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Tricare Provider Forced to Drop Patients

Locked_outManaging Editor's Note: This post is an excerpt from Angela Warner's blog Autism Salutes. She's a military wife who has taken on the challenge of fighting for services for children with autism whose parents are serving this nation. Are you listening Obama and McCain?

I love Eva. The kids love Eva. Angie who is Eva’s Medical Assistant is very efficient, full of kindness, and she is just plain great at what she does. After checking Isaac over and looking at a couple observations done recently by therapists in our home, Eva was filling out the EFMP paperwork for Isaac. At the end of our visit, Eva handed me an envelope, and I am still devastated. And still seeing red… red, red, RED!

The envelope… I told her that I “think I know what this is”… one of those surreal moments. She is letting us go because of TRICARE’s re-imbursement rates.

She is letting all of her 100 plus, TRICARE patients go. She is not renewing her TRICARE contract so she can keep her doors open. I am seeing RED all over again just thinking about it! Eva told me that TRICARE’s typical re-imbursement rate is ONE THIRD of what civilian insurance re-imbursement rates are… Nice… Priceless for TRICARE.

I did check this out, given my medical background and “prowess”. TRICARE’s re-imbursement rate is comparable to that of Medicare and Medicaid. Our military members and dependents receive care and services that is comparable to that which our elderly do if they are dependent upon Medicare. Our military members and their dependents also receive care and services which are comparable to that of welfare.

Read the full story from Angela HERE.

Comments

Danette

Someone is going to have to show me where OBAMA VOTED for this. Just because the newspapers/media say he "voted" doesn't mean he did. I can't find any voting record on Obama at all.

This is the major bill that he claims to have "supported" (aka..voted for)...BUT HE DIDN'T!!!

he law (H.R. 4986 (National Defense Authorization Act for Fiscal Year 2008 ):

Title VII: Health Care Provisions - Subtitle A: Improvements to Military Health Benefits - (Sec. 701) Extends through FY2008 the prohibition on increases in certain charges and premiums for care and coverage under TRICARE (a DOD managed care program) Prime, TRICARE Standard, and TRICARE Reserve Select.

(Sec. 702) Provides copayment limits, for the period beginning on October 1, 2007, and ending on September 30, 2008, for the receipt of generic, formulary, and nonformulary agents under the retail pharmacy system of the DOD pharmacy benefits program.

(Sec. 703) Provides that, with respect to any prescription filled on or after the date of enactment of this Act, the TRICARE retail pharmacy program shall be covered by the federal pricing limits applicable to covered drugs under the VA retail pharmacy program.

(Sec. 704) Authorizes the Secretary to pay a stipend to a reserve member who is called or ordered to active duty for a period of more than 30 days so that such member may maintain civilian health care coverage for a dependent whom the Secretary determines possesses a special health care need that would be best met by remaining in the member's civilian health plan.

(Sec. 705) Expands eligibility for temporary health benefits coverage under federal civilian employee provisions to include any person specified in regulations prescribed by the Secretary who loses entitlement to DOD health care services. Allows such temporary coverage for up to 36 months after the loss of such entitlement.

(Sec. 706) Amends the Warner Act to continue eligibility for TRICARE Standard coverage for certain members of the Selected Reserve.

(Sec. 707) Amends the Reagan Act to extend through FY2010 a pilot program of cooperative health care arrangements between military installations and local and regional nonmilitary health care systems. Extends related report requirements.

(Sec. 708) Includes mental health care within the definition of "health care" under the TRICARE program. Requires a report from the Secretary to the defense committees on the adequacy of access to mental health services under the TRICARE program.

The truth:

Not Voting - 6

Clinton (D-NY) McCain (R-AZ) Menendez (D-NJ) Obama (D-IL) Thune (R-SD) Warner (R-VA)

Angela Warner

Monique,

I very much appreciate the information you put up with the links. I knew I had read that grading somewhere, but for the life of me (too much crammed into this head of mine and I run out of room sometimes :D) I could not remember where. I will look at it later this afternoon when I have more time. Thank you.

I did happen to remember the organization for mental health professionals to donate time to our troops... http://www.giveanhour.org/skins/gah/home.aspx

I would love to take you up on your offer for the information you have. McCain's speech last night... I was astounded and excited! We watched it late on OPB and after I heard autism roll from his mouth I started crying and had to get up... there was no way I was going to be able to sleep!! But as we all know there is alot more to this election than the autism epidemic, although I know for our community that will play an incredible role when we cast our vote. And the only way to make a truly informed decision is through research, so I would love to read what you can share. autismrr@gmail.com

I apologize for confusing you with someone else... Welcome to Age of Autism! It's one hell of a TERRIFIC place!!!

Monique

Angela,

My intention was not to make this a political issue, but I thought it was important to bring up the Senators approach to veteran's healthcare because I feel it may offer a window on their stance to the general public's healthcare. And we all know healthcare, like the econonmy is a hot-button issue.

With that said, here are a few things I've uncovered

Iraq and Afgahnistan Veterans of America, who are non-partisan, did give John McCain a rating of D, while Obama received a B based on their voting scorecards

http://www.iava.org/full-ratings-list

They have yet to update for 2008, but their scores are based on votes within the last two years, as we know 2 wars are occuring.

Also, Disabled Veterans of America gave John McCain a 20 percent rating, while Obama received an 80% rating

http://capwiz.com/dav/scorcard.xc?chamber=S&state=US&session=1092&x=5&y=12

Believe, I have done my research about this election. And I admire both men. However, I was not trying to encourage the voting of one candidate over the other with my comment, but I think it is important to look at records as well as life stories. Many people assume John McCain has always voted for veterans legislation because he was former military and that is not entirely true.I have only observed what non-partisan veteran groups have reported let others know so they can make up their own mind.

In fact, IAVA says that McCain only voted on the veteran's way 58 percent of the 155 Senate votes it tallied 2001-2006.

Vietnam Veterans of America reports that McCain voted against 15 of 31 priority bills it tracked between 2001-2008. Note: The U.S. has been engaged in conflict during this entire period.

http://politifact.com/truth-o-meter/statements/573

Also, you can google to find more about their records on veteran legislation or I can e-mail you more specifics about different bills if you like.

And I agee with your last statement entirely.

Also, this is my first time posting here at Age of Autism but I would be happy to correspond with you in the future.

Thanks, Monique

Angela Warner

Robin... Thanks for the email today, comment, and I love the bumper sticker - It's AWESOME!!!!

I thought about putting that youtube video link up when I posted this piece. I think I may do just that before bed.... I've seen it too many times and too many times in the past few days.

Exhausted 8:38 pm here... must... do... before bed :D
Ang

Angela Warner

Monique,

I would like to address what you said:

"However, I am afraid that the attention of Austism will falter. Right now, I have heard many officials want to downplay PTSD for the servicemembers mainly to keep cost low for counseling and other treatments needed for the troop's mental health, so I would be surprised if children with Autism would become a priority."

TRICARE is continually looking for ways to reduce costs and ways to minimize the associated cost of war and PTSD (and anything else related to the "war") for our troops. Look at Walter Reed. Perfect example. While I am not currently able to provide you with a link, what I can tell you is that TRICARE and thus DoD has reduced costs in treating our returning troops from PTSD and other mental health issues they may suffer from. There was a calling, I want to say within the last year or so, for mental health providers to DONATE a certain amount of time to treat our troops for mental health issues. I commend those professionals. Thank You All!

With regard to autism and it's treatment within the military healthcare system, it will NOT falter!

What I can say is that I find it interesting that you would turn this into a political issue... I can somewhat understand??? but I do not recall you posting on Mark's, Sarah Palin column (forgive me if I missed something or you did comment and your comment goes up before mine), so again, I find it interesting that you would bring politics into this.

I am riding the fence for this election, as I think sooo many of us are. I am registered as a Democrat, but I have crossed party lines before at voting. Still, I am riding the fence.

If you are going to make such a bold statement such as the following, I would definitely expect some citations or links to back this up.

"John McCain has consistently voted against funding the Veteran Affairs and legislation for veterans healthcare, while Obama has voted in favor of legislation. McCain actually received a D rating from the Iraq and Afghanistan Veterans of America, while Obama received a B."

While I believe it is very possible that Obama has voted in favor of legislation for veterans’ healthcare, I find it quite difficult to put any faith in the statement that you made with regard to McCain’s voting against funding Veteran Affairs and legislation for veterans’ healthcare (unless it was a completely bogus waste of monies and he was intelligent enough to realize it), as McCain was a POW for FIVE years in Hanoi, Vietnam.

With a statement such as you made, I would have expected at the very least, a link to the website where you received the “grades”.

All that said, if you are that unhappy with TRICARE, I would encourage you to contact me. autismrr@gmail.com It’s been awhile since I’ve seen you post, and from what I remember you’ve brought a lot to the table. The community of military spouses working “the issues” could use some intelligent help 

Disclaimer: For this election all bets are off and I currently have NO party affiliation. I am hopeful we will have an answer from Obama and one from McCain (DIRECTLY) in the coming days regarding ALL autism treatments for ALL children regardless of whether civilian or military dependent…. And I do pray and hope there was a SERIOUS “party” in Jersey tonight :D

Monique

I am a wife of an active duty servicemember with 2 boys diagnosed with Autism and my eldest has speech and social problems as well. I am also frustrated with the medical services.

However, I am afraid that the attention of Austism will falter. Right now, I have heard many officials want to downplay PTSD for the servicemembers mainly to keep cost low for counseling and other treatments needed for the troop's mental health, so I would be surprised if children with Autism would become a priority.

On another note, John McCain has consistently voted against funding the Veteran Affairs and legislation for veterans healthcare, while Obama has voted in favor of legislation. McCain actually received a D rating from the Iraq and Afghanistan Veterans of America, while Obama received a B. Of course this is not indicative of their stance on Autism, but it does raise ths scope of who is really concerned about the healthcare of our veterans, and in a way, the country as a whole.

Robin Nemeth

I have a new bumper sticker. It is here:

http://wideopenwest.com/~r_nemeth/new_improved.htm


It says 'vaccines poison children', and 'new and improved, now poisons US troops too.'

I was inspired to make it after seeing this:

From WLWT-TV in Cincinatti, "Worst cover up in the history of the military"--

http://www.youtube.com/watch?v=Xj7AN4fRe6s&eurl=http://www.wtprn.com/

Lisa

I had a provider who was willing to accept payment from Tricare as an out of network provider. I called Tricare myself to get all the details. They informed me about my deductible and the reimbursement rate, then said to just submit my receipts to them. Great, I thought, this is going to be easy. What they hadn't bothered to tell me before they rejected my claim was that the out of network provider had to be "certified" by them and that the process could take up to six months. So the provider submitted all the paperwork. Months went by and we heard nothing. He made calls; they refused to give him any information. It was always "someone will call you back." I called repeatedly and was told they couldn't speak to me because I wasn't the provider. We went in circles with no recourse. The provider just gave up, and I paid out of pocket, too busy to even try to find out how to appeal as I was battling my school district and medical assistance at the time. I am sure my situation is not unique. I have no doubt Tricare limits the number of providers, especially those who provide very specialized services such as those for children with autism.

Kim Davis

Angela,

As a former military spouse, I can attest to all you say about the appalling medical care offered to military dependents.

Since divorcing my active duty husband, I've received Medicaid services for myself and my children (including 2 with autism) in 2 states. Let me tell you, and your readers, that the care I receive through Medicaid far exceeds anything I received through the military.

Jeanne

Ang, great job!!! You really hit the mark with this piece!
:-)

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