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Tricare Prime is getting "cleaned up"
Old 06-05-2009, 03:06 PM   #1
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Tricare Prime is getting "cleaned up"

Received this as part of an email from MOAA. It got me to thinking that it may take me over 30 minutes to get to my MTF even though it's in thae same city that I live in.

Quote:
You Could be Bounced from TRICARE Prime


A new DoD policy aimed at "cleaning up" TRICARE Prime enrollment at military treatment facilities (MTF) could mean some significant changes for many Prime enrollees.

TRICARE has long had established travel access standards to help beneficiaries receive timely health care. The standards require that enrollees shouldn't be assigned a primary care manager (PCM) at a military hospital or clinic that's more than a 30-minute drive from the beneficiary's home address.

As a practical matter, DoD never really enforced that policy. But it will be enforced now.

If they want to continue to be seen in the MTF, current Prime enrollees in the U.S. who live farther away than a 30-minute drive from the MTF will have to request a waiver of the drive-time standard from the MTF commander or the TRICARE Regional Office. Drive times will be determined by a computer program similar to MapQuest. Approved waivers will have to be renewed annually from now on.

Unless they apply for and are granted a waiver before October 1, enrollees who live more than 30 minutes (but less than 40 miles) from the MTF will be assigned a civilian primary care manager closer to their residence. Absent a waiver, those who live more than 40 miles from the MTF will be disenrolled from Prime and revert to TRICARE Standard as of October 1.

TRICARE contractors are mailing letters to all affected beneficiaries, providing detailed instructions on the waiver process
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Old 06-05-2009, 05:53 PM   #2
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Does the email provide a link within the MOAA web site?
dh2b is retired military.
He does not utilize an MTF because we do not have one nearby, unless a VA outpatient clinic now qualifies. He says he was never eligible to use that, and VA clinic staff confirmed that.
He has a civilian doctor who accepts Tricare Prime, one of the few left in the area. Doctor's office is within 10 miles of residence.
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Old 06-05-2009, 11:18 PM   #3
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Thanks for the heads-up, I hadn't heard of this. We're closer than 30 minutes to base and won't be affected. 30 minutes isn't very far in some congested areas. I wonder why Tricare is doing this now? I wouldn't think it would save them money to have more patients treated by civilian providers.
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Old 06-06-2009, 07:50 AM   #4
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It's a way to save money, because the military doctors are being paid whether there is a patient in the office or not. If the military cuts the number of retirees being seen at a military hospital they can cut the number of doctors. Cut enough doctors and the military can start cutting supervisors and hospital size. If you go to the civilian doctors the government will have to pay only if you are being seen. I guess it falls under the idea that wealth is made by the control of assets (paying the civilian doc) not the ownership of assets (employing a military doc). It sounds like the military hospitals are looking for ways to cut costs.

Freebird--I don't think you were informed correctly, or something was lost in translation between the regs-- the tech--dh2b--you--the forum. All veterans have access to VA hospitals and clinics. The vets must pay for the treatment, if it is not for a service connected disability.
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Old 06-06-2009, 09:33 AM   #5
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Quote:
Originally Posted by lets-retire View Post
...Freebird--I don't think you were informed correctly, or something was lost in translation between the regs-- the tech--dh2b--you--the forum. All veterans have access to VA hospitals and clinics. The vets must pay for the treatment, if it is not for a service connected disability.
I will follow up on this again. TY No service disability involved. He retired with full 20 yrs service.
I am still learning about Tricare Prime. It will eventually be my secondary medical insurance once I drag the poor guy
(or he drags me ) down the aisle.
It is in our best interests to get up to speed on the particulars for a 2nd spouse with her own primary insurance. I do subscribe to the Tricare e-newsletter and am slowly absorbing the info...whew!
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Old 06-06-2009, 10:26 AM   #6
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Quote:
Originally Posted by freebird5825 View Post
Does the email provide a link within the MOAA web site?
dh2b is retired military.
He does not utilize an MTF because we do not have one nearby
Since he does not receive care from a MTF, I do not believe that it will affect him. As stated, I'm sure that this has a great deal to do with reducing costs or impact on very busy MTF due to war-time casualties and increase in the size of the force.
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