Q For Any Military Reservist Mamas

I've been a military dependent (of active duty and inactive reserve), and active duty military myself.

Tricare, like nearly anything having to do with the military and medicine, has it's frustrations. It is PARTICULARLY trying, when you're dealing with switching from active to reserve. It's the paperwork & referral business coupled with HAVING to do that, when you've been used to ...if you're sick or hurt you see the Dr. now.

That said. I will never recommend Group Death to anyone, either for health care or for seeking employment. (Aha! Look! Bias, bias. Yup.) The sheer number of; bad outcomes, substandard care, mismanaged cases, and ridiculous administration fumbles that I have personal knowledge of is far too high. Here's a short list (of people with their insurance) that I know of. Family & friends where I was present only...if I gave you the list from what I've learned in school and from friends and from working in the field, I'd get sued:

- Teenage female patient with pneumonia & temp of 103.7 denied immediate acute care either in ER or with their "group" of regular doctors (because of being MISCLASSIFIED as a child...to whom acute care for high fevers is only given after 105...at their hosp). Soonest appt available was 5 weeks out. Parents had to seek care outside of network and pay 100% out of pocket for care & medicines. Parent was BSRN. Patient was myself. Told by docs at Swedish that I was lucky to be alive.

- Teenage male patient who had an accident in woodshop and sliced their arm from wrist to elbow and had arterial spurting controlled only with direct pressure of the towel another student held to their arm, sent to PSYCHIATRIC waiting room for evaluation for over four hours BEFORE anything was done to treat the injury. Injury was only treated because 2nd student applying direct pressure got tired and shifted their grip & blood squirted across the waiting room & sprayed receptionist. Receptionist was treated before lacerated student. Student who was holding the towel, and who had witnessed the accident, was myself.

- Early 20's female patient who fell off of dirtbike (although given xrays) was misdiagnosed with sore muscles/sprained back. In all actuality 3 vertebra were fractured, and two discs were ruptured. Mistake WAS caught by GH staff...8 Days after being seen. My diving coach.

- Mid fifties female patient suffers severe heart attack & mild stroke. Is taken to nearest ER by ambulance. GH deemed that said heart attack and subsequent treatment not covered by their plan, since it was treated out of their network. 2 years of legal battles. GH won. Fine print reads emergency service can be provided by non GH facility if deemed by GH to be immediately life threatening to patient. Deemed is key word. Their choice, no recourse. Patient had to pay 100% out of pocket. My aunt, at a family Christmas party.

- 84 year old man is run over by bicycle on Burke Gilman trail. Knocked unconscious. Ambulance takes him to nearest hospital. Same results as above. My grandfather.

- 4 and a half year old female patient given NINE spinal taps over the period of a few hours by multiple providers, for a misdiagnosis. Not only an incredibly painful procedure, but one that was done incorrectly 7 times. Permanent damage has ensued. One of my nieces. My SIL called me during one of the procedures to ask if what they were doing was kosher. Had her call the local childrens hospital, who sent an ambulance and took my niece to their ER. Low and behold...GH allowed it and paid. I suspect they were afraid of a major lawsuit. Written consent had only been given for one tap.

Anyhow...the list could go on and on and on. Like I said, I'm limiting this to things that happened while I was present. Here are some more: Patients given drugs they are allergic to because the chart is improperly marked, or a duplicate name...failing to follow universal precautions...a fisbone lodged in a patients throat is determined to be "psychiatric" in nature. Yet for some reason, NW had no problem removing said "imaginary" fishbone. pretty much, you name it, and it's happened. To every single person I know who has had GH. A biased sampling, but a sampling nonetheless. The thing is ALL hosp./med professionals have "bad days". It just seems that GH has more then their fair share...and that it happens to nearly ALL of their patients...and that their attitude towards it is "Screw you."

So in a nutshell...Tricare is a pain, but I wouldn't fear for my life.

Group Health is all inclusive, you pay only your co-pays for office visits, hospitalizations and drugs thru their pharmacies. If your Group Health physician says you need procedure xyz, you get procedure xyz. Group Health has partnered with Kaiser Permanente, so their network of hospitals and doctors is larger than the Northwest. Regence is an PPO, fee for service type of insurance company, and physicians, hospitals, labs and clinics negotiate their contracts with them thru out the year, so you may find that your dr no longer accepts Regence and you can't change insurance companies until open enrollment period or you'll have to find a dr who is in their network. I'm not sure if Regence provides for prescription drug coverage. Also, when it comes to pre-authorizations, co-insurance payments, deductibles and the higher co-pays for any hospitalizations, therapy treatments, there are tighter hoops to jump thru in comparison to Group Health, that's why it's more expensive up front. My in-laws were Group Health consumers and loved them. Personally, I liked the ability to pick my physicians from a broader list of providers and use the hospital closer to home. Everything depends on your plan. Tri-Care is the armed services insurance plan. How it works specifically, I don't know, but I do know folks who use it and it works for them. I suggest calling Madigan Hospital in Tacoma or the V.A. Hospital in Seattle and ask to speak to someone in their billing offices. They would be a good source of information or look thru the benefit information that your husband was provided with.

Hi T. - I have used TriCare Remote when my husband deployed but when he returned we did not sign up for the Reserve Select because his job covered all our insurance premium. When we were on TriCare it is very comparable with "standard" insurance - one good thing is the coverage & services has massively improved on where it was 10 years ago. When the Reserve Select first started the rates were a little high but the rates came down really good this last year & hopefully they will stay in this very good range. How can you beat $180 for the entire family? You almost cant. If we had to pay for coverage and had this as an option we would take it.

I suggest that you go on the Reserve Select site: http://tricare.mil/mybenefit/ then follow the "profile" steps (this way it gets the correct info for your specific area), step 3 you click on TriCare Reserve Select. Then read about what it covers/costs and what your needs may be. Also check to see if your regular doctors are providers, if not you can always ask them to become one, that is what we had to do when my husband deployed. Because we live in a rural area several of us families went around to the medical offices & talked with them about it. It was great because most of them became providers & so we got to keep who we were already comfortable with. One thing to remember as it is with other insurance coverages is you may have to get referrals for specific things but if you follow the guidelines within the program it should work easy. Hope this helps as this could be a great way for your family to save some money! Take Care

I'm not going to speak from my own personal usage of the plan, but my Dad was enlisted for 20 years and I know that's what my parents had. My Mom passed away almost 2 yrs ago from colon cancer and took 65 days to pass while being in St Vincent hospital (SO hard as I was pregnant and needing MY mommy-another story!) Anyway, I know thruout her process with cancer, there were some frustrating times of having to be diligent and making phone calls for referrals and coverage, but in the end, I think my Dad had only a couple of hundred dollars he had to pay for her long stay at the hospital-her bills were in the hundreds of thousands! That was truly amazing. I could ask my Dad more questions (he has had quite a bit of health issues himself, but goes to the VA hospital) about how the insurance was otherwise if you'd like me to. Let me know and good luck!

K.
____@____.com

as a military wife and a mom of 2 i would love to say that the tricare reserve(TRS) is good insurance and if you choose a perfered provider then you dont have to worry about paying and the getting reimbursted.. I just went from having TRS to getting blue cross because of the change in hubbys job. just go to the tricare web site and you can check out the providers in your area. www.triwest.com
click on beneficiary then click on find a provider on the left hand side (under quick links).then you can search by area or dr if you have one you want to see if the are perfered. hope that gives you info to use. please thank your hubby for his service.

Well, I don't have either of those insurance plans but I used to work billing insurance for a chiropractor, so here is my advice. Before you change plans find out if the doctors you see take the military insurance. You may not be able to see the same doctors you've been seeing and may not have a large selection to choose from.

We are thinking of switching our kids to state insurance (because we now qualify for it) and when I checked with my pediatrician I found out their pediatric group is one of very few that take state insurance.

Compare the group health and military plans side by side, look at deductibles, copays, and co-insurance (this is the percentage that you are still responsible for after your insurace pays their part, for example you may have a $30 co-pay and your insurance covers 80%, so you are still responsible for the other 20% of the bill). Compare the other benefits of your plan, perscriptions, specialists, even alternative care (such as chiropractors, accupuncture, massage). Once you compare them side by side it is often very easy to see which is better suited and more affordable for your family in the long run.

Good Luck! Feel free to contact me if you have any other insurance questions!

M.

Hi!
My parents use Tricare and LOVE IT!!

*K

My experience with Tricare is from the medical office point of view. When I try to refer our Tricare patients to other specialists I find it very hard to find doctors that will take Tricare. The unfortunate reason being that Tricare pays about the same as Medicare which usually doesn't even cover the medical office costs so they make no money seeing someone with Tricare. The cost to you is minimal once you find someone that takes Tricare. The other thing is it takes days to get urgent referrals from Tricare. We have had to put important patient care on hold just because Tricare requires 24hr for a STAT referral. You may want to check with your daughter's Ped to make sure they take it.

I have Tricare and I have been very happy with it. Some co-insurance costs. Maybe $10 - 15 a visit. I have not had any trouble with Doctors accepting it. We go to The Everett Clinic. We have had Tricare for over 5 years and before my husband deployed we were only paying $253 a month for family coverage. Way more affordable than insurance through my ex-employer.

Good Luck!