All Branch Topic (ABT) Tricare

[Tortelloni]

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Other day I was hanging out with a pulm/cc attending in civilian hospital who spent 45 minutes yelling at a few insurance reps on the phone for denying his patient a CT and telling the doc to wait 3 months. Do you experience that much with Tricare?

 

[Homunculus]

for in house items, no. i can get pretty much whatever i want*. and in spite of the dysfunctional system, within the physician corps we all play together pretty nicely for the most part and will bend over backwards to accommodate each other with walk ins, consults, and bending rules to help each other out.

for enteral feeding supplies, certain medications and devices (even home ventilators now, apparently) yes we do occasionally have the peer to peer throwdown you witnessed (but mine aren't 45 minutes).

it's one of the saving graces of my practice. i can get pretty much whatever medication, imaging, or procedure** i want.

--your friendly neighborhood serial calprotectins and MR enterography ordering caveman

* support staff, new equipment, parking, schedule-- not so much.

** FDA approved. no fecal transplants or gastric sleeves or the like as far as i know.

 

[pgg]

We don't really deal with Tricare.

Someone needs a CT on the inside, they generally get a CT. We don't hear much or care much about insurance issues.

 

[HighPriest]

It is exceedingly rare, but I have had to argue with United Healthcare on a few occasions. Usually it is when I'm ordering a compounded medication that our pharmacy doesn't stock from a third party. Once when I referred a patient off post for a pre-op sleep study (last study was 5 years old, and the patient was worse symptomatically) and UH denied this. Once when I tried to take a patient to surgery at an outside facility with which we had an ERSA agreement.

It's very rare to have to argue, but it happens.

 

[DrMetal]

We don't really deal with Tricare.

Someone needs a CT on the inside, they generally get a CT. We don't hear much or care much about insurance issues.

This is probably one of the nicest things in the milmed---that we work well together and (as long as we're following good clinical reasoning) we can generally get the next diagnostic test or intervention without having to fight an insurance company.

I must say, while deployed, Tricare has been very generous. They haven't balked at any of our requests. We're getting a TTE in Dubai at their super megacomplex health center, that probably costs 5 figures....Tricare approved it right away, all I had to do was show an EKG.

 

[deleted480308]

Other day I was hanging out with a pulm/cc attending in civilian hospital who spent 45 minutes yelling at a few insurance reps on the phone for denying his patient a CT and telling the doc to wait 3 months. Do you experience that much with Tricare?

it's also important to note that no insurance can deny a procedure...they can decline to pay for it

the patient is the ultimate responsibility for all charges and arrangement for payment is their end responsibility

 

[Tortelloni]

it's also important to note that no insurance can deny a procedure...they can decline to pay for it

the patient is the ultimate responsibility for all charges and arrangement for payment is their end responsibility

This is not helpful. Getting a payment denial letter for most patients makes certain procedures cost prohibitive.


Thanks to the rest of you for sharing your experience.

 

[deleted480308]

This is not helpful. Getting a payment denial letter for most patients makes certain procedures cost prohibitive.


Thanks to the rest of you for sharing your experience.

you don't understand yet that it's helpful. Insurance saying no doesn't always mean healthcare ends. Remembering that can mean the difference between that patient getting the CT when they need it or waiting 3 months for it. Insurance is just one method of handling something...

 

[Tortelloni]

you don't understand yet that it's helpful. Insurance saying no doesn't always mean healthcare ends. Remembering that can mean the difference between that patient getting the CT when they need it or waiting 3 months for it. Insurance is just one method of handling something...

I understand perfectly. It's not helpful because it doesn't answer the question I posed for physicians. But nice try.

 

[j4pac]

What's insurance? 🙂

We don't fight over insurance but there is sometimes pushback from specialist to see patients. In the civilian sector that doesn't seem to be as a big of a problem. Generally, most specialists (including Rads) are great...but it does happen every now and then.

 

[deleted480308]

I understand perfectly. It's not helpful because it doesn't answer the question I posed for physicians. But nice try.

did the patient get their CT?

 

[Tortelloni]

did the patient get their CT?

Yep, after my attending yelled at the right person far enough up their ladder.

 

[deleted480308]

Yep, after my attending yelled at the right person far enough up their ladder.

I'm glad the patient got what they needed