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Military Health Care
Old 06-19-2007, 06:23 PM   #1
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Military Health Care

I'm not sure how many vets are on this forum, but I wonder what experiences or opinions we have of the quality of the military health care system? There's been some front page stories recently about the problems at Walter Reed, and periodically there are negative stories about VA hospitals. But, as with most press stories, that's what sells newspapers, and the truth is somewhere in the middile.

My own experiences include 20+ years of only using military health facilities for myself and family, and 20 some years of using mixed civilian and military facilities. I've had one surgery at a VA hospital, one at a military hospital, and one at a civilian hospital. We've also had three deliveries and a number of other procedures in the military system. I've not been treated for anything serious yet (knock on wood), but have had the usual run of tests, diagnoses, referrals, etc. As I get older my needs and interest in quality of care increases.

Based on my personal and limited experience, I've seen no difference in quality or results between military and civilian hospitals. I think military hospitals and doctors are quicker to run advanced tests and offer more procedures, since insurance and costs are not a major driver. On the other hand, the civilian doctors I've seen tend to be more focused, get the problem fixed and move on to the next patient, but are also more experienced in the specific problem. One advantage of the civilian system is that the patient can choose a doctor (except for some insurance plans) and research the background and experience of specific doctors. In the military system, you pretty much get the doctor you're assigned to, there may only be one specialist, and there is little to go on for background.

The civilian facilities themselves also tend to be more up to date and cleaner, though the equipment seems about the same. The VA hospital was the worst as far as cleanliness. Air Force hospitals are the cleanest, and I dare say that applies to Air Force facilities as a whole as compared with sister services (not that I'm prejudiced).

There are obvious problems with specific portions of the military health system, as in the stories of continuing care at Walter Reed for those returning from Iraq. Having been treated at WR, I see this as a problem, but not one of medical quality, it's a problem of not having money or facilities to house those soldiers for extended periods. Not an excuse, it's consistent with the lack of post- Saddam planning by DoD.

The above is just my limited experience, and I wonder if there are others with similar or contradictory experience.
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Old 06-19-2007, 09:13 PM   #2
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I am less than thrilled by my civ (Blue Cross) primary care doctor - I feel like I am just a number (but my gyn is great, so that really does count!) My VA primary care physician is awesome - and yes, both the VA and military run through advanced tests quicker (that is probably why I feel like they take care of me on the medical end) - who knows how long it would have taken BCBS to get me into physical therapy for my knee?! No major complaints personally about my military treatment, but they do keep my shots up to date!
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Old 06-19-2007, 09:42 PM   #3
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I've always felt that the military healthcare staffs were rushed for time-- "Get in here, buddy, snap it up, what's your problem, here'saMotrinseeusnextweekifyou'renotfeelingbetter NEXT!" However when we needed an ambulance RIGHT NOW they were always there for us at least a half-dozen times. I was able to reach deep into the awards system and pull out a Navy Achievement Medal for a young doctor who'd done three times what it takes to earn one. Other than the usual paperwork screwups, no complaints.

Tripler Army Medical Center is a huge bureaucracy with a labyrinthine architecture and a too-small parking lot. Their natal staff flat-out blew it on our daughter's delivery (not that I'm bitter) but after 14 years I might give them another chance. Their pediatrician did a great bedside-manner job on setting our kid's broken wrist and they're generally brisk & efficient with referrals & prescriptions. They run their MRI equipment 24/7-- I literally had an appointment for 1:30 AM Tuesday (but the parking was very good). They're quick to refer us retirees to civilians, although the Iraq war probably has them fully loaded and they can't jerk us around like they used to. They're probably the Pacific Rim experts on trauma care & orthopedic surgery now-- if I broke a bone or an artery I'd skip the Navy clinic and go straight to Tripler.

10 years ago a friend of ours got bent diving in Guam, was MEDEVACed to TAMC, and was totally paralyzed for three months. (It permanently changed his personality too.) He ended up in Tripler's VA ward for a couple weeks and it was pretty grim. However they now have a Fischer House up there and it seems to be a much better place.

But as a retiree I love our local civilian clinic, 10 minutes from our house. The residents are young enough to know that they don't know and not afraid to display ignorance. They don't hesitate to whip out their PDAs to look up details or to bring in their supervisor for a chat in front of the patient. They seem to be willing to listen to me for 15-20 minutes if it'll sort out a diagnosis, and they're quick to seek referrals (even if they have to go through Tripler). In five years I've never ever had a complaint with any of them, even though they rotate through every 12-18 months. I'd pay for my own routine medical care before I'd go back to the Pearl Harbor clinic or Tripler as my PCM.

I'd make some snippy comment about Air Force facility cleanliness reflecting their lack of enough real-world missions to keep them busy, but then someone else would just point out that submarine reactor compartments are even cleaner...
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Old 06-20-2007, 09:12 AM   #4
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I've been doing some more research on the quality of military health care and found that in 1985 the DoD set up an External Peer Review Program composed of civilian doctors. This was set up to review military care following a bunch of problems back then. Here is a link to the 1985 story.

CIVILIAN DOCTORS TO VIEW QUALITY OF MILITARY CARE - New York Times

I've read a few of their reports and they seem to conclude that military care meets all the standards of civilian care. But it does appear that in the 1970s and early 1980s there were some problems, but then the entire military had problems in the post-Vietnam environment. I recall one friend who filed a malpractice suit over his wife's care in the 1970s, though one anectdotal case doesn't prove anything.

Here's one example of the excellent care I've received at Walter Reed. I got a scrape on coral while diving in the Caribbean and the scrape festered and got infected. After trying a number of antibiotics with no effect I was referred to infectious diseases at WR and the specialist there (a full Colonel) thought I had a certain type of nasty germ found in tropical waters. He wanted to get it biopsied to grow the germ and walked with me downstairs to surgery to talk to the surgeons about what he wanted done. He then told me to call him on his personal phone when I was scheduled so he could be there during the biopsy. Even though I don't think the biopsy was a big deal, there was an entire surgical team there, they did the biopsy, cultured it, and he put me on the right antibiotics (which were awful to take). He followed up with me for several months until I was cured.

To counterbalance that story, I had a hernia repaired in another military hospital many years ago. The surgery was fine but I thought I might be getting an infection in a suture. Saw the military doc and he acted like I was a wimp and just about threw me out of his office. Military docs have that latitude, since you can't go down the street.

By the way, be careful in those Hawaii waters, if you get a scrape that doesn't heal and starts producing bumps under your skin along the lymph nodes go see a skin specialist. There's something known as mycobacterium marinum that is pretty nasty and it's one of these emerging bugs that's resistant to lots of things. Most doctors don't yet know to spot these at an early stage and by the time it's treated it can be a problem. This germ is now also in the Chesapeake on rock fish and a lot of fishermen are getting it. You can even get it scraping your finger in fish tanks.

The Air Force keeps its mission areas very clean. I'm impressed that Navy reactor compartments are clean, when you can't even play golf in them.
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Old 06-20-2007, 02:10 PM   #5
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I'll relate a few quick stories of my military medical. The wife was bitten by a spider behind her ear. After having to receive an escort by the Georgia Highway Patrol, because she could drive a straight line, to the hospital, the doctor said run some Benedictine on it and you'll be fine. Of course my next question was, "they use Benedictine for spider bits?" it was only then the doctor took it seriously.

I severely sprained my ankle, the recipe was here's 800 mg of military candy take it a few days and if your ankle still hurts in a couple weeks come back. Three months later when I was able to get back to the hospital I had to go to physical therapy, because the injury still hadn't healed up properly. A few years later I injured the same ankle and had to go for surgery at a civilian doctor. During the surgery the doctor cleaned up the injury I suffered in the military and showed before and after x-rays.

One of my troops had a deformed daughter. Her hands looked like someone had wrapped rubber bands around her fingers when she was a new born. Those areas did not grow. After five years of following the system the young troop was about to leave the military and decided to call his Congressman and Senator. Approximately three months prior to him getting out he was given medical benefits for his daughter so she could be fixed, at a civilian hospital, with the G paying for it.

I have over thirty years of military hospital horror stories involving me and my family, but I will not go into them on this forum.

I have not had bad service at a civilian doctor. I've not had any bad experience with civilian insurance either. Even when I needed PT for injuries I had suffered BC/BS was Johnnie on the spot. My last PCP was very good and if she thought for a moment our problem might be out of her skill level we were referred. When my wife was diagnosed with a brain tumor, I was picking up the phone to call the doc to fill her in on the situation, but my doctor called me first to find out how my wife was doing. She seemed more concerned about my family's mental well-being than providing treatment or obtaining the necessary stuff for the insurance (although she did those parts well also).
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Old 06-20-2007, 02:18 PM   #6
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By the way, be careful in those Hawaii waters, if you get a scrape that doesn't heal and starts producing bumps under your skin along the lymph nodes go see a skin specialist. There's something known as mycobacterium marinum that is pretty nasty and it's one of these emerging bugs that's resistant to lots of things.
The Ala Wai Canal is far more dangerous!

My paranoia is that someday the probabilities are going to catch up with me when I'm wearing an air tank over a sharp coral reef.

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I'm impressed that Navy reactor compartments are clean, when you can't even play golf in them.
I'm no longer cleared to recall any unauthorized incidents occuring in naval nuclear propulsion spaces. And I'm especially not allowed to talk about the pictures...
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Old 06-20-2007, 03:10 PM   #7
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lets-retire, thanks for sharing your story. Sorry to hear about your wife's condition, and hope everything has worked out for her.

If I had experienced what you did I would have gotten as far as possible from military facilities. As I said, my experiences are somewhere in the middle of the scale or better. If you don't mind, what brach of the military were you and were you at smaller bases, overseas, or CONUS? I think there's a large difference between care depending on those things. WR is close to the best medical research and pratice facilities in the world, thought that's no guarantee. OTOH, I've been at some small bases with only a GP, and anything serious had to be referred elsewhere -- if they agreed it was serious enough for a referral.

I will say this, I think with military health one needs to be more proactive in getting the right diagnosis, otherwise you can get caught in the "two aspirin" situations you describe. Before I was sent to WR for my infection I was given the usual dose of low power antibiotics and creams that didn't work. I eventually found a medical journal article on the internet that described my symptons exactly, and was due to the same thing, a diver scraping on coral. I felt a little embarassed when I took the article into my doc with a self diagnosis, but that's when I got referred and found out that's exactly what I had. Thank goodness for the internet. I've wondered if this had been a Navy instead of an Army doctor if they would have recognized a diving related incident quicker.
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Old 06-20-2007, 03:54 PM   #8
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SoonToRetire--The three stories I related were at different bases. My wife was bitten at Robins GA, and we went to the ER. My ankle sprain was at Charleston AFB, and I went to Flight Medicine (yes the same as the pilots).

My troop went to doctors in Japan, I don't remember where he was stationed, Robins Ga, Big Willy at Lackland, and I think one in Hawaii.

Actually the best care we had from the military was a very small base in Turkey. I think it was primarily because everyone knew everybody else. I know while I was there a lot of things seemed to happen "off the books". Although the dental sucked, within two years of my wife having her teeth filled she had to have them all redone.

I agree with the correct diagnosis comment. At my last base my unit worked closely with the aircrews, some flew with them. These people brought back new and interesting type of illnesses. I caught one bug and after two weeks was able to make it to the hospital. The doc had seen it several times from the flight crews, prescribed a concoction of pills and sent me on my way. I was well within a few days. A couple weeks later, my wife caught the same bug I had. When she went to the hospital they told her it was a cold and go home and get some rest. Unfortunately, she was still seeing family practice not flight medicine and the news hadn't flowed to that section yet. She suffered with the flu like symptoms for, I think, three more weeks before she was able to get back in and be treated. It was amazing she received the same combination of pills I had and was again well within a few days.
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Old 06-20-2007, 07:58 PM   #9
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When my DH and I were married, he was in the Air Force. I was not feeling well and went to the base hospital. They checked me over and took blood and I never heard back from them. I went back for another problem about 3-4 months later and when the doctor came in he asked me how my mono was doing. I told him that I did not know what he was talking about. He could not believe that no one had told me that I had mono when I went the first time.

As soon as my DD's fiance gets his orders (he finished Medical Corpsmen school 5/25/07) he is taking leave and coming home and they are getting married. The plan is that she is going to stay living at home and go to college here, since her college is paid for if she stays here. She is covered under my BC/BS gov health insurance currently and I assume that she will go off of it as soon as they are married. Does anyone know where she can go to get her dependent's ID card? We are located in WV. Would she have to go wherever his orders send him, in order to get it? Also, will it cover her for medical problems here? Does anyone know a website where I could get this info?

Thanks in advance,

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Old 06-20-2007, 08:48 PM   #10
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When your daughter is married, her husband will have to enter her into the Defense Enrollment Eligibility System (DEERS) at his home base. She has to be in the DEERS system to be eligible for any benefits as a military dependent, including issuing of ID cards and health care. Here is some DEERS info

http://www.defenselink.mil/ra/mobil/pdf/deers.pdf

Once she is in the DEERS system, she can go to any active duty military base (not sure about national guard bases) and request an ID card. There are no active duty bases in WV that I'm aware of, but you are close to a number of bases in the Washington DC area. You should have her call first to make sure they will issue her an ID card without her husband present. Since he is in the USAF, she should call either Bolling AFB or Andrews AFB. Here are their web sites:
Andrews Air Force Base - Home
11th Wing - Home

As soon as your daughter is in DEERS she can get health coverage at any military hospital. If she is in WV outside of military coverage she can use the Tricare system, which is the military equivalent of a civilian insurance program. There are various types of Tricare coverage, and it can be a bit confusing, but here is the site. She can just ask a doc if they take tricare, most of them do, and then file with tricare. There are some deductibles and such but it's pretty simple. Once she is on a military base there would be no charges for medical coverage.
Welcome to TRICARE.mil

That's terrible about not telling you about the mono. I think they are doing better now that they are automating the health record system, but still things can fall through the crack.
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Old 06-20-2007, 09:30 PM   #11
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Our family had good health care in the Air Force system for 20+ years. Our daughter was born in a Navy hospital (Charleston--yea SUBGRU SIX!) and things went fine, but it was very assembly-line oriented. My DW never saw the same doctor twice, there were 8 women per room, etc. But the quality of care seemed good.

I used to think that the military system didn't run enough tests. When you went in with a complaint, the doc (or, more likely, the PA) prescribed something he/she thought might work, and you came back for a follow-up to try something else. This could go on for a long time. There didn't seem to be a lot of effort to discover exactly what the problem was. Anyway, I've since learned that this is the way medicine is practiced both in the military and out.

In general, I think the military system does a superb job with trauma care (gunshot wounds, extensive burns, orthopedic care for jump injuries, etc). The care for longer-term, more routine ailments is not as top notch.

They also expect patients to learn the ropes and put up with some inconvenience. It is not unusual in many pharmacies to wait an hour for a prescription to be filled.
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Old 06-20-2007, 09:42 PM   #12
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lets-retire, thanks for sharing your story. I've wondered if this had been a Navy instead of an Army doctor if they would have recognized a diving related incident quicker.
I'm thinking "No." You did the best thing by self-diagnosing, although in an ideal world it wouldn't be necessary.

Navy doctors are also very familiar with sanitation & hygiene issues like TB, rotavirus, tetanus, & hepatitus... but Navy diver doctors are a very small part of the community. You'd practically have to have an Undersea Medical Officer (who'd normally be spending all his time with divers) who thought to ask about your specific diving experiences.

I spent two decades of active-duty ignorance in hyper-stretching my joint ligaments. Only one guy noticed. A Navy doctor, a well-known triathlete, commented on the extreme knee instability during a routine physical about 10 years into it but he thought it was genetic and I thought it was a good thing. He didn't ask about stretching and I didn't think to volunteer. The comment didn't come into focus for me until 15 years later, about five years after I'd torn both ACLs...

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As soon as my DD's fiance gets his orders (he finished Medical Corpsmen school 5/25/07) he is taking leave and coming home and they are getting married.
Well, tell him congratulations! Way better than BUD/S, and I hope he appreciates his new quality of life.

When he's ready for his independent-duty corpsman (IDC) tour, he'll probably have two options-- crawling in the sand with the Marines or crawling in the submarine bilges sharing his new office with the torpedomen's countermeasures locker. If he does it in the submarine force then he won't have to get a haircut and he can collect submarine pay instead of combat pay. He can also earn his dolphins. Hope he gets to choose.

What SoonToRetire said. As soon as they're married he can use the wedding certificate at his command to request that his new spouse receive "command sponsorship". There may be a form for that or they may just send him over to his local Personnel Support Detachment (PSD) to fill out the DEERs forms. Then his new spouse can go get her ID card.

She should also join Military.com, start networking with the other military spouses there, and read Chris Michel's The Military Advantage". He won't have enough time to do that job himself, and you & we veterans shouldn't be the ones showing her the ropes!

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It is not unusual in many pharmacies to wait an hour for a prescription to be filled.
Boy, that's been one big retirement change that the military is losing a lot of money on. I can save us all some taxpayer dollars by waiting for 45 minutes at the Navy's Makalapa Clinic (20 minutes each way from home) for the kid's prescription acne medicine, or I can shop for 20 minutes and pay a $3 copay at Long's Drugs (five minutes from home). I don't think I'll be going back to a military pharmacy anytime soon...
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Old 06-20-2007, 11:04 PM   #13
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Thanks SoonToRetire and Nords! I love this site! DD's fiance is actually in the Navy-it was my DH that was in the AF many moons ago.

It sure has been fun trying to plan the wedding. The first question asked is when is the wedding and we tell them we are waiting on him to get his orders and then he is coming home for 5 days and they will be married during those 5 days. You ought to see the looks we get and the "Oh My" responses! I am hoping that it will be after 07/07, the date that many people are getting married on.

I just hope that no medical problems arise between the time of marriage and when she gets set up on their system. Can you tell that I have a tendency to be a worrywort? I will be doing a lot of reading on the Tricare site. Thanks a bunch for the links!
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Old 06-21-2007, 07:31 AM   #14
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DD's fiance is actually in the Navy-it was my DH that was in the AF many moons ago.
Oh, sorry about that, I thought he was Air Force. Can't win them all.

In that case, what Nords said was right, I guess, but the DEERS system does apply to all the services. Never heard of a command sponsorship with a wedding certificate, must be some kind of Navy thing. Maybe that's how the Village People got started.

samclem, pharmacy waiting times vary greatly. I can wait an hour at Walter Reed or 5-10 minutes at my local military clinic.

Nords, a piece of trivia for you. I wondered if dreamer could use a guard base in west virginia, so I looked up Navy National Guard. Never heard of such a thing but what I found is that the constitution forbids Navy National Guard units because of a provision against states having ships in peacetime. I guess that's to make it harder for the South to rise again. What they don't know is that southern double wides float
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Old 06-21-2007, 11:12 AM   #15
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Does anyone know where she can go to get her dependent's ID card? We are located in WV. Would she have to go wherever his orders send him, in order to get it? Also, will it cover her for medical problems here? Does anyone know a website where I could get this info?

Thanks in advance,

Dreamer
I'd check your nearest reserve center for the ID card. It doesn't matter what branch as many share the same real estate. Call them first and ask about the DEERS situation and what she would need to bring to get the card.
Try this site for locations
RAPIDS SITE LOCATOR
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Old 06-21-2007, 01:28 PM   #16
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Nords, a piece of trivia for you. I wondered if dreamer could use a guard base in west virginia, so I looked up Navy National Guard. Never heard of such a thing but what I found is that the constitution forbids Navy National Guard units because of a provision against states having ships in peacetime. I guess that's to make it harder for the South to rise again. What they don't know is that southern double wides float
Thanks, I never knew that!

We've been watching most of the Navy Reservists (especially SeaBees, Supply Corps, & lawyers) get mobilized to the desert anyway. The latest trick is allowing senior officers who didn't get a pay billet to stay in a pay status anyway (instead of going to the IRR). Seemed like a good deal until they realized that not being in a billet meant they were eligible for world-wide mobilization...

Speaking of ships of state, I heard that Canada insisted on negotiating the Great Lakes Treaty just because they were worried about the Michigan Militia getting their hands on waterborne transportation!
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Old 06-21-2007, 03:45 PM   #17
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After being treated by civilian Docs for about 20 years, I returned to military medicine almost 3 years ago.

I can say with no hesitancy that the medical care that I have received in that time from on-base military (Tricare) medicine has been superb. They have ferreted out several medical issues that my civilian doc never even checked on. I feel that my treatment has added many years to my life.

I had a Q today about the results of a recent lab test and called the clinic for further clarification. I was on the phone for 15-20 minutes with the nurse who thoroughly responded to every question that I had in great detail. Can not ask for more than that.

My wife (recently retired) is also just getting on the same program and has had no negative comments, but time will tell.
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Old 06-22-2007, 08:36 PM   #18
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Thanks JPatrick!
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Old 06-23-2007, 06:56 AM   #19
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I just retired from the Army Guard and in 19 years will get my first retirement check and be eligible for military health care (all at age 60).

I think the quality of care really depends on location. Some areas are great, while some are not so great.

Most of the complaints I hear from fellow soldiers is about the waiting time for treatment, and all the red tape. The system is overwhelmed by the influx of all the GWOT patients.

I hope the increased business (unfortunate as it is) and public awareness pumps some funding into the entire military health care system. Not just for my benefit, either.
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Old 06-23-2007, 09:23 AM   #20
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For those of you who use Tricare standard and are under 65, you might consider the MOAA Mediplus Tricare supplement that pays the 25% copay after meeting deductibles. I had it for a few years then went Prime so don't have copays. I'm thinking of going back to Standard + Mediplus for a wider choice.

TRICARE Supplements
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