment and had to call my PCM. I thought when they got the blood results of my pregnancy test that they would automatically do the referral since I had already signed off on everything. The nurse didn't do it, I was patient because I wasn't in a huge rush, but called back after checking with Tricare twice. They said Oh No It will be done right away, I don't know why the nurse didn't do it.

    It usually it doesn't take a long time once the paperwork goes through from your PCM to the insurance, Hopefully it happens ASAP for you. Keeping my fingers crossed.

    You might also get a contact at Tricare that your PCM/Doctor can directly contact with any issues so that there isn't more confusion, not sure if they do that, but it makes sense in my mind.

    ReplyDelete
  3. I don't have experience with TriCare, but all insurance companies are a headache. I hope you get it sorted out soon!

    ReplyDelete
  4. Oh my gosh, this is terrible. I really don't have any advice, but to keep calling. Who watns to do that? It's doctors and PAs like that who give everyone a bad name. I hate when I hear about stuff like this. Just change the damn referral, even if it means you stay late or miss lunch, you're a doctor, deal with it. I hope it resolves soon, feel free to share my words with him/her. :)

    ReplyDelete
  5. Unfortunately, as a civilian I have no idea how to deal with all of that - but I hate that you're going through this. You really shouldn't have to worry with this right now!

    PS - how are you? I miss you!!! Hope all is well!!!

    ReplyDelete
  6. Is there any way to just go to your Doc's office and sit there until you have the confirmation it was done? I have not had to do a referral from a civilian doctor but I'd imagine they have to have referral numbers or confirmation numbers or SOME kind of identifying number that you could request. That way when you call triCare you would have a way for them to locate your paperwork.

    ReplyDelete
  7. Yikes! I am not on Tricare, but I have heard it can be very frustrating! I hope it all gets worked out for you!

    ReplyDelete
  8. I hear you Tricare pain. They have been great for us, but really don't understand why it is taking so long to get it corrected. The next call I would make is too someone on post who should be able to help with Tricare issues. We don't live by a base so we are Prime Remote and have no issues getting referrals. Good luck and if you need more help you can have hubs talk to his leader and see what he can do.

    ReplyDelete
  9. Sorry to hear about your dilemma. That really stinks. Have you considered switching to Tricare Standard? With standarad you don't have to worry about the whole referral process. The only thing you need to do is make sure the doctor you choose to see takes tricare. The tricare website can give you a listing of all the doctors in the area that do. I have been both prime and standard and have to say I prefer standard for this very reason. No need to deal with referrals and or mismanaged paperwork. There is some cost involved but it is very very small and is based on your spouses rank. In my opinion the cost is worth the freedom. I am not saying Prime isn't good, there are awesome doctors and staff out there in military facilities. I just prefer to be able to see who I want to see when I want to see them. I can see any type of specialist I want and have no PCM. If you do decide to switch it is an easy process and they can tell you exactly what your out of pocket expenses will be. Hope this helps! I also hope you get in to see the doctor very soon!

    ReplyDelete
  10. You should get in contact with a Health Care Advocate. All the tricare areas have them and they will take care of the situation. I had something similar happen to me (in DC area) and my husband somehow figured out who the health care advocate was, called them, explained the situation, and it was taken care of that day. It was awesome. You may even be able to call tricare and ask who the local advocate is. Give it a shot and good luck!

    ReplyDelete
  11. Switch to Tricare Standard! I love it and I don't have to deal with referrals. And in all honesty it is worth paying about $10 for a visit to save myself the headache of referrals. Good luck!

    ReplyDelete
  12. My advice is to keep calling, keep calling, keep calling, until you get a representative that is helpful. Tricare is awful to deal with sometimes, but in my experience, it's usually because of the rep you get on the phone.

    Also, you could request a case manager, who will plead your case for you and keeps all your records straight. . . but since I'm not sure of your specific situation, I don't know if they would grant you one. When my daughter was having so many different referrals, etc, because of her surgery at birth and the post surgery follow ups, etc, that was SO HELPFUL to have one number that I could call and KNOW that I was going to get somebody (the same accountable somebody) to help me.

    Hang in there! Tricare Prime is worth it if you can get past all the red tape! Thinking of you!!!

    ReplyDelete
  13. My advice.. switch to Tricare Standard! I was constantly having issues when I was on Prime so I switched to Standard and I've been very pleased with it.

    ReplyDelete
  14. SWITCH TO STANDARD!! WELL WORTH IT TO PAY A SMALL COPAY. BETTER HEALTHCARE, LESS HEADACHES. My husband and I are stationed at Charleston AFB and the med clinic here is AWFUL. I am constantly hearing stories similar to yours and the pediatricians here are so awful I am surprise they are still able to practice. I am SO glad my son and I have standard so we dont deal with all that garbage. Call tomorrow. switch now!

    ReplyDelete