The VA is Not Alone in Causing Veterans Stress

I have been working with a client who is a retired military member. Sergio is having trouble with TRICARE and getting the services he needs for his wife. Sergio has been using TRICARE since he retired and hasn’t had any problems until the last five years with getting what he needs. Sergio’s spouse has a life-threatening medical issue and they are getting the run-around by TRICARE about authorizations and referrals to see a medical specialist. I know from experience he is not alone. I too have been getting the runaround by TRICARE, especially when it concerns needing a medical specialist. Since TRICARE has been taken over by Humana military in the eastern region, and Health Net Federal Services LLC in the western region things appear to have gotten worse. I have a daughter on the east coast who’s an office manager for a specialist, she informed me that TRICARE on the East coast is no better than what we have here on the West coast. TRICARE’s customer service is inadequate, there has become a shortage of medical doctors who now take TRICARE. In my opinion the customer service TRICARE provide has declined with each new contract.

Tricare contract has changed 4 times since 1994, it appears each change has caused a decline in services. TRICARE use to be a premiere insurance but appears to be failing over the recent years and has become, just another insurance company. Tricare claims they seek to improve the delivery, quality, and cost of health care services from previous contracts. From what I have seen there is a decline in services, payments to physicians, co-pays, and treatment with each change. I used to tell doctors I have TRICARE and they said, that’s good insurance, now I tell them I have TRICARE and they say, OH! I have had TRICARE since it was CHAMPUS. The changes throughout the years have not been for the better.

In the last change in 2016 TRICARE changed our primary care physician without notifying us. My wife went to an acute care facility away from our home area after receiving an authorization from TRICARE. She was told by TRICARE over the phone that we needed to get an authorization from our primary care physician after we went to acute care. We went to our primary care physician once we returned home to get the after the event authorization, that’s when we found that our primary care doctor was no longer our primary care doctor, TRICARE had changed it without telling us. We have had the same primary care doctor since I retired, and he still took TRICARE, but TRICARE wanted us to go see someone else. It took us weeks to get our primary care provider back, in the meantime we were stuck with the acute care bill. These types of actions by the insurance company is what causes a lapse in the continuity of care for the patient. When doctors are changed, medical issues get missed, and people can die. It’s not about the quality of care for the patient that TRICARE wants their beneficiaries to believe, it is about profits for their shareholders. As the years have progressed the co-pays have increased, causing more out of pocket expenses.

A couple of the issues TRICARE patience are facing is the increase in co-pays and getting to see specialist. The co-pays used to be small and now they are double what they were in the past, that includes prescription medication. Sergio explained his wife’s issues needed a specialist and TRICARE tried to send them to a provider in Orange County. Sergio found a specialist at Loma Linda and had to fight TRICARE to see the specialist who is an hour closer than the oneTRICARE wanted her to go to see, Sergio stated they could not explain why, my guess is the specialist in Orange County was cheaper.

The loss of providers is astronomical for the Veterans community. I have seen where veterans have tried to make appointments in our area and many providers have left TRICARE due to the low payment for services and TRICARE’s notoriously slow payment to their providers. I have seen providers wait up to 6 months for payment of services, and some have stopped taking TRICARE because they cannot get paid.

All these issues place a high burden on veterans and their families. Constantly fighting the insurance company for what veterans have earned for them and their family causes undue stress.

The constant changing of insurance providers, the changing of primary care providers without letting the veteran know, and the increase in co-pays increase the stress of veterans and their families. The inability to find a provider all ads stress to those who have served. Since September is Suicide Awareness Month I wanted to float the idea that having to fight the insurance companies adds stress to already venerable veterans like Sergio and his family, most veterans are elderly, and the undo stress is hard on them. Senior citizens are the biggest risk for suicide. The stress of dealing with TRICARE or any insurance company does not help.

For questions or comments, I can be reached at bo@afterdutyvets.com or visit our website at afterdutyvets.com.