Tricare Prime, how good is it?

[xmsr3]

On paper Tricare Prime sounds great, especially for ADSMs, but I was hoping to hear from people who are in the military, (or family members of service members) who have used it in the past.

What's the REAL story regarding Tricare Prime? How often have you used it? For what Services? What is the typical wait time for primary care visits? Specialty Referals? Any things to watch out for?

How does Tricare Prime compare to private health insurance you have had in the past? Basically, how happy are you with Tricare Prime?

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[a1qwerty55]

On paper Tricare Prime sounds great, especially for ADSMs, but I was hoping to hear from people who are in the military, (or family members of service members) who have used it in the past.

What's the REAL story regarding Tricare Prime? How often have you used it? For what Services? What is the typical wait time for primary care visits? Specialty Referals? Any things to watch out for?

How does Tricare Prime compare to private health insurance you have had in the past? Basically, how happy are you with Tricare Prime?

Like everything it depends -

In many locations there aren't enough doctors who accept Tricare Prime - that is a problem .

If you live near an MTF it is pretty good as you get priority for appts, and the MTF has to meet Tricare access standards - 30 days for a routine appointment, I think 48hrs for urgent care etc.

The drug benefit is stupidly generous and not sustainable - you can get 50K worth of medication for nothing if you get it from a military pharmacy or if you go civilian, the copay is trivial.

In the event you have something catastrophic happens or you need something ridiculously expensive or only performed in a center of excellence somewhere - it is a tremendously good policy as the government pays airfare, hotel, all care, etc. if you have to go to let's say Mayo, and covers you bone marrow transplant etc. I've been blown away with what Tricare has approved - often things that most private insurers would deny.

 

[IgD]

I think Tricare Prime is really good if you are a retiree because it's like something for nothing. If you are on active duty it is mediocre at best because it is difficult to access specialty care. In the past there has been problem with the military hospitals refusing to authorize out in town visits even though they don't have the capacity to treat patients. I think it is called right of first refusal. With my civilian insurance any of my family members can see pretty much any doctor they want. The catch is we have to pay a monthly premium and a co-pay for visits and meds which we don't necessarily mind.

 

[BigNavyPedsGuy]

My wife and I have loved. Of course I'm at a big MTF, and I'm not scared to use my resident connect to get "back door" appointments. But so far we are very happy, especially when I look back and compare it to the Blue Cross Blue Shield days while I was in medical school.

 

[The White Coat Investor]

The insurance is fine. Access sucks, but as a doc you can usually back door your way into clinics as needed around the MTF. It's the rest of the military that suffers on the phone trying to get an appt.

 

[orbitsurgMD]

The insurance is fine. Access sucks, but as a doc you can usually back door your way into clinics as needed around the MTF. It's the rest of the military that suffers on the phone trying to get an appt.

The access sucks because the payment schedules suck. Ask anyone who actually relies on insurance payments to do wacky things like keep their practice afloat. Tricare is a crappy payer. Tricare prime is even worse. Taking Tricare is an act of generosity.

 

[NateintheED]

The access sucks because the payment schedules suck. Ask anyone who actually relies on insurance payments to do wacky things like keep their practice afloat. Tricare is a crappy payer. Tricare prime is even worse. Taking Tricare is an act of generosity.

Agree with ADMD as above. Access sucks on the outside as OSMD mentioned, and within the military MTF's because the clinics are overburdened and have their hands tied by AHLTA. I saw 3 kids in the ED today that were taken to Peds clinic only to be told there were no available slots for their problems that needed evaluation but could have been seen in clinic.

For patients seen in the ED at least, I can usually get urgent follow-up as I need. And providers can pretty much backdoor what they need from colleagues.

 

[73BARMYPgsp]

When I was a young, single NCO who never went to the doctor it was great. Married with 2 kids gives me shivers every time I am about to hear from my wife about the last appointment/phone call/consult/Runny nose ER visit.

 

[The White Coat Investor]

The access sucks because the payment schedules suck. Ask anyone who actually relies on insurance payments to do wacky things like keep their practice afloat. Tricare is a crappy payer. Tricare prime is even worse. Taking Tricare is an act of generosity.

Oh yeah, well, there's that. You know how you see seniors complaining that no one takes medicare and so they can't find a PCP? Tricare pays at the same rates.

 

[a1qwerty55]

Oh yeah, well, there's that. You know how you see seniors complaining that no one takes medicare and so they can't find a PCP? Tricare pays at the same rates.

Yep - If big brother drops reimbursement, private insurers quickly do the same. Physicians incomes have dropped steadily while practice expenses have steadily increased, I saw a fascinating graphic outlining this. Frankly Tricare has issues but so do most every other insurance policies. One tremendous irritant with Tricare however is the fact that when you change regions have to re-enroll and essentially reinvent the wheel for let's say home oxygen, etc. Stupid policy if you ask me.

Same when you go TDY!. totally stupid.

 

[Mirror Form]

In the past there has been problem with the military hospitals refusing to authorize out in town visits even though they don't have the capacity to treat patients. I think it is called right of first refusal.

Right of first refusal means that the hospital retains the right to deny referrals to the civilian network if the hospital has the capacity to treat the disease.

Overall it makes sense b/c often times people with tricare are being seen by a civilian FP, who then refers them to a civilian specialist. If there is a military hospital nearby that has the specialist, that is where right of first refusal comes in. The military hospital may decide to deny the tricare referral and demand the patient be seen at there. Theoretically this would not prevent people from getting referrals if there was not the appropriate specialty at the military hospital, but who knows.

 

[JackADeli]

I have never had to live under TriCare....

...In many locations there aren't enough doctors who accept Tricare Prime - that is a problem .

...The drug benefit is stupidly generous and not sustainable...

...If you are on active duty it is mediocre at best because it is difficult to access specialty care...

...Access sucks ...the rest of the military that suffers on the phone trying to get an appt.

The access sucks because the payment schedules suck. ...Tricare is a crappy payer...

I had an attending that "moonlighted" at our hospital but was on active duty at a local large military post hospital. He often said, "Son, every military doctor knows, the true enemy of every soldier's survival is TriCare. TriCare is the enemy and why I am leaving the military in 4 months, 3 weeks, and 2 days!".... Now reading through everyone's response to this thread, I have a better understanding. It is sad to think our men & women in service and/or their families get less then their fat cat senators.

 

[YellowRose]

as an FP doc who outsources referrals, i can't tell you how many times i get letters from civilian providers stating "i'm sorry, i must send patient XXXX back to the military network as the Tricare reimbursements are so low i can no longer accept Tricare as a insurance any longer." its sad really...

 

[Winged Scapula]

Like others, I still accept TriCare (and get a lot of referrals because of it and an AFB close by) but am considering dropping it as well because of the low rates.

 

[IgD]

I wonder how it stacks up for mental health. I think psych is happy to get any insured patient these days regardless of the reimbursement!

 

[Gastrapathy]

The group that I moonlight with won't accept Tricare. They tried but just couldn't justify the cost. They were willing to lose money caring for military but not that much money (and time for their staff, since the billing process is apparently extra painful). Its convenient for me because I can't run into a Tricare beneficiary while moonlighting.

 

[JackADeli]

...I still accept TriCare ...but am considering dropping it as well because of the low rates.

The group ...won't accept Tricare. ...tried but just couldn't justify the cost. They were willing to lose money caring for military but not that much money...

WS is a specialist directly involved in women's health. I think her concerns as someone with real world experience in providing care for a real and unfortunately far too common a spectrum of disease is valuable. These are our women of service or their spouses or daughters.... and they may not have access (or "easy" access) to specialty care. I bet Senators get the surgeons they want.

I'd like to see if BD and/or other FPs as PCPs might have some experience or thoughts about this "payer"?

 

[deleted87716]

I live in an area with lots of military. We only accept Tricare Standard. It's not a very good payer.

 

[DrMetal]

I live in an area with lots of military. We only accept Tricare Standard. It's not a very good payer.

Is there not some justification for Tricare's stinginess? For instance, my wife goes to see a civilian dentist under the Tricare Dental plan. Dentist want's to charge $500 for a routine 20-minute exam (not even a cleaning). Tricare sais, "No, we're going to pay you $200 and you'll take it." Likewise, for a simple ER visit at a civilian ER--triaged and out in 45 minutes--the hosptial wants to charge $1000, Tricare sais, "No, we're going to pay you $400."

And do we think the civilian HMOs/PPOs will continue to pay some of the exhorbitant charges that civilian providers levy??? Don't you think they're going to put the kibosh on that (become more stingy, like Tricare) , especially if healthcare gets more expensive?

 

[former military]

try to care? or try to find care? both jokes sum up the harsh reality.

 

[deleted87716]

Is there not some justification for Tricare's stinginess?

Not really. Their payments don't cover the cost of providing care. The only reason we're able to see Tricare and Medicare at all is through cost-shifting from better-reimbursing commercial payers. A government-payer-only practice would not be sustainable.

If you really want to lower healthcare costs, you can't simply lower payments. That's why Medicare's current SGR formula is flawed. You have to provide less expensive care.

 

[sethco]

I would like to echo what some of the others have said. Tricare's reimbursement schedule is really poor, and that is putting it mildly.

Working at a small MTF around a medium-large city with plenty of medical resources, it is becoming increasingly hard to find many providers who still take Tricare. As an example, we may have about a 100 neurologist in the area and no more than 5 take Tricare. About 30 dermatologist and only 2 are in the network. The list goes on and on.

It has gotten to the point that I actually question why any civilian provider that I refer to would take Tricare. Do they have a small patient population and are desperate for patients? Are they new to the specialty? Are they new to the area? Do the other docs in the area not refer to these specialist for a reason? These are some of the questions I ask myself, but I am stuck referring to them. If I was in an area around a major MTF (i.e. San Antonio, DC, etc.), I would imagine I would not have these questions.

So to answer the poll, while I don't think Tricare is the devil, from a military provider (at a small MTF) standpoint, it is certainly worse than private insurance.

 

[orbitsurgMD]

I would like to echo what some of the others have said. Tricare's reimbursement schedule is really poor, and that is putting it mildly.

Working at a small MTF around a medium-large city with plenty of medical resources, it is becoming increasingly hard to find many providers who still take Tricare. As an example, we may have about a 100 neurologist in the area and no more than 5 take Tricare. About 30 dermatologist and only 2 are in the network. The list goes on and on.

It has gotten to the point that I actually question why any civilian provider that I refer to would take Tricare. Do they have a small patient population and are desperate for patients? Are they new to the specialty? Are they new to the area? Do the other docs in the area not refer to these specialist for a reason? These are some of the questions I ask myself, but I am stuck referring to them. If I was in an area around a major MTF (i.e. San Antonio, DC, etc.), I would imagine I would not have these questions.

So to answer the poll, while I don't think Tricare is the devil, from a military provider (at a small MTF) standpoint, it is certainly worse than private insurance.

The best comparison is Medicare and Medicaid, not private insurance (although UHC is getting close.)

 

[JackADeli]

...If you really want to lower healthcare costs, you can't simply lower payments...

Must agree.

 

[orbitsurgMD]

Not really. Their payments don't cover the cost of providing care. The only reason we're able to see Tricare and Medicare at all is through cost-shifting from better-reimbursing commercial payers. A government-payer-only practice would not be sustainable.

If you really want to lower healthcare costs, you can't simply lower payments. That's why Medicare's current SGR formula is flawed. You have to provide less expensive care.

True. The only result of continuous cutting of payments is market failure and the rise of black markets. Such poor students of history to ignore the lessons of the East Bloc economies.

 

[Chonal Atresia]

The Mayo Clinic just announced that they are starting a pilot program in AZ where they are NO LONGER ACCEPTING ANYMORE MEDICARE due to a loss of over $800 million in FY09. This loss obviously doesn't include the proposed 20% reduction in reimbursement set to take effect on March 1st. Kind of ironic that Obama held Mayo up as the "torch-bearer" when it came to control of healthcare spending - now it's s..t in his face. It will be interesting to see who's going to take care of all these "new" people with insurance (can you say ER?). Medicare/Medicaid/Tricare is going to be dropped like a bad habit by the majority of private practice physicians in this country. Gotta love Obamacare!

 

[a1qwerty55]

The Mayo Clinic just announced that they are starting a pilot program in AZ where they are NO LONGER ACCEPTING ANYMORE MEDICARE due to a loss of over $800 million in FY09. This loss obviously doesn't include the proposed 20% reduction in reimbursement set to take effect on March 1st. Kind of ironic that Obama held Mayo up as the "torch-bearer" when it came to control of healthcare spending - now it's s..t in his face. It will be interesting to see who's going to take care of all these "new" people with insurance (can you say ER?). Medicare/Medicaid/Tricare is going to be dropped like a bad habit by the majority of private practice physicians in this country. Gotta love Obamacare!

Mayo is notorious for ordering a million unindicated tests, I suspect many get rejected by Medicare (appropriately as not indicated). I recently had a family member go to Mayo for what I suspected was anxiety - fairly classic history. This resulted in a CT Chest, Thallium, Echo, spirometry and a Methacholine Challenge (in a known asthmatic), EGD and Colonoscopy, a zillion labs and of yes a sleep study. The Mayo wallet biopsy model is thoroughly not sustainable as a national strategy - it works great when you have a liberal private insurance policy.

 

[DocArmy]

Mayo is notorious for ordering a million unindicated tests, I suspect many get rejected by Medicare (appropriately as not indicated). I recently had a family member go to Mayo for what I suspected was anxiety - fairly classic history. This resulted in a CT Chest, Thallium, Echo, spirometry and a Methacholine Challenge (in a known asthmatic), EGD and Colonoscopy, a zillion labs and of yes a sleep study. The Mayo wallet biopsy model is thoroughly not sustainable as a national strategy - it works great when you have a liberal private insurance policy.

My thought's exactly. I worked at Mayo for a while after college and every time I went to the doctor I ended up paying out the nose to the lab. Mayo is a wonderful medical resort, where you can obtain the very best and latest, but they definitely know how to get their money.

 

[Chonal Atresia]

You are certainly entitled to your opinions about Mayo. I disagree with them and would venture to say the majority of the world population disagrees with you since the institution is regarded as one of the best (if not THE BEST) medical center in the world. I grew up near Rochester, MN and kings, queens, princes and other world dignitaries were always flying into our tiny airport to get care at the clinic.

You seem to be suggessting that Mayo wastes an excessive amount of money on unecessary tests. If this is indeed true, ever wonder why it happens (see TORT reform). Also, our illustrious government's answer to cost control is to cut Medicare/Medicaid/Tricare reimbursement to practitiioners and hospitals instead of addressing things like TORT reform. Without TORT reform, physicians will continue to practice CYA medicine because the only person left hung out to dry if we "miss" something by not ordering a test, scan. etc is us.

 

[AnesCoord]

Back to the original question....

Tricare has its share of flaws, but overall it isn't a bad program. I'm a retiree, and one of the things we were promised throughout our careers was "healthcare for life". I pay about $500 a year for coverage for my entire family, and that's what a lot of people pay in a month or two. Last year I had to have major surgery, which included a six-day stay in the ICU. All the visits leading to my diagnosis (including evaluation by three different specialists), all the testing (labs, CT, MRI, etc.), the surgery, hospital stay, discharge meds, follow-ups...Everything added up cost me about $300 out-of-pocket.

 

[73BARMYPgsp]

I think Tricare Prime is really good if you are a retiree because it's like something for nothing. If you are on active duty it is mediocre at best because it is difficult to access specialty care. In the past there has been problem with the military hospitals refusing to authorize out in town visits even though they don't have the capacity to treat patients. I think it is called right of first refusal. With my civilian insurance any of my family members can see pretty much any doctor they want. The catch is we have to pay a monthly premium and a co-pay for visits and meds which we don't necessarily mind.

"Difficult to access specialty care" is the understatment of a lifetime. I have never been to the Dr for anything but shots and stupid Medpros repated stuff until this year. All of the tests/procedures I have needed for the current problem have had to be done in the economy. UNBELIEVEABLE HOW DIFFICULT IT IS. And that includes getting the "special treatment" of being a provider and having all my friends as the ones putting in the consults.

One example--MRI done off post. Obtained the disk before I left like I was told. The disk had images but no radiologist report on it. Hospital correspondence had to contact the off post facility to request it 3 times! Then, disk had to be digitized into radiology library. Walked over there with the disk, but nooooo. There has to be an order for the disk to be digitized. Not even the provider who ordered the thing knew that. He assumed, like any normal person that if you are authorized to get imaging off post, then the need to digitize the images (so specialists could view them) would be implied. This was one of about 1000 things that have gone wrong since I first walked into the Drs office and said, "well, I am having this problem" 8 months ago. I would rather just be sick.

 

[DocArmy]

You are certainly entitled to your opinions about Mayo. I disagree with them and would venture to say the majority of the world population disagrees with you since the institution is regarded as one of the best (if not THE BEST) medical center in the world. I grew up near Rochester, MN and kings, queens, princes and other world dignitaries were always flying into our tiny airport to get care at the clinic.

You seem to be suggessting that Mayo wastes an excessive amount of money on unecessary tests. If this is indeed true, ever wonder why it happens (see TORT reform). Also, our illustrious government's answer to cost control is to cut Medicare/Medicaid/Tricare reimbursement to practitiioners and hospitals instead of addressing things like TORT reform. Without TORT reform, physicians will continue to practice CYA medicine because the only person left hung out to dry if we "miss" something by not ordering a test, scan. etc is us.

It is the best hospital in the world. By far. If I were a rich man, I'd go there to have my yearly physical just like the POTUS, former POTUS, or the King of Saudi Arabia.

We do need TORT reform in the US. I think that cost of care should also enter into treatment decisions. For example, a micro screen that can be run on an $8 plate and read within 48 hours in the micro lab vs. a $350 PCR that had results within the hour. Very neat, very fast, but not always necessary. I had literal arguments with more than one doctor there about all of the tests they wanted to run that I knew were not necessary on myself or my spouse.