Tricare questions/long rant
overtonhayes
member
I'm visiting from 2nd trimester because Tricare is driving me INSANE, and I don't know why I didn't think of coming here before.
DH is in the National Guard and is now on active duty orders. This means we're elligible for free Tricare, whereas before we would have had to pay for it (we never set it up because we couldn't afford it).
We have been given so much hassle trying to get it organised. Basically, pretty much daily I call Tricare and ask what we need to do so that Tricare takes effect. I'm told, "it's automatic". I tell them that something's obviously gone wrong in our case because we do NOT have Tricare, despite being elligible and being told it's automatic, and what I'm told to do is ridiculous. Here's a (shortened) list of what I've been told I need to do:
- DH needs to take his orders to the DEERS office where his unit is based. He has to take them there in person.
- DH can email or fax his orders to the DEERS office where his unit is based.
- DH needs to personally drop off/email (we've been told both) his orders to the DEERS office at the base where he now works (not the same as where his unit is based)
- We need to call this hotline *we're connected to a number which is out of service*
- DH needs to talk to his immediate superior and they will handle everything
- DH needs to talk to one specific person in one specific office who never picks up his phone.
We've got so sick of all this that this weekend we drove to his unit's base and handed in his orders ourselves at DEERS. You won't believe how much of a nightmare just doing that was, because they are incredibly lazy there and told us they were closed, despite it being two hours before their closing time. Anyway. We handed in the papers and they looked at us blankly. They told us to take them to someone else in the building for them to upload to the 'system'. We got that done and went back to DEERS, where they told us that there wasn't anything they could do because it would take 24 hours for them to appear on the system, so by the time it appeared on their system their office would be closed; and by the time the office re-opened again the deadline would have passed for new Tricare applicants for this month.
Specifically, they said that DH would have Tricare as soon as his orders appeared (so in 24hrs), but I wouldn't have Tricare until the 1st of the next month, provided we complete the process before the 20th. They were saying, however, that because it was a weekend and blah blah blah it wouldn't be done before the 20th, so I have to wait another whole month for Tricare. THEN, to make things worse, someone in the same office said that was ridiculous and he'd never heard of that, and he's pretty sure I get Tricare in two weeks!
We're so sick of being given the runaround and being given conflicting information by the people who are meant to do this stuff for a living. Does anyone know how Tricare is supposed to work in our case? I have no frequent prenatal care because we can't afford it and we don't have insurance. I really can't wait a whole month for insurance to take effect...
Uuuuugh. Thanks for reading (listening to?) my rant!
EDIT: To make things worse, I'm not eligible for Medicaid, food stamps, or any other government program designed to help people like us (I'm eligible for WIC, which I get). To make things worse still, we can't afford the so-called 'sliding scale' at our health department. That part's a long story, but essentially my husband was making under $300/month before he went active. Although he makes more than that now, money is still a real problem. So I REALLY need Tricare, as soon as possible.
Re: Tricare questions/long rant
Do you qualify for Medicaid? I would look into that ASAP since you may be waiting awhile for Tricare. Prenatal care is very important and you are getting close to your 20 week mark when the anatomy ultrasound is typically done.
I wouldn't necessarily say that the employees of DEERS are lazy. At many bases, they close their acceptance of more people so that they can finish the customers they already have.
I'm very sorry you're so frustrated.
That sucks..sorry you all had to go through all that..What idots..They just didn't want to do their job..Did you try to sign up for Tricare Prime? If so, then yes, that will take effect on the 1st of the next month after a certain date of registering..but you should automatically have Tricare Standard coverage..call Tricare again and ask them if you currently have Prime or Standard..Bet you have Standard.
Two Issues at hand here.
1) You are confusing TRICARE STANDARD and TRICARE PRIME. We are all automatically eligible for TRICARE STANDARD when our sponsors are Active Duty.
Standard is a PPO type policy, where you can go to any authorized/participating provider. You will be charged a co-share,15%-20% of the bill, once you meet your early (fiscal year) deductible. Once you reach the Catastrophic Cap of $1000 (active duty), TRICARE will then cover all the remainig out of pocket costs for the rest of the fiscal year.
TRICARE PRIME is the HMO policy. THIS policy is enrollment based - hence the representatives comments about not getting coverage until the first of the month. They have to process your enrollment within the system and assign you a Primary Care Manager.
If you want to go PRIME, which has no out-of-pocket costs, YOU ARE STILL COVERED UNDER STANDARD until your Prime enrollment starts. All you need to do is call TRICARE to get a listing of providers.
2) DEERS has nothing to do with enrolling people into TRICARE PRIME. Your information goes into the DEERS computer system to show if you are eligible for Active Duty (ie Standard and Prime if you choose it) vs Reserve Select, vs Retiree, as well as if your sponsor has purchased the Active Duty or Retiree dental plan.
The TRICARE Managed Care Support Contractors for the three regions manage the enrollment into Prime. You will have to provide your paper work for Prime to the TRICARE Service Center at your MTF or mail it in directly.
So...once your DH's information process within the DEERS system you will have medical coverage. You will have to decide if you want to pay out of pocket or use the MTF.
She is not going to "waiting long". She will have TRICARE as soon as her husband has provided DEERS their updated information, his orders to Active Duty and - if she has never been entered in DEERS before, her information as an eligible dependent.
She will be able to see any TRICARE Standard authorized provider or even a provider within the TRICARE Network (that will drop her cost share to 15%). She can even call the MTF and explain the delay and see if they can ease her in SPACE A, until her Prime enrollment is completed.
Or, she can stay on Standard and call the surrounding OBs in her area and start seeing someone as soon as she can be seen, using the Global Maternity plan.
Thank you, for ALL of that. I may be sending a PM your way! That clears up SO much. I have to add, though, that unfortunately the problem is that this one particular DEERS office really is lazy. My husband knows a few of them personally and they never get their work done. He's just been on the phone to Tricare and we found out that they didn't even upload his orders to the system this weekend, like they promised us they had already done! Now they're closed because it's a federal holiday; so we try to leave a message on their machine and we're told it's full. This is despite someone at DEERS telling us that he "checks all of the messages personally, twice a day", and basically using that to claim that he couldn't see us because we didn't have an appointment (they now see people by appointment only, which is a new development we weren't aware of, and they were saying that because we haven't called or left messages - which we did! - they had no idea we were coming so we should leave). Anyway. Mini-rant over.
As I said, my husband is on the phone to Tricare now. We've just been told that "once DEERS updates their system, your wife will be on standard". The trouble with this is that DEERS haven't updated their system, so my husband is showing up as ineligible for Tricare, and the representative just confirmed that since DEERS didn't upload his orders, I now won't get Tricare until April 1st.
However, she's just told us this: we can be reimbursed if we see someone and pay for it ourselves, since we've been eligible this whole time and we've tried to set it up. She said that my initial visit will be subject to15% cost share and a deductible, and for all visits after that, we don't pay anything. So we could see someone tomorrow, and Tricare would pay us back the cost of the visit, minus the deductible and the 15%.
Does that sound about right to everyone? As I say, we've been told so many different things, and whether or not that's because of confusion between Tricare Prime/Prime Remote/Standard, we can't afford to go out pay out-of-pocket for an appointment right now unless we know we can be reimbursed. My worry is that we'll do that, and then it will turn out that on our next visit (the 'first visit' under Tricare), that's when we have to pay part of the costs and be reimbursed: in other words, we'll pay twice.
And this is when the squeaky wheel gets the grease. I would call the DEERS office so much today that it clogs up their phone lines. "Is my stuff done? Is my stuff done?" Like a kid saying "Are we there yet?" Annoy the crap out of them until they get tired of hearing it.
But I'm not a very nice person, apparently, so..there you have it.
My little angel RIP August 12, 2010 - September 5, 2010
I went through something really similar and got told all of the above as well. What ended up happening was my DH took his orders to DEERS (they had to update his info first) and then we went over to the health care office and they put me on Tricare (standard). The whole process took maybe a two hours because there was some waiting involved. (However I still don't have my military ID because their machine broke and I have to find a way back up to base at a later date). That said I did get put onto Tricare.
The people at our DEERS office gave us wrong information too however once we got up there and he had his orders and was there physically, it went more smoothly. We'd tried faxing things up before because we live off post and it started the process supposedly but really didn't do anything.
Yes. Your Tricare coverage/eligibility will be back dated to the date your husband started his orders. Stop calling the DEERS office lazy. See, there's these funny things called computers and networks that don't always work right. I've fallen out of DEERS, twice actually, and neither time was it anyones fault except the silly system. Unless you've worked there and you know for a fact, stop spreading rumors.
Are you going to be on Tricare Prime or prime remote? Have you found a doctor that will accept tricare? Are you close a base so you can be seen at the MTF?
CJ 05/29/2013
I want to kind of correct/expand on this. In the National Guard if you are on active duty and more than 75(I believe) miles from an MTF you qualify for Tricare Prime Remote. It's just like Tricare Prime, you are assigned a primary care manager(PCM) but you are seen in your town by someone who accepts tricare. You are automatically enrolled in Tricare Standard and it will back date to the date his orders started. In order to enroll in tricare prime, or prime remote(whichever applies) you must fill out the form on the tricare website and either a) fax b)mail it in. If you enroll in Tricare prime you can do it on there website, the last time I enrolled in prime remote, I couldn't do it online and had to mail it.
Also, you have to have at least 30 days worth of orders in order to be eligble for Tricare. This sometimes causes a hiccup with the system, especially if he is on month-to-month orders. Sometimes the DEERS/Tricare thing doesn't happen until the first 30 days have passed(this is my experience). Also, if he is on orders more than 180 days(6 months) he will be eligible for TAMP(temporary tricare) for an additional 180 days when he comes off of orders.
CJ 05/29/2013