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Tak
12-03-2011, 03:04 PM
..........

oregonbean
12-03-2011, 06:17 PM
I truly love the medical benefits. With three births, tons of surgeries, meds etc...I bet af had paid
Well over 100k and I really appreciate that...Hell I can even get same day appts...pretty nice benefit
That gets no credit...thanks tricare

What is this same day appointment you speak of? I thought that was just a myth. I've never been able to land one of those, even when I had influenza a few years ago(the year the vaccine gods chose the wrong strain). I could barely talk or breathe, but when my husband called Tricare to get the OK to take me off base, they told him that I had to make the request, and we needed to wait until after the base clinic closed to seek treatment.

Other than that, I've never had any real problems with Tricare. The MTF itself. . . that's a different story.

giggawatt
12-03-2011, 07:20 PM
Wait! A positive post from Tak? First WJ5 and JB agreeing on something political and now this? It must truly be the end of times!

AeroNut
12-03-2011, 07:56 PM
I've recently been assigned to a new PCM at our clinic and she is actually a great doctor. Unfortunately, I've had about a 10:1 ratio of bad doctors (PAs, actually) to good doctors in military clinics. Our base gets pretty backed up so usually we're referred off base for almost everything, which is nice. My wife spent a weekend in the ER and required surgery, so Tricare saved us over $30k there. I have to take medication which costs over $400 a month, so I'm saving a ton of money there.

Overall, Tricare rocks. I have no problem with Tricare, just the crap quality of [many] military doctors.

alaskaresident
12-03-2011, 08:03 PM
Two knee surgeries for me, dental surgery, two births plus a late miscarriage that required a D&C, a son with autism that has so far required two rounds of tubes in his ears, extensive therapy, EEG and an MRI, possibly facing brain durgery...we are still waiting on the results from the MRI...yeah TRICARE has paid a crap load out for my family. God bless insurance on that aspect. It does suck when it comes to dental coverage for dependents though. DH needs to work done but they wont cover what needs to be done and I'm sorry we do not have $5,000 laying around to cover it. I've given up on trying to get into my PCM and getting the run around on base. If I need to be seen I will wait until I know there will be no more same day appointments then call so I can be referred to urgent care off base and go there. There is no way in HELL I can afford to get out of the military.

imported_BRAVO10000
12-03-2011, 08:05 PM
Having shopped the FEHB for civil service, TriCare rocks. I'm on Plus for retirees overseas; urban legend id that you wait a long time to be seen. I called on a Friday and was able to make an appointment for the next Friday at LRMC. It was/is completely free. My teenager in college has a small premium for Prime - keeping him covered comes right out of my retirement pay so I never really miss it.

The latest DAA, care of John McCain, wants to change that...

Airborne
12-03-2011, 10:51 PM
Dont you love socialized health care!? I have had good luck too, but unfortunately, the care varies widely from station to station, person to person.

VFFSSGT
12-03-2011, 11:23 PM
What is this same day appointment you speak of? ...

I think that is what we refer to as the ER.


yeah TRICARE has paid a crap load out for my family.

Compared to the actual cost of the procedures and amount billed to TRICARE...they actually have paid VERY LITTLE. Most of the time you (we) are causing a financial lost to the civilian providers we see.

I have had several MRI's myself...each billed out at around $2,500 - $3,000 depending on the type and TRICARE only paid ~$300 per each one.

I have had a $50,000+ surgery...TRICARE only paid ~$15,000.

Just got a statement of benefits for some medicine I take routinely...billed out at over $500, TRICARE, well ExpressScripts, paid ~$90.

This is why clinics and businesses are fleeing government provided healthcare...they are consistently loosing money.

OtisRNeedleman
12-04-2011, 12:33 AM
I think that is what we refer to as the ER.



Compared to the actual cost of the procedures and amount billed to TRICARE...they actually have paid VERY LITTLE. Most of the time you (we) are causing a financial lost to the civilian providers we see.

I have had several MRI's myself...each billed out at around $2,500 - $3,000 depending on the type and TRICARE only paid ~$300 per each one.

I have had a $50,000+ surgery...TRICARE only paid ~$15,000.

Just got a statement of benefits for some medicine I take routinely...billed out at over $500, TRICARE, well ExpressScripts, paid ~$90.

This is why clinics and businesses are fleeing government provided healthcare...they are consistently loosing money.

On the Tricare side, remember, these providers/drug stores signed contracts to provide services/products. They wouldn't sign those contracts if they were going to take a loss every time. Also, Tricare pays the providers pretty quickly, at least where I live. Far as the medicines go, most generic medications are relatively inexpensive, and Express Scripts pays at the Government rate. From what I can tell, Express Scripts pays fairly close to the market rate for branded medications. The drug stores may not make a lot on each prescription, but they'll get the volume. Same thing with the providers, who will also have patients with insurance that pays better than Tricare. Having said that, if you think Tricare pays poorly, Medicaid pays much worse, and many doctors will not take Medicaid patients at all.

OtisRNeedleman
12-04-2011, 12:39 AM
What tricare agrees to pay is probably the closest the hospitals ever see to someone paying the real cost.
The fact they accept the low amounts speaks volumes.

Indeed. About a year ago had an angiogram - a heart test done in an operating room, outpatient. Hospital charged Tricare over $35,000 for the test and recovery - was there total of about six hours. Tricare paid just barely over $5,000. Doctor charged Tricare over $700, they paid him about $300. I paid nothing at all.

The people who get raped are American citizens/legal immigrants who can't afford insurance but aren't poor enough for Medicaid. They get socked with the full price, at least initially.

LogDog
12-04-2011, 07:08 PM
On the Tricare side, remember, these providers/drug stores signed contracts to provide services/products. They wouldn't sign those contracts if they were going to take a loss every time. Also, Tricare pays the providers pretty quickly, at least where I live. Far as the medicines go, most generic medications are relatively inexpensive, and Express Scripts pays at the Government rate. From what I can tell, Express Scripts pays fairly close to the market rate for branded medications. The drug stores may not make a lot on each prescription, but they'll get the volume. Same thing with the providers, who will also have patients with insurance that pays better than Tricare. Having said that, if you think Tricare pays poorly, Medicaid pays much worse, and many doctors will not take Medicaid patients at all.
The thing to remember with drug stores is where they get their supplies from. Like the military, they have contracts with pharmaceutical distributors and their prices are partially dependent upon the amount of volume they do. A drug store chain in a particular region will get a larger discount from the distributor than a single drug store. At the end of the year, if a drug store has purchase more of drug(s) than the distributor projected they could get a rebate from the distributor for the extra volume. The distributor also receives a rebate from the pharmaceutical companies if they too buy more than want the companies projected.

Also, another way drug stores make money is by selling information on what individual doctors are writing prescriptions for. Patient information isn't being given because the pharmaceutical companies want to know which doctors are not prescribing their line of drugs. This is how and why pharmaceutical salesmen are always visiting doctors.

OtisRNeedleman
12-04-2011, 07:14 PM
The thing to remember with drug stores is where they get their supplies from. Like the military, they have contracts with pharmaceutical distributors and their prices are partially dependent upon the amount of volume they do. A drug store chain in a particular region will get a larger discount from the distributor than a single drug store. At the end of the year, if a drug store has purchase more of drug(s) than the distributor projected they could get a rebate from the distributor for the extra volume. The distributor also receives a rebate from the pharmaceutical companies if they too buy more than want the companies projected.

Also, another way drug stores make money is by selling information on what individual doctors are writing prescriptions for. Patient information isn't being given because the pharmaceutical companies want to know which doctors are not prescribing their line of drugs. This is how and why pharmaceutical salesmen are always visiting doctors.
Another way one chain is trying to make more money from Express Scripts is by trying to charge Express Scripts for things such as counseling patients re their medications. Don't know if that's been hashed out yet but if it isn't that particular chain's contract with Express Scripts won't be renewed.

imported_blacksheep1208
12-04-2011, 10:18 PM
I was able to get PRK done at the Air Force Academy for free. I'd say that's a pretty good benefit right there.

Medic0721
12-05-2011, 06:43 AM
I was able to get PRK done at the Air Force Academy for free. I'd say that's a pretty good benefit right there.

No more wait list, they are opening it up to anyone who needs it. Well worth it if you need it.

alaskaresident
12-05-2011, 02:01 PM
My son's pediatrician at our MTF is GREAT!!! She has never questioned our need for a referral due to his autism. She is now watching our daughter a little closer to see if she starts showing any signs of being delayed so we can get help for her sooner if needed. Our last pediatrician provider kept putting things off and kept saying, "let's wait and see."

AF Comm Guy
12-05-2011, 02:51 PM
I certainly have no complaints. My daughter was jaundiced when she was born so she had to stay several days getting treated for it. My wife stayed there most of the week and Tricare paid for it all. I even got to stay in the room with them most nights and got fed. Okay, eating hospital food isn't exactly what I would call "getting fed" but you get the idea. It was kind of funny really because after a few days the nurses in the baby ward were telling us to GTFO and go eat, see a movie, etc. That was probably some of the best advice we got from the hospital.

Funny how people can gripe about so called "socialized medicine" as if it were the epitome of all evil yet they don't have any problem with the military having it although what we have really isn't social medicine. As for John McCain, I don't know if any bigger traitor to the military that is still alive today and not behind bars. Few have fought against VA benefits more than he has. In my opinion he should be publicly lynched on Pennsylvania Ave. with his body left for the birds to feed on.

What? Too harsh?

PburghNo1
12-05-2011, 04:09 PM
I have to concur with Tak. My son was sick it cost upwards of $750K (Yes, I know, that's just the full cost billed on the SOB). TriCare payed nowhere near that much and I paid...you guessed it... $0.00. I don't know what would've happened to me or my son if I wasn't in the military. Oh, yeah--and the AF paid for him and I to travel 4 hrs to a regional center every 2-6 weeks (it varied based on his condition) for 2-3 nights throughout his yearlong treatment.

I just LOVE when people come to me and bitch about TriCare and say the benefit isn't worth it. Yeah, I know my situation is unique, but I never thought it'd happen to my family...

VFFSSGT
12-05-2011, 06:51 PM
Indeed. About a year ago had an angiogram - a heart test done in an operating room, outpatient. Hospital charged Tricare over $35,000 for the test and recovery - was there total of about six hours. Tricare paid just barely over $5,000. Doctor charged Tricare over $700, they paid him about $300. I paid nothing at all.

The people who get raped are American citizens/legal immigrants who can't afford insurance but aren't poor enough for Medicaid. They get socked with the full price, at least initially.

And those that pay higher premiums and deductibles to cover the losses from those on government managed care and those with no insurance*...and those that pay the taxes to pay our bills - and don't say you pay taxes because technically you don't - you are paying taxes with tax money; actually taxes are paid by civilians.

But insurance is nothing but a money making business...a middle man that is not needed for general care. There have been doctors who have tried to cut the middle man out of the picture by instituting a small monthly fee to cover a person's care whenever they needed it. Guess what stopped them? …government regulations that exist to protect insurance company's existence.

Then there are the lawyers...different subject though.

The source problem with medicine though...the government, well you could say the AMA when it started like 100 years ago...

OtisRNeedleman
12-05-2011, 07:05 PM
And those that pay higher premiums and deductibles to cover the losses from those on government managed care and those with no insurance*...and those that pay the taxes to pay our bills - and don't say you pay taxes because technically you don't - you are paying taxes with tax money; actually taxes are paid by civilians.

But insurance is nothing but a money making business...a middle man that is not needed for general care. There have been doctors who have tried to cut the middle man out of the picture by instituting a small monthly fee to cover a person's care whenever they needed it. Guess what stopped them? …government regulations that exist to protect insurance company's existence.

Then there are the lawyes...different subject though.

The source problem with medicine though...the government, well you could say the AMA when it started like 100 years ago...

I hear you, but disagree that I don't pay taxes. Yes, I pay taxes. You pay taxes. Doesn't matter how our respective salaries/pensions are funded, we pay taxes. AF takes those taxes (Federal and state, as applicable) from our checks.

Today's AMA has changed from what it originally started to be, which was a means to ensure proper training of doctors and good medical practice. Not sure what today's AMA is, but it doesn't seem to be a help to medicine any more.

imported_BRAVO10000
12-05-2011, 08:06 PM
I hear you, but disagree that I don't pay taxes. Yes, I pay taxes. You pay taxes. Doesn't matter how our respective salaries/pensions are funded, we pay taxes. AF takes those taxes (Federal and state, as applicable) from our checks.

Today's AMA has changed from what it originally started to be, which was a means to ensure proper training of doctors and good medical practice. Not sure what today's AMA is, but it doesn't seem to be a help to medicine any more.

Truth is, many of us in uniform, as well as many of these "taxpaying" civilians - usually the ones withthe balls to tell you that they "pay your salary" - are paying zero tax. Some get more in returns than they paid in all year. I think I read that 40% of Americans live tax-free in our country (most of them sitting in an OWS rally some damn where...).

I just hope that 40% is the majority chunk of the 60% of our nation that doesn't bother to vote. That would be at least somewhat just.

LogDog
12-05-2011, 08:12 PM
Truth is, many of us in uniform, as well as many of these "taxpaying" civilians - usually the ones withthe balls to tell you that they "pay your salary" - are paying zero tax. Some get more in returns than they paid in all year. I think I read that 40% of Americans live tax-free in our country (most of them sitting in an OWS rally some damn where...).

I just hope that 40% is the majority chunk of the 60% of our nation that doesn't bother to vote. That would be at least somewhat just.
That 40% figure is because they don't earn enough money to be taxed on.

sandsjames
12-06-2011, 04:31 AM
Funny how people can gripe about so called "socialized medicine" as if it were the epitome of all evil yet they don't have any problem with the military having it although what we have really isn't social medicine. As for John McCain, I don't know if any bigger traitor to the military that is still alive today and not behind bars. Few have fought against VA benefits more than he has. In my opinion he should be publicly lynched on Pennsylvania Ave. with his body left for the birds to feed on.

What? Too harsh?

Yes, we have socialized medicine, but we all also have jobs and contribute. The problem with socialized medicine for the rest of society is that it's just another way for those who are willing and eager to misuse the system to do so. I've got no problem with "free" medical care as long as the person has a job. I don't want to be paying for the lazy people or the illegal people.

VFFSSGT
12-06-2011, 05:00 AM
I hear you, but disagree that I don't pay taxes. Yes, I pay taxes. You pay taxes. Doesn't matter how our respective salaries/pensions are funded, we pay taxes. AF takes those taxes (Federal and state, as applicable) from our checks.

Today's AMA has changed from what it originally started to be, which was a means to ensure proper training of doctors and good medical practice. Not sure what today's AMA is, but it doesn't seem to be a help to medicine any more.

The amount of money the government could save by not managing the taxation of tax dollars is substantial...but then again, if we cut out that bureaucracy, that would take out a large pool of people whose money is redistributed through the tax code to the "needy."

Sure they ensured "proper training"...but the other way to look at is certain people who thought they were above others who may or may not have had much training provided medical care at a cheaper cost than the 'elite' where providing it. So, they created an organization who lobbied for government regulation to protect their elite status aka licensing. The result, more expensive care and less medical personnel.

Then the AMA got a hold of the schools and their credentials. The result, decrease availability of school/training slots, increase cost for training resulting in increased cost of care and even less medical personnel available to the public.

And here we are today with this vicious cycle continuing and people are taught the AMA is/was there to protect the people just like the government claims everything they do is to protect the people...and that the Civil War was only about slavery. :frusty

The AMA was/is to the medical profession what the Fed was/is to the banks...a protection mechanism of the elite.

wildman
05-24-2013, 05:21 PM
I'm new here so if this is the wrong area please move it to the correct one.

For a good number of years the insurance provider for our Tricare was Triwest. I had absolutely no problems when dealing with them an have to say they had their act together. Well recently we change to United Healthcare, an let's just say they SUCK . They over billed me for the wife's coverage an three attempts, one talking with a so called supervisor accomplished nothing more than the ole run around. They showed themselves to be inept, incompetent, uncaring an rude. If anyone knows the email address at DOD where I can send a formal complaint please post it. Needless to say I am real ticked off about this an if possible will not let them get away with this crap.

Always
Wildman

VFFTSGT
05-24-2013, 06:01 PM
Go to your hospital, see the tricare beneficiary counselor, present your facts.
I know your pain. I have my guy help me with insurance issues. Just bring
Them on base your papers and theyll help. United will improve. Good luck.

http://www.militarytimes.com/article/20130502/BENEFITS06/305020029/Complaints-spur-DoD-action-Tricare-West

http://www.startribune.com/business/208195711.html


Tricare will waive the usual penalty fees levied on those who see a specialist without approval until May 18, according to a memo sent to the military services’ assistant secretaries for manpower and reserve affairs from Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson.

Woodson acknowledged the problems beneficiaries have been having with referrals, authorizations and customer service since UnitedHealthCare Military & Veterans assumed management of the Tricare West Region contract on April 1.

You need to go see your local Referral Office - should be on in the clinic/hospital on base.

TriWest did not have their crap together; that is why they lost the contract. They were scamming the government.

http://usatoday30.usatoday.com/news/washington/story/2012-01-27/triwest-military-health-care-fraud/52908332/1

VFFTSGT
05-24-2013, 06:02 PM
Go to your hospital, see the tricare beneficiary counselor, present your facts.
I know your pain. I have my guy help me with insurance issues. Just bring
Them on base your papers and theyll help. United will improve. Good luck.

http://www.militarytimes.com/article/20130502/BENEFITS06/305020029/Complaints-spur-DoD-action-Tricare-West

http://www.startribune.com/business/208195711.html

What Tak said; your base clinic/hospital should have a Tricare/Referral Office -that is where you need to start.

From one of his links...


Tricare will waive the usual penalty fees levied on those who see a specialist without approval until May 18, according to a memo sent to the military services’ assistant secretaries for manpower and reserve affairs from Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson.

Woodson acknowledged the problems beneficiaries have been having with referrals, authorizations and customer service since UnitedHealthCare Military & Veterans assumed management of the Tricare West Region contract on April 1.


That waiver was to expire Saturday, but the government extended it until at least June 18, when Tricare officials will once again judge the speed with which UnitedHealthcare is providing care.

Also, TriWest did not have their crap together, which is why they lost their contract.

http://usatoday30.usatoday.com/news/washington/story/2012-01-27/triwest-military-health-care-fraud/52908332/1

OtisRNeedleman
05-24-2013, 07:14 PM
I'm new here so if this is the wrong area please move it to the correct one.

For a good number of years the insurance provider for our Tricare was Triwest. I had absolutely no problems when dealing with them an have to say they had their act together. Well recently we change to United Healthcare, an let's just say they SUCK . They over billed me for the wife's coverage an three attempts, one talking with a so called supervisor accomplished nothing more than the ole run around. They showed themselves to be inept, incompetent, uncaring an rude. If anyone knows the email address at DOD where I can send a formal complaint please post it. Needless to say I am real ticked off about this an if possible will not let them get away with this crap.

Always
Wildman

+1!!!!!

Yeah, we have UHC, too. For all the time they had to get ready to take over from TriWest they are doing a shit job. Slow to process referrals and they are paying my primary care doctor less than TriWest did. TriWest always did a great job for us.

Try this site to lodge a complaint:

www.tricare.mil

You might also want to let your Congressperson/Senator know, too, if things are bad enough.

garhkal
05-24-2013, 07:16 PM
That 40% figure is because they don't earn enough money to be taxed on.

Well if they don't "Earn enough to get taxed on" why should they get any rebate/return?

From seeing the amt of money payed out to those with families here, it shows us single folk cost the govt less.

VFFTSGT
05-24-2013, 07:19 PM
+1!!!!!

Yeah, we have UHC, too. For all the time they had to get ready to take over from TriWest they are doing a shit job. Slow to process referrals and they are paying my primary care doctor less than TriWest did. TriWest always did a great job for us.

Try this site to lodge a complaint:

www.tricare.mil

You might also want to let your Congressperson/Senator know, too, if things are bad enough.

TriWest scammed the government, which is why they lost the contract.

UHC shouldn't being paying less than TriWest as Tricare rates are tied to Medicare rates.

OtisRNeedleman
05-24-2013, 09:09 PM
TriWest scammed the government, which is why they lost the contract.

UHC shouldn't being paying less than TriWest as Tricare rates are tied to Medicare rates.

Well, from what I have seen on my explanations of benefits they certainly are. They are paying my primary care doctor twenty dollars less for a visit than TriWest did. I think that's despicable. That woman saved my life.

Also, the UHC website sucks canal water. Information is lacking. Can't access EOB pdfs, either. UHC has had months to get this stuff ready. No excuse.

And here's a good one...we aren't supposed to go to an acute care clinic on weekends/holidays/evenings without a referral from our primary care manager. WTF? If my primary care manager's office were open I wouldn't need to go to an acute-care clinic. Oh, well, if we really need care outside regular hours we'll go to the ER...a quantum leap more expensive for Tricare than going to an acute-care clinic but no prior authorization needed. Get the head out of the ass, UHC. Didn't need to do this with TriWest.

VFFTSGT
05-24-2013, 10:53 PM
Well, from what I have seen on my explanations of benefits they certainly are. They are paying my primary care doctor twenty dollars less for a visit than TriWest did. I think that's despicable. That woman saved my life.

Also, the UHC website sucks canal water. Information is lacking. Can't access EOB pdfs, either. UHC has had months to get this stuff ready. No excuse.

And here's a good one...we aren't supposed to go to an acute care clinic on weekends/holidays/evenings without a referral from our primary care manager. WTF? If my primary care manager's office were open I wouldn't need to go to an acute-care clinic. Oh, well, if we really need care outside regular hours we'll go to the ER...a quantum leap more expensive for Tricare than going to an acute-care clinic but no prior authorization needed. Get the head out of the ass, UHC. Didn't need to do this with TriWest.

Not really because Tricare doesn't pay much for an ER visit. If UHC is paying less, I don't understand how because the rates are tied to Medicare - maybe medicare rates changed about the same time?!

I thought Humana Military had the best website. I don't think I ever successfully got into the TriWest one...every time I tried something went wrong.

This just displays the ineffectiveness and inefficiency of Tricare as a whole though. Why we have to register every time we PCS. Why every region does things different, etc. It's so much redundancy and waste.

I was shocked to see my prior authorization for a medication crossed over from one region to another, which they only paid about $80 for a nearly $600 dollar (retail list price) medication.

wildman
05-25-2013, 01:31 AM
What really ticks me off is that they told us if we stayed twenty or more years on active duty ours an our spouses medical care would be free. Well I stayed that amount of time, three years with the U.S. Army an seventeen years with the U.S.A.F. My medical care an the spouses had not been free. I for non military connected reasons have been on Medicare part A and B for some time. The wife will be eligible this coming August.

Always
Wildman

LogDog
05-25-2013, 03:05 AM
What really ticks me off is that they told us if we stayed twenty or more years on active duty ours an our spouses medical care would be free. Well I stayed that amount of time, three years with the U.S. Army an seventeen years with the U.S.A.F. My medical care an the spouses had not been free. I for non military connected reasons have been on Medicare part A and B for some time. The wife will be eligible this coming August.

Always
Wildman
I've heard this a lot, especially since my father was retired Navy. But like I tell everyone who says this, show me in writing where it is promised. Every time you reenlisted enlistment contract had a clause that went something like this:

The agreements in this section and attached annex(es) are all the promises made to me by the Government. Anything else anyone has promised me is not valid and will not be honored.

I've seen this in my enlistment papers and I'm not smarter than most people but I actually read what I signed and I knew there was no promise of free medical care when I retired. What I did know was that the military did provide medical care for retirees for very little compare to what our civilian counterparts paid. My civilian friends pay 3 - 5 times a month in what I pay in a year under Tricare.

I'll be on Medicare Part A and B in a couple of years but even then the prices is, for me, more than reasonable.

OtisRNeedleman
05-25-2013, 04:55 AM
Not really because Tricare doesn't pay much for an ER visit. If UHC is paying less, I don't understand how because the rates are tied to Medicare - maybe medicare rates changed about the same time?!

I thought Humana Military had the best website. I don't think I ever successfully got into the TriWest one...every time I tried something went wrong.

This just displays the ineffectiveness and inefficiency of Tricare as a whole though. Why we have to register every time we PCS. Why every region does things different, etc. It's so much redundancy and waste.

I was shocked to see my prior authorization for a medication crossed over from one region to another, which they only paid about $80 for a nearly $600 dollar (retail list price) medication.

TriWest's website wasn't perfect but I expected better from UHC.

I can't really complain overall about Tricare. They handled my open-heart surgery very effectively. When the surgeon submitted the request for authorization early afternoon after seeing me, he got an approval by COB that same day. And my total out-of-pocket for a $250K operation was $56, counting the copay for the consult with the surgeon. Less that $12, for $44 I got all the pre-op stuff at the hospital, plus the surgery, ICU, etc., just everything. Was only in four days. The only thing Tricare wouldn't cover was home visits by a nurse but no big deal. I'm a big boy and could take care of myself.

Yeah, I don't understand the difference in payments either.

garhkal
05-25-2013, 05:54 AM
My civilian friends pay 3 - 5 times a month in what I pay in a year under Tricare.

I'll be on Medicare Part A and B in a couple of years but even then the prices is, for me, more than reasonable.

I can't remember if i ever signed up for tricare when i got discharged or not.

wildman
05-25-2013, 07:25 PM
So if someone lies to you and it is not in writing that is okay? I guess integrity is of no importance? Oh well I guess I should have run for congress, you should see what kind of health care and retirement they have!

Always
W#ildman

VFFTSGT
05-25-2013, 08:15 PM
TriWest's website wasn't perfect but I expected better from UHC.

I can't really complain overall about Tricare. They handled my open-heart surgery very effectively. When the surgeon submitted the request for authorization early afternoon after seeing me, he got an approval by COB that same day. And my total out-of-pocket for a $250K operation was $56, counting the copay for the consult with the surgeon. Less that $12, for $44 I got all the pre-op stuff at the hospital, plus the surgery, ICU, etc., just everything. Was only in four days. The only thing Tricare wouldn't cover was home visits by a nurse but no big deal. I'm a big boy and could take care of myself.

Yeah, I don't understand the difference in payments either.

All of this experience is based on being Active Duty with Tricare Prime...

I hate Tricare because of the managed care concept itself. If a doctor says you need to go see an orthopedic...some bureaucrat sitting in an office shouldn't be "overseeing" the doctor's recommendations. You should go see an orthopedic.

Then there is the medicine side of it too. I got prescribed a liquid form of a medication. Not covered. I paid for it out of pocket; wasn't like I was going to go back to the ER at midnight to play trial and error with another prescription. Tried to challenge it and lost. It didn't cost anymore than the pill form and it was of medical necessity that I had the liquid; mouth was wired shut. It simply wasn't on their list of approved medications.

Then there is a prior authorization I had to get for Prevacid. It had already been documented it worked for me and other PPI's didn't. But I had to go through a process of trial and error with other drugs just to satisfy Tricare's/ExpressScripts' wishes to give me prior authorization for a non-formulary medication that they only pay pennies on the dollar for anyways so I don't understand why it's not on the list anymore to begin with.

My point is, Tricare pays only pennies on the dollar for all services and medications. Why one service/medication is not approved based on cost is beyond me because they don't pay the retail costs or anything close to them.

It's like the hesitation of Doctors on base to refer you off base for a MRI because it's expensive. In the real world, sure a couple thousand dollars. Tricare only pays a couple hundred though.

They spend more money to save a lesser amount of money. Tricare is an sham that serves no other purpose than to provide employment to people with nothing better to do and serve special interest (insurance companies).

The DOD complains about healthcare cost. We could save so much money if we got rid of the whole Tricare system and just paid some Airmen or GS-5's to process payments for off base services/medications the base doesn't have.

OtisRNeedleman
05-25-2013, 09:46 PM
All of this experience is based on being Active Duty with Tricare Prime...

I hate Tricare because of the managed care concept itself. If a doctor says you need to go see an orthopedic...some bureaucrat sitting in an office shouldn't be "overseeing" the doctor's recommendations. You should go see an orthopedic.

Then there is the medicine side of it too. I got prescribed a liquid form of a medication. Not covered. I paid for it out of pocket; wasn't like I was going to go back to the ER at midnight to play trial and error with another prescription. Tried to challenge it and lost. It didn't cost anymore than the pill form and it was of medical necessity that I had the liquid; mouth was wired shut. It simply wasn't on their list of approved medications.

Then there is a prior authorization I had to get for Prevacid. It had already been documented it worked for me and other PPI's didn't. But I had to go through a process of trial and error with other drugs just to satisfy Tricare's/ExpressScripts' wishes to give me prior authorization for a non-formulary medication that they only pay pennies on the dollar for anyways so I don't understand why it's not on the list anymore to begin with.

My point is, Tricare pays only pennies on the dollar for all services and medications. Why one service/medication is not approved based on cost is beyond me because they don't pay the retail costs or anything close to them.

It's like the hesitation of Doctors on base to refer you off base for a MRI because it's expensive. In the real world, sure a couple thousand dollars. Tricare only pays a couple hundred though.

They spend more money to save a lesser amount of money. Tricare is an sham that serves no other purpose than to provide employment to people with nothing better to do and serve special interest (insurance companies).

The DOD complains about healthcare cost. We could save so much money if we got rid of the whole Tricare system and just paid some Airmen or GS-5's to process payments for off base services/medications the base doesn't have.

My experiences are with the Retiree Prime. Yeah, also had to establish medical necessity for a Tier-3 PPI, Protonix. But the medical necessity was approved.

I hear you re the primary care manager concept. To me it hasn't been a real problem. My primary care manager has done a great job of making sure I get specialty care. And the doctors downtown don't hesitate to refer you for any test or imagery. When my heart problems started think I had just about every test except tearing the heart out and checking it out. If authorizations were needed TriWest didn't dawdle.

Just an opinion...believe when Obamacare really gets rolling next year things will be in such a clusterfuck that we'll be mighty glad to have Tricare.

VFFTSGT
06-02-2013, 06:15 PM
Recently got an explanation of benefits....

$20,000+ procedure - Tricare paid a little over $2,800.

This is everything that is wrong with government health care.

I am not saying $20K isn't inflated some but knowing what was done...$2,800 seems awful cheap.

OtisRNeedleman
06-02-2013, 09:03 PM
Recently got an explanation of benefits....

$20,000+ procedure - Tricare paid a little over $2,800.

This is everything that is wrong with government health care.

I am not saying $20K isn't inflated some but knowing what was done...$2,800 seems awful cheap.

Even at $2800 the provider is making money. Providers know their cost structure and take it into account when negotiating contracts with Tricare or any civilian medical insurance company. Providers aren't going to contract with Tricare if they can't make money. The only people who might pay the full $20K would be certain of the uninsured who can afford to do so. I know what it's like...Tricare was billed about $250K for the heart surgery. They paid a few bucks under $58K. The other $56 came from me. No complaints or further billing from providers. No complaints from me.

LogDog
06-02-2013, 10:14 PM
There's an interesting article concerning why U.s. health costs are the highest in the world. The article uses Colonoscopies as a comparison.

http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?hp&_r=0

VFFTSGT
06-03-2013, 12:03 AM
Even at $2800 the provider is making money. Providers know their cost structure and take it into account when negotiating contracts with Tricare or any civilian medical insurance company. Providers aren't going to contract with Tricare if they can't make money. The only people who might pay the full $20K would be certain of the uninsured who can afford to do so. I know what it's like...Tricare was billed about $250K for the heart surgery. They paid a few bucks under $58K. The other $56 came from me. No complaints or further billing from providers. No complaints from me.

Providers don't negotiate rates with Tricare. Tricare rates are tied to Medicare rates and they are set by bureaucrats.

Actually, there are a lot of providers who state they lose money a lot of the time with Tricare. They accept as a service to the troops. Got a friend who went to an off base provider...when the doctor saw he was Tricare he stated something to the effect of great, not getting anything out of this.

http://www.usmedicine.com/articles/tricare-currently-tied-to-medicare-rates-threatened-by-debt-deal.html#.Uavdo5UTt68