Tricare cost-saving
Army active-Reservist Captain Shane Morgan, an Afghanistan veteran, felt funny while he was taking his PT test last year, so he went to the doctor to check it out, according to CBS News;
“As we were doing the push-ups I got 15 in, and I noticed that it was a lot harder for me to do push-ups than it has ever been,” Shane said.
“So he hooked me up to the EKG and said ‘I’m 99.9 percent certain you’re having a heart attack.’”
One artery was completely blocked, but there was another problem, the Army determined the heart attack did not happen in the line of duty, so its been withholding medical payments.
I’ve been jerking around with Tricare myself lately. They get real picky – a few years ago they sent me to an ALS clinic, now they want to bitch about paying for it. So I guess that’s how they’re going to save money on health care that they promised – they just won’t pay for it. But back to Captain Morgan;
With bills piling up, the Morgan’s credit rating suffered, but the Army has just reopened the case. A spokesman told WBZ: “The physical and financial well-being of our soldiers and their families is a top concern for Army and Army Reserve leaders at all levels.”
“I am cautiously optimistic,” Shane said.
Yeah, if the well-being of servicemembers is a concern, the Pentagon wouldn’t be screwing them at every corner.
Thanks to Top Kone for the link.
Category: Veteran Health Care
“The physical and financial well-being of our soldiers and their families is a top concern for Army and Army Reserve leaders at all levels.”
The BS flag is flappin’ hard.
It’s probably all of the hot air in that statement that’s making the flag do that.
Ever notice how every problem gov’t claims to solve or to have a solution for is a problem that the gov’t created in the first place?
BOOM!
I can’t think of one problem this election season that needs “fixing” that they didn’t create by policy. But I am no grad student.
Feature, not bug-as far as they’re concerned.
Yet, there are those that frequent tax payer funded “medical” services monthly and get the cheese for “free”. Oxy and Xanax for everyone! We certainly can’t leave out the Amitiza, poor folks need to shit.
It is a disgrace that our veterans have to beg for treatment while the leeches of society get the shit handed to them whether they need it or not.
Cocksuckers.
Had the same thing happen to a SFC in my NG unit it turned out some ass hole at HRC or S-1
F’ed up his paper work
Tri Care would have to dip into the funding for reworking the plumbing of transgender Soldiers.
This.
If Tri Care paid for the heart attack this guy suffered while doing his APFT, Chelsea Manning’s “transition” might have to be delayed a few months…
I’ve literally spent a minimum of 12-15 hours a month on the phone dealing with TRICARE issues for myself and my family the last 16 years
Worst health care plan ever
Not to mention the ONLY hits on my credit report are because of TRICARE
Bingo! Same here.
The idiots in their billing departments either don’t know how to fill out the paperwork properly or Tricare, as in all bureaucratic levels, changes the paperwork requirements on an hourly rotation.
Either way, I contact Tricare when I get the kickback for non-payment. Then I call the doctor’S office explain it to them, then still get a bill.
Fuck all of’em; from DC on down.
I’m too old to worry about friggin’ credit ratings.
I’ve had pretty good luck with Tricare Prime. I turn 65 next year. I’ll see how Tricare for Life works out.
Any lifers on the blog?
Yo. I’ve had TFL for 10 years with no issue, probably because medicare is first pay. And I’m relatively healthy.
Wife was in the hospital for over a week with colitis (took some time to diagnose as she also has MS). Medicare was first payer and Tricare for Life/US Family Health Plan (which is only available in a few places around the country from what I understand) must have taken care of the rest as I never heard word one or received bill one for any of it. This was over three years ago. Having MS, the wife’s meds are pretty spendy, but the co-pay is very reasonable and many of the meds are generics. So far I have no complaints. [Fingers crossed, knock on wood, etc.]
A serious question: does Tri-Care determine Line of Duty? I thought that would be an Army thing.
Why would Tricare even care if you are service connected?
TRICARE doesn’t deal in service-connected. But for a reservist, it does care if an injury or condition was incurred in LOD or NLOD.
If an injury or medical condition was incurred LOD, TRICARE will cover it. If not, the reservist is responsible.
Example: if a reservist is injured in an auto accident on the way to IDT (drill), in theory TRICARE should cover that; that injury is considered in LOD. However, if they’re injured in a traffic accident while commuting to their civilian job during the week, that’s NLOD – and TRICARE doesn’t cover it.
Reservists can sign up for TRICARE-RC, and be covered full-time. Many don’t.
I was in a traffic accident in a GSA van on Fort Dix (NG) not too long after I got back from Afghanistan in 2013. Sent 4 of us to the local hospital for checkup – I was still under Prime from deploying, they were on AT orders. Tricare payed my bills as if I was stationed there Active, the other poor slobs are still getting contacted by credit bureaus because NY still hasn’t settled the bill.
That was my thought. This sounds more like sloppy paperwork on an AGR’s part than something done by Tricare.
The Army does line-of-duty investigations when you’re injured on active duty. The VA that makes a final determination as to whether a problem is “service connected,” to determine whether you get VA benefits based on that problem. (They aren’t bound by the findings of the Army investigation but they are likely to be influenced by it.) I’m not aware that any of this has to do with Tricare.
What follows is conjecture, and it could easily be wrong. But the following scenario explains why TRICARE might give this guy a hard time.
1. Individual in question was on IDT or AT during his PT test.
2. Individual was not seen by military medical personnel regarding this condition while on IDT or AT.
3. Individual went to see his civilian doctor some time after his drill weekend/annual training. At that time, he was in civilian vice military status.
Medical care provided to a member of the Reserve Components outside of IDT or AT/other active duty service generally is on their nickle, unless they have TRICARE-RC. The usual exception is care for an injury or condition that is traceable to an injury or condition occurring while on IDT – and that usually has to be well-documented.
If he wasn’t seen by medical personnel while on IDT/AT, then there’s no “paper trail” linking the condition to military service – and reservists do sometimes develop medical conditions unrelated to military service. Hence the issue with TRICARE not agreeing to pay for a Reservist’s medical care for a condition or injury with no documentation connecting it to performance of military duty.
Again: I could be wrong; this is conjecture on my part. But I’d certainly love to know precisely when he took that PT test – and how long afterwards it was before he saw his doctor. And I’d also love to know if he was seen by military medical personnel at all while on IDT or AT for the incident in question.
This was posted in Army times a few weeks back.
1. The unit was responsible for conducting a line of duty. This was done by a “regular” officer and not a medical professional. IIRC, the cause of the heart attack was due to blockage of an artery, which didn’t just happen during a random IDT PT Test, but rather over a period of time outside of drill.
2. TRICARE can only cover what is determined to be within the line of duty for RC soldiers. I can’t blame TRICARE for following the rules on this.
3. The LOD is appealable (I believe he is appealing) on multiple grounds, starting with the expertise and scope of the investigating officer. This wasn’t a guy who had a wreck on the way in to IDT, or fell of an M1, but a complex medical issue requiring a call by an MD.
4. There are other avenues to address if the blockage may be service connected, as the officer has 8-10 years on active duty previously.
5. Where is his civilian insurance in this?
Hadn’t seen that AT story. Could you post a link?
Regarding question #5 – damn good question. By law, TRICARE is second-payer to anything other than a TRICARE supplement policy. His civilian insurance pays first; TRICARE pays next – if the individual is covered, of course. So unless he’s got really crappy civilian insurance or doesn’t have any, he should be looking at his normal civilian insurance deductables vice paying for the “whole enchilada”.
Follow-up: disregard, found the article.
From looking at the raw numbers in the article, it appears his civilian insurance covered around 74% of his total medical expenses related to the incident – but he’s on the hook for the remainder, and it’s not negligible (around $30k). That’s why he’s trying to get the LOD determination changed.
After my run-in with Tricare and duty status issues, you are correct with #2. The biggest issue is that you need to be seen by the people at your unit clinic, even though they can’t and won’t do anything for you. However – there’s a nasty catch to it – there are a LOT of medical insurance companies that refuse to treat something that occurred or was exacerbated during drill status – I was in that boat personally, and it’s a pain in the ass to deal with. Hopefully he has someone in his unit that he made some kind of comment to about the pains and problems since they can become a valuable witness in his appeal process. Tricare for reservists isn’t quite as good as they make it sound, either, in all fairness.
Not sure about Army, but Air you MUST be in a drill status or on orders to be able to take a PT test simply because of this very issue. You get caught doing a test in a “civilian” status, you stand a chance of being reprimanded formally for failure to obey. As a former ANG Civil Service Technician that was a huge, huge issue with us.
-if- his normally “studly” PT score dropped abruptly to “Dud-ley” at the test described, that would tend to support the attack occuring on duty.
If he toughed it out, and said nothing, then he may not be able to sustain the appeal, especially if the scores show no deviations.
And here the funny part.
If you have another insurance carrier, TRICARE claims that they are not insurance, but a benefit.
I’m pretty sure that TRICARE is technically a government benefit vice insurance, GT. If so, they’re technically correct in calling it a benefit. I believe the same is true of VA medical care.
If you’re talking about TRICARE always paying second, that’s because Federal law mandates it. The only exceptions of which I’m aware are (1) when TRICARE is the only healthcare coverage you have, and (2) when you have a TRICARE supplement policy. TRICARE supplement policies are legally allowed to pay second. Any other private health insurance you have pays first.
Yeah.
And good luck getting them to pay anything.
However, in their defense, they have a great prescription drug plan in place.
“With bills piling up, the Morgan’s credit rating suffered”
BTDT
Other than attaching a letter to your credit report explaining why you fell behind everything for six months, there is nothing you can do. Even if you get back pay and catch up with every single debtor your credit is screwed,
It’s Tricare today and gov’t-run healthcare (not health insurance) for all tomorrow. Tell me again that the gov’t is comprised of public servants. In fact, I haven’t heard that term in many years. Up is down and down is up in the New Amerika of oBaMa/Clinton and company.