Why is the Military health "care" service, Tricare, so incredibly flawed? What can be done to fix it?

Question

I just went through SIX different phone calls with Tricare and my issues has still not been resolved. All I want is an appointment for an injury I just had while on vacation. How hard can a simple referal authorization be!!!!! I have had nothing but trouble with Tricare. I am convinced that they purposely make things so difficult so that the patient will just give up and suffer through just so that Tricare can save a dime. I pay into this insurance every month and they SUCK!!!!

Yes we do pay for Tricare Prime. It comes out of my husband's paycheck (so does dental) AND we also pay for it with our taxes.

Answer 1

We have had a lot of experience with Tricare this year as my daughter was injured and, as it was an emergency and had to be handled immediately, treated at civilian facilites. The trick to getting a referral is to ask your PCM (primary care doc) to put it in for you. That is the only way Tricare will give you the referral..be it to another military facility or to a civilian one.

I also work as a billing manager and have dealt with many insurance companies in that capacity. All insurance companies like to make things confusing and difficult. They want you to talk to different people every time you call. They want to find tiny errors or mishandle claims and reject them. They do all of this to delay having to make payment on your claim. I will say this, Tricare does pay it's bills to providers faster than other companies (Medicare comes to mind).

The trick to getting good service is this...ask questions and take notes. Always write down the name of the person you speak to, the time of your call and , if possible, ask for that person's ID or extension number. Write down everything they tell you, word for word. If you don't understand, ask them to explain it again. If they refer you to anothe person, be sure to get that person's contact info as well. Always ask for a direct number to call them back if there is a problem with the information they give. And if there is a problem, when you call back, immediately ask for a manager or supervisor. Once you have a problem, do not go through the maze of general customer service reps. It will only frustrate you and delay the answers. Finally, hard as it may be, never yell at the person on the phone. You can let them know you are angry, but for the most part they are not the one who lost your information or denied your claim. Staying calm and pleasant with them will get you more help than you can imagine..these folks get yelled at and blamed all day, every day. Acknowledge that they did not make this mess but that you hope they can help you sort them out.

What can be done to fix it?? Better care for military members and dependents, especially when using civilian providers and a huge overhaul of the dental program. More access to one provider...we had huge problems trying to get a diagnosis for me when I kept having to follow up with a different provided as my PCM was "unavailable" at the last moment. It took nearly two years to figure out the problem and another 6 months to get it taken care of. Luckily, it was not life threatening. Easier access to same day care...many times we have to end up sitting in the ER because clinics had no same day appointments available when the kids get an ear infection or have a high fever. Allowing us to get more care from civilian providers without having to jump through hoops. My 12 year has recived fantastic physical therapy at a military PT clinic after a serious leg injury, in spite of the fact none of the techs had any peditric expereience and we have had to miss half days of school left and right as Tricare would not approve a civilian PT clinic with evening hours.

Health care is one reason many military members (especially ones with family) give for enlisting and staying enlisted. However, the options are shrinking and the care is becoming less dependable. Military members can find themselves with thousands of dollars to pay (again, dental coverage is the biggest culprit here) from an already minimal paycheck. To keep the higher ranking enlisted in, there will need to be a change in the program in the next 10 years.

Answer 2

Sadly I don't know how to help you, but I do agree with you when you say the TriCare system is flawed.

Every time I call to make an appointment, I'm always referred to a telephone conference. The latest attempt was for a blood serum and urine pregnancy test since I'm over a month late, and get this-the technician answering the phone, wanted to place me in for a TELEPHONE CONFERENCE!! Seriously now, is the nurse going to stick a needle and cup in the phone to take my blood and urine? How pathetic is that? Talk about lazy. And she wasn't even pleasant to talk to.

What makes it worse, is when I go in to be seen by a doctor-I'm always the one to be seen at the end of the day, and by the time I get there (always 20 minutes early), I patiently wait in an empty waiting room for 30 minutes just to be called to have my vitals taken. When I'm actually seen by the doctor, I'm refused a blood and urine test, told that I have a thyroid problem (without doing tests), and I feel as if I'm being rushed out the door and not getting the answers I want and NEED just because it's his/her quitting time.

TriCare Prime (the free one offered in overseas Europe...I don't know if it's available state-side) is a great military benefit, but they really REALLY need to rethink their courtesies when it comes to making appointments and visiting the doctor.

Answer 3

Fix Tri-Care????

1. Stop charging retirees and service members. I spent 19 years in with the promise of free health care on retirement. Then for several years couldn't even get free health care on active duty!

2. Actually make an effort to sign up civilian doctors!

3. Scap the mess and recruit doctors into the Military hospitals that don't provide free health care to congress.

4. make Congress use it instead of Walter Reed and Bethesda. Note Congress never saw the bad parts of Walter Reed because they were pigging all the resources in the nice part! Makes me sick

ret. USAF SNCO

Answer 4

I worked at Tricare for a month. It sucked. I feel sorry for the military.

Answer 5

Remove 8-10 layers of bureaucracy and let the health care professionals do their Job. Then give them the funds and personal that getting rid of the bureaucrats would free up.

Answer 6

I had Tricare after I served in Peace Corps and didn't have any problems with it.

All health care has the same rigmarole--this is why we need major reform.

Answer 7

umm, Active duty Family members do NOT pay anything for Tricare services.

Answer 8

In the military. All are not created "equal".
When I was in service, and it came to getting treated at a
medical facilitay. The officers got treated first and then the
enlisted or drafted got treated.
I had a friend of mine, who asked a question to the Navy
Press: When It comes to addressing military personal, It is
referred to as: Officers and their "Lady's, and for the enlisted
men It was referred to as: Enlisted men and their "Wives."
He went on to ask: Is not an enlisted man's wife considered
a "Lady? And what if the woman being escorted is not his
"wife" ? Well, He was reported to "Captain's Mast." I wonder
If that standard is still in effect "today."

Answer 9

Check out Moore's movie "SICKO", that is exactly what it deals with. I thought it was going to be about those with no Insurance, but it's not. It shows how the Private insurance companies reward their employees who deny authorization to Policy holders. It's incredable and terrifying. Time for a National medicare program.

Answer 10

to get a referral you have to see your pcm. call the appointment line and book an appointment with your regular assigned doctor once you have seen them ask them for a referral. the appointment line cant give you a referral only your pcm can. book an appointment with your primary care manager they will set the referral up