'White Paper' Stirs Talk Of 'TRICARE Standard' Reforms

Fleet Reserve Association ^ | Aug. 22, 2002 | Pete Peterson & John Vann

[Davis]

In April last year, TRICARE stopped a $12 co-payment for doctor visits by active duty family members using TRICARE Prime, the military’s managed health care plan. Six months later, service elderly gained access to TRICARE for Life, the ``golden supplement’’ to Medicare.

Between these two populations of generally satisfied beneficiaries are three million military retirees, family members and survivors under age 65. According to a ``White Paper’’ drawing attention on Capitol Hill and at TRICARE headquarters, many of these younger retirees are bitter, frustrated and clamoring for their own health care reforms.

Two thirds of them, about 1.9 million beneficiaries, use TRICARE Standard, the fee-for-service health insurance, formerly called CHAMPUS. Out-of-pocket costs under Standard are far higher than under Prime. There is a $300 annual deductible, a 25 percent patient cost share on ``allowable’’ charges to retirees, and additional costs if doctors refuse to accept TRICARE rates or decline to participate in TRICARE at all.

Even as TRICARE Prime becomes more attractive and less of a hassle, many retirees are stuck under Standard. Many live too far from a military base or physician network to enroll in managed care. Others accept the higher costs for the freedom to choose their own doctors. Many more retirees don’t enroll in Prime because they have health insurance through civilian employers, and use TRICARE Standard only as a second payer plan. They’re the lucky ones, the White Paper contends, because Standard isn’t the same CHAMPUS plan of the pre-TRICARE era, regardless of what officials say.

TRICARE officials concede that over the last seven years or so they have concentrated on establishing Prime networks and explaining their features to potential enrollees. As a result, perhaps it has paid too little attention to costs and others challenges faced by Standard users. The failings of Standard have become more obvious as Prime improved and service elderly won TRICARE for Life benefits. Meanwhile, the success of Prime has shriveled access to base hospitals and clinics for Standard users.

The White Paper, researched and written by nine activists calling themselves the Military Retiree Grass Roots Group, was delivered in June to all 535 members of Congress, in hard copy and on compact disk

``I would be comfortable saying we have tens of thousands of people who agree with us,’’ said retired Army Col. John M. Vann, one of the nine. Vann and his twin, retired Lt. Col. Dave Vann, and retired Army Col. Jim Engelage, all residents of northern Virginia, said they had a lot of help because many retirees and their families are angry.

The group’s top priority is passage of legislation that would allow retirees to ignore TRICARE and enroll in the Federal Employees Health Benefits Plan, the menu of health insurance options open to federal civilians and retirees. Military retirees, assuming they would get free lifetime health care, which tended to dampen pay levels, should pay only about a third of the FEHBP premiums paid by federal civilians, the paper suggests.

Two of the authors, retired Air Force Master Sgts. Jim Whittington and Floyd Sears, have worked since 1999 with by Rep. Ronnie Shows (D-Miss.) to get such legislation enacted. The ``Keep the Promise Act’’ (HR 179/S 278) has plenty of co-sponsors in the House but still is not top priority for Congress, even when weighed against other personnel initiatives.

But the Senate Armed Services Committee asked TRICARE officials to comment on the grass root group’s concerns and got back a six-page response just addressing issues raised in the group’s cover letter. TRICARE officials were still reviewing the 144-page White Paper.

The White Paper claims Standard is suffering a ``steady decline’’ in the number of doctors who accept TRICARE patients because of low reimbursement rates. Thus the advantage of Standard – a choice of physicians -- doesn’t exist for many beneficiaries. The White Paper blames inherent weaknesses in the TRICARE concept built around profit-driven support contractors. The paper even questions the commitment to TRICARE reform of large service associations that offer supplemental insurance to cover those heavy out-of-pocket costs. [A web address to view the White Paper is: http://rebel.212.net/mhcrg/MRGRGwhitepaper.htm

TRICARE officials disagree with much of the criticism, which is blunt and mostly anecdotal. There are small pockets of the country where participating doctors are scarce but not many, they argue. They also remain opposed to a military FEHBP option, saying potential costs are alarming and too many challenging cases, which keep staff well trained, would go to civilian providers and impact readiness.

Yet despite the paper’s harsh tone toward TRICARE, some TRICARE officials acknowledge, with key congressional staff, that the time might be right to address weaknesses in design or execution of Standard. The buzz created by the White Paper, said Steve Lillie, director of program development for the TRICARE Management Activity, ``is a good opportunity for an initiative to make sure those people are not left behind.’’

A Senate aide agreed.

``Some of it is misunderstanding and some are legitimate issues,’’ the Senate staffer said after a briefing by grass roots members. ``Access to [physician care], especially in remote areas, is something we want to look into…Also the whole process related to the Standard benefit, and going to the managed care support contractors for that benefit, and how all that works.’’

Important ideas, it seems, are rising again from the grass roots.

Comments and suggestions are welcomed. Write to Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or send e-mail to: milupdate@aol.com

[Davis]

It is a travesty of great proportion when our government refuses to take care of the Health of our retired military. We should all get involved in this issue!!

[trebb]

Being a retiree myself, I can only agree. TriCare Standard sucks (I'm still responsible for children fro a previous marraige and there are no military facilities where they live) as I pay about 50% of all my kids bills.

Also, even with Prime - military facilities are set up to handle active duty first (as it should be) and deployments like Afghanistan made it so many Prime members (paying for the insurance that they were promised they would never have to do) are being turned away or delayed if their illness is not deemed serious enough to warrant timely care.

[SteamshipTime]

With all due respect to our retired military, whenever a commodity is provided to its consumers and any portion of the cost shifted to others, demand for the commodity will rise and supply of the commodity will shrink. Scarcity and rationing are the inevitable result. No amount of money can change this outcome.

And besides, we're too busy doling out money for public schools, farmers, and foreign aid.

[advocate10]

Are you aware of the "concurrent receipt" problems and the pending legislation which may or may not correct the problem? Presently, a retired and disabled veteran has his/her retired pay reduced dollar for dollar by the amount of the VA disability compensation received! Talk about a travesty!

[WellsFargo94]

Even for active duty on Tricare Prime it can suck. If you are not near a base/post good luck finding a doctor who will accept the rates and the paperwork/hassle. A couple that I know (they are active duty, Tricare Prime) their kids are visiting grandparents in another state and the kids got sick. Grandma who isn't familiar with the system had trouble finding a doctor, so mom had to make several calls to find one, then when grandma picked up the prescription for the kids she had to pay the total amount, over $100 for their antibiotics and now the parents have to jump through hoops to get Tricare to cover the charges. The kids weren't able to see a doctor until 2 days after their symptoms started so they became even sicker. Grandma is trying to care for sick kids, deal with a difficult system, deal with doctors, pharmacy, etc. and keep in constant touch with the parents. Meanwhile the parents, are trying to get ready for the packers to come, clear post, clear housing, etc. But before they can leave, and in the midst of a chaotic situation, they are once again on the phone to Tricare to figure out all of the nonsense that they need so that Grandma can get reimbursed for the meds. TRICARE SUCKS!

[TADSLOS]

...over $100 for their antibiotics and now the parents have to jump through hoops to get Tricare to cover the charges

Hey, they could always use their Government Credit Card the military issued them. /Sarcasm off/

[Militiaman7]

The whole damn system sucks. Just another promise made to sucker you in for 20+ years of service and then throw you to the dogs.

Medical benefits for you and your dependants after you retire = I got a bridge in Brooklyn I can sell ya.

[Hardcorps]

Well said. Makes me mad as hell. Tricare reminds me of the IRS. Strong message to follow!

[3k9pm]

Agreed! This was one of the things that really steamed me. I would go to the hospital or clinic for an appointment and see a waiting room full of retired military and/or their dependants waiting in the lobby for service while some broke-dic* private wanting to get out of PT dropped by for sick call.

The retirees were last priority, there were days where they sat in the lobby all day and didn't get to see a Dr.
This is shameful and disgusting.

And don't get me started on TriCRAP.

[twyn1]

Agreed ! After 22+ years of service, you'd think we'd get some sort of decent health care. We have Tricare Prime, better than Standard, but it's still a joke, the booklet explaining our benefits is worse than a computer manual. We never see the same doctor twice (half the time it's just a PA) and every single bill is disputed. My poor husband spends at least a half-an-hour on hold every time he calls, only to be told the wrong information. It usually takes 3 or 4 phone calls to fix the problems, it so frustrating. Now our provider doesn't know whether they should still charge the $12 co-pay...half the time we pay, half the time we don't. It's such a hassle that I am 6 months overdue on making an appointment for a much needed physical and mammogram...I just hate the whole system.

[caboonia]

Some info contained in the White Paper and on website of MHCRG really make you scratch your head and say HUH!!!!!!! What are these Tricare contractors smoking? This is what we do to our retired military and yet, we have these groups complaining about treatment of GITMO prisoners and prisoners in jail and illegal aliens. Our military retirees deserve better than this. On the white paper is a url to send a message to congress its:

http://capwiz.com/naus/issues/alert/?alertid=305111&type=CO

http://rebel.212.net/mhcrg/

http://rebel.212.net/mhcrg/MRGRGwhitepaper.htm
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"You questioned on your website why TRICARE Prime is not available in your area. When DOD designed the TRICARE Prime program for the state of Arkansas, the area in which you live was designated as a TRICARE Standard area. By definition a contracted network of TRICARE Prime providers is not available. Most of the physicians in your area have very busy practices and may not be motivated to accept TRICARE beneficiaries. There are TRICARE certified providers in surrounding areas and we encourage them to accept TRICARE beneficiaries. Generally, their busy practices may also discourage them from accepting TRICARE patients."

Important: Enrollment in TRICARE Prime does not guarantee civilian
health care, nor does it guarantee military health care.

Even if a hospital participates in TRICARE Standard, sometimes the
doctors and other providers who care for you there do not. If possible,
check on this by phone before you go to get care.

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You cannot pay this office call bill yourself. The provider must submit it. (Doctor will not see you again until bill is paid in full).

We need to know the Doctor's degree.

Again, from Anthem Alliance: "The Grievance Department completed an extensive investigation on your behalf. The Grievance Department does not have access to the information contained in the claims system therefore, depends upon information provided by the Claims Department. We trust this information is correct."

"I just received a letter from my doctor along with a package of information forwarded from TRICARE. TRICARE informed my Doctor they will be unable to process my $61.00 claim unless they have my name, social security number, date of birth and address - all of which was on the TRICARE form that they returned to the doctor!"
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