There are a range of proposals being discussed in Congress right now for the 2016 fiscal year that affect military families. The Tricare reforms catch our attention because of the changes to procedures or policies in our health care system. One detail that particularly stands out is the proposed changes in emergency room care.
An ER fee is only a single proposal among many that are being considered by lawmakers related to health care for military families.
Under the 2016 plan, military families would have to pay a fee depending on your sponsor’s rank to utilize emergency room care for a misused visit.
What would deem a misused visit?
That’s still up for debate and can spark a whole new issue if the proposal does get approved.
Do you frequently visit the ER because your MTF is closed at nights or on the weekends?
Military families are rallying together to oppose the emergency room fees arguing that often times we are driven to use ERs for immediate care. When a parent would call their local MTF (Military Treatment Facility), it might be weeks or at worst months to schedule an appointment with their PCM (Primary Care Manager).
Additional factors that drive families to ER visits are MTF locations closed at needed times (evenings or weekends), not being able to receive the proper referrals to an Urgent Care facility and not to mention, the wait for paperwork to get pushed through, so you can start utilizing your new MTF location.
For example, immediately after my PCS to Virginia (literally 3 days after we moved in), I caught a sinus infection. My husband wasn’t due to report for another couple weeks, but I knew I had to see a doctor as soon as possible. Because of the tight turnaround, I didn’t have the proper paperwork ready or even changed our MTF facility yet. At the recommendation of hospital personnel, I used the emergency room so I could be seen and receive prompt attention.
Would this circumstance be considered a legitimate emergency under this proposal?
Also, you never really know what would constitute as a non-emergency when you may not actually know what’s going on yet. For example, if your daughter is complaining about her knee after a hard fall, do you take her to the ER on Saturday morning? Or wait it out until Monday when the MTF is open?
This proposal leaves a lot of questions unanswered and as a result, we start playing the waiting game on our family members’ health.
Keep in mind that adding a fee to emergency room care is only a single proposal among many that are being discussed by lawmakers. National Military Family Association, a nonprofit that advocates for military families on Capitol Hill, breaks it down for us here.
NMFA argues that the problem stems from military families not given the proper avenues for urgent care and day-of appointments. The organization is working toward “improved access to acute care appointments for all military families using MTFs.”
In addition, NMFA started a petition for this particular issue. If you disagree with the emergency room care fee, sign their petition here.
The key point in this is: what is an emergency? What a frantic mom might consider an emergency, might not be according to the ER. On the other hand, if one puts off going to the ER because he or she thinks it’s not that serious, might get chewed out by a doctor the following day as it was serious enough to be seen in the ER so the treatment might call for something different than would have been done if seen sooner. I think it’s going to end up as “in the eyes of the beholder” type thing. Unfortunately, the patient will probably lose in most cases.
You also will have to deal with the state laws for child protective services. If parents do not bring their childern in for treatment for things like broken bones, spraines, virus‘, and other urgent care items, then they get involved and will start investigating the parents ability to take care of the children properly.
Having been an ER military tech for several years, I have seen misuse of the ER by military families. However, because of the unavailability of 24-hour non-urgent care in the military, these families are left with no other recourse then to utilize what is available. And who is to say what is non-emergent? A sick child in the middle of the night crying and miserable sends parents over the edge, but because these children are not small adults and their care is specialized, are they not urgent? This is going to be a very tricky situation. I’m hoping that if this goes through Congress, that whoever is appointed to review the cases is fair and knowledgeable of the facts.
As a retiree we all ready have a copy for ER visits thru tricare.. I do not think active duty should have a ER fee as most of the time it’s Tricare sending you there not by choice..but if they do implement a fee it should be based on the level of tricare you have ie prime or standard not rank.
Until they do this for Medicaid recipients they better think twice or thrice about this. There is much more abuse over there!
I hurt my shoulder 3 weeks ago. I tried conservative home care for a week before I called my doc at the MTF. They didnt have an appointment available until May 27…and THEY sent me to the ER. Should I have to pay a fee for THEIR inability to treat me? I ended up having a muscle strain and being prescribed a muscle relaxer. As a nurse and former EMT I HATE going to the ER if I dont have to, but if thats the only way I can get care in a reasonable amount of time, what am I supposed to do? Maybe the MTFs need to be expanded to handle the people they are caring for now after the retirees were forced to go back to the MTFs for care vs seeing their own doctors out in the community.
Let me just say that the ER will be the last place I go. Terrible emergency service.
My son suffered a concussion and it took 5 hours for a CT scan- all while he was vomiting!
He has Autism.
It was terrible. Never again!
I’ve been to a civilian ER twice, 3 years ago. It was no different than the military ER. Moms with kids, folks coughing, etc. And unless one had chest pains, the waiting time was very long. I was checked because of severe back pain. I was given medication and told it was just overuse. The next day I had to go back because it was worse. I had to use crutches to walk as my left leg wouldn’t hold me up. I was given an MRI, released and told to see a spine surgeon. I think whether military or civilian, circumstances will dictate how long one waits.
ERs have always been used/abused as walk in free clinics since I joined in 1971.. It’s been a joke that the busiest day of the year in a military hospital ER is Super Bowl Sunday because daddy is watching the game and mommy takes all of the kids to the ER for the runny noses they’ve had for the last 3 weeks.. I think a small $20 fee for any visit is very reasonable.. If the patient is admitted, or the doctor determines it was an emergency, the fee should be returned or not charged, but if not, it should be because it obviously isn’t an emergency..
If they plan to do this, then they need the tricare nursing staff hotline available to say “do not go” and they must be willing to assume legal responsibility for their decision.
I agree with these families. We don’t have urgent care and its easier said than done to get tricare to give us a referral off base for one including nights and weekends. Our ERs are our urgent cares. Yes I feel emergency rooms should be for extremes only but if myself or especially the children are running a really high temp. that medicine wont break, that cant wait til Monday..then you better believe I’ll be at the ER. Even tricare says your ER is your urgent care for holidays, weekends and nights. So before charging us, give us options that suit our needs.
Life, Limb, Eyesight. That is the definition of an emergency. Unfortunately, the rampant abuse of the EMERGENCY system means that we may have to pay a co-pay for our middle of the road urgent (but not emergent) problems. (There is a lesson in there somewhere). BTW, by never using an Military Emergency Room (at 9 duty stations) for anything but emergencies, I have never waited longer than 10 minutes to be seen.
A lot of times, if the kid was sick, the MTF was not open evenings or weekends if there was even an MTF where I was stationed (Idaho Falls comes to mind). As for retiree’s, I am one and I have been in a MTF since I retired in 2000. Tricare keeps me with civilian doctors even now that I am only 5 miles from an AFB.
This is so said how congress has been trying to change the everything but themselves. It takes me months to see my doctor at a MTF. If I was using a civilian doc it would only taken 1 week. How about provide better options and people won’t have to use the ER so much.
We are retired military. I have occasions of unexplained internal bleeding. In the past six years, I have gone to the ER four times for being tired, dizzy, etc. Twice, I was sent home and told to rest because it was a bug, and twice I was admitted immediately and given two units of blood each time. It comes on sudden and you don’t know if it is serious or not. People like myself would probably find themselves either in an ambulance, if someone finds them early enough, or dead if we don’t just go and pay the expense.