I have hurt my wrist, I don’t know how and I’m not entirely sure I know what is wrong with it. I don’t even think my PCM knows what is wrong with it. But, she has sent me to a Physical Therapist anyway. Maybe that person will know what is wrong with it but wait….. that means a referral… UGH!!! I’m not a huge fan of being sourced out for every little thing. I don’t do well with new places and people. But, I need to go and so the referral from Tricare is in. So, I get this call from Texas (yes you are reading that correctly) to make an appointment for PT. At first, I was thinking it was strange but then was like, whatever, and made the appointment. Well, in the interest of my sanity and my children’s well being, I canceled the appointment and decided to look into the place Tricare was sending me. Turns out it is downtown and not in the greatest of locations. I would have to pay a toll and parking to go there. WHAT?! So not going to do that when there is a PT place a mile from the base! Got on the phone called Tricare and had my referral changed to the place a mile away. It was so simple and within a couple of hours the new place had called me to make an appointment. The appointment was for a time where I wouldn’t have to worry about what the hell I was going to do with the kids. Sometimes it is just that simple with Tricare and sometimes it’s not. So here are some helpful…. well, I hope they are helpful, tips for dealing with our health care system so you get the care you want and most importantly NEED.
1. You must manage them. Tricare is your health insurance. You pay for it (ok, taxes pay for it) so you manage it. It is all yours! So when you want a referral to go the way you want, then it is up to you to make that happen. This will require you to educate yourself on the limits of your plan whether it is Prime, Remote, Standard or Extended. Know what you are entitled to and make sure you get it. Just like me knowing I could be seen at practice that was closer and was a good one because I knew several people who had been seen there. A friend needed surgery and knew who she wanted to do it and so she made that happen. She made it happen, not the Tricare Rep! Just like owning a business, you must manage your health care.
2. Educate yourself on your plan. This was just mentioned in tip #1 but it is a tip in itself. You must know what you are entitled to. For example, if you are on Prime your prescriptions are covered BUT you must get them from the base pharmacy. So, when you visit the ER with a sick kid who needs antibiotics, don’t let them “call it in”, ask for it to be written down and take to the base. Standard and Extended have their benefits BUT you have to pay extra for them and you will most likely have a co-pay.
3. Make sure you transfer your region when you PCS. I feel confident most spouses know that there are different regions and then overseas for Tricare. Each region has its own contractor and policies can vary. It is important to know which region you are in and the policies of that region. With every PCS the member needs to contact Tricare and inform them of your move to ensure you are under the right region.
4. Don’t schedule specialized appointments without referrals! Seems like a no brainer, right? Well, there are people who have done this and then had to fight with Tricare to have their appointments paid for. Just because the doctor tells you are going to be referred out doesn’t mean you get to go ahead, find the doctor you want and make the appointment. If, you get the referral and it isn’t with your doctor of choice, that’s fine. You can change it like I did but wait for the authorization letter first, then make the switch. Things have improved and referrals are coming through faster as time goes on. Better to wait an extra few days then have a battle on your hands.
5. Know where the Tricare Representatives office is located and know their contact information. This is important because sometimes no matter how careful you are or how much you think you have it down something will happen and you will need their help. For example, I ran a half marathon got super dehydrated and needed EMT care. Well, the EMTs said not worry that they deal with Tricare all the time and being seen wouldn’t be an issue and I didn’t need anything to take back to my PCM. Yeah, till I got the bill in the mail! Refer back to tip #3! But, we headed over to the Tricare Rep and it was fixed with no issues.
In my final thoughts on this topic, I want to share with you how lucky I feel to have the health care we have. Yes, it can be frustrating at times. We often have to fight the good fight for the care we deserve BUT at least we are insured and for the most part everything is covered. I feel grateful to have had two c-sections for FREE and the peace of mind that if my kids get sick I can take them to the doctor. It is those things that make all the bullshit of Tricare worth it. The trick is knowing the system and managing it yourself and not expecting others to do it for you.
There is a link to the Tricare website on my Resource page.
A big THANK YOU to my dear friend and fellow milspouse, Sarah, for helping me with this blog!