We all know that just getting in to see the doctor can be a hassle. But when you’re trying to navigate the healthcare system with a child who has medical complications, it can be downright scary.
Tricare Issues for Military Kids
All kids might face issues and concerns with the Tricare system though. And you deserve to know what you’re facing.
Referrals to Specialists
Need to see a (fill in the medical specialist here)? Oh, that’ll be a 6-12 month wait! That’s if they’re in-network and accepting new clients.
Sure, sometimes you get lucky and can get in ASAP, but often there’s at least some waiting involved.
On Tricare Prime and USFHP, beneficiaries are required to get a referral from their PCM in order to see a specialist. While Prime and USFHP offer no or very low-cost co-pays for all services and referrals, finding and getting into a provider can be difficult.
Select beneficiaries can select their own in-network specialists without a referral, but getting in to the correct person can still mean they’ll be waiting.
Often, on-base specialty clinics are full or limited to active duty personnel. Other times, finding a specialist who is in-network, accepting new patients and within a reasonable driving distance is a struggle.
Help! I Need Advice!
Perfect! That’s what the Nurse Advice Line is designed for! You can call 1-800-TRICARE (874-2273)—Option 1 to speak to a registered nurse about your concern.
The nurse you speak to can listen to your child’s symptoms and the progression of the illness/injury. Then, they’ll provide the next best steps in terms of seeking treatment or providing care at home. The nurses can even help you locate an ER or urgent care clinic.
Where Do I Go If…?
For military families, knowing where to get medical care in the event of an urgent or emergent medical issue is vital. Emergencies never seem to happen when you’re safely tucked into your familiar hometown. No, your child is sure to get into something dangerous or spike a terrible fever when you’re somewhere completely new. Of course.
What do you do then?
First, you no longer need pre-authorization to seek treatment at an urgent care center near you. However, there’s a catch: your urgent care center must be in-network. In some cases, that could mean driving long distances to be seen somewhere in-network even though there is a perfectly good clinic within 5 minutes.
After you’re seen, just call Tricare’s regional call center to let them know about your visit. If you’ve gone out of network, be prepared to pay point-of-service co-pays.
Second, you can be seen at any ER anywhere. If you’re on Prime, be sure to call Tricare to let them know about your visit or if you’ve been admitted.
Getting the Records Straight
Moving every three years doesn’t make it easy to keep records, even digital ones. Ensuring that your child’s medical files are complete and accurate can be a full-time job, especially when they run to the hundreds of pages – as is the case for many medically complicated children.
With each move and every new report generated, there is more to keep track of and pass along between providers.
Making sure that the most important details, like a deadly allergy or surgical records, be communicated is extremely important.
If you’re working with off-base, civilian offices, getting the records for your records can be costly. Many medical offices charge a fee per page copied but will transfer your records digitally or via fax to another doctor’s office for free.
Can you see that provider or get that needed supply now? That’s a strong maybe!
Not all medical care needs fit into neat little boxes. What is needed for one child to thrive may be excluded under current Tricare policy.
For example, dyslexia treatment is not allowed, but ABA therapy is covered as long as your child is enrolled in a special Tricare program.
Figuring out which much-needed providers will be covered by insurance or should be added to your already tight budget can be an extreme balancing act!
Do We Need ECHO?
The Extended Care Health Option (ECHO) is available to support military families with medical needs that might go beyond standard Tricare coverage. These can include home nursing and some supplies, like diapers.
ECHO offers a lifeline for many military families, at a low cost-share, who are struggling to meet the needs of a medically complicated child while also being financially smart.
Hospice Care Now Covered
No one wants to consider this scenario, but it’s comforting to know that hospice care is now an option for military dependents and troops. Hospice is designed for people who have a life expectancy of fewer than 6 months. Care will focus on comfort and daily living rather than a treatment plan in hopes of a cure.
However, military families have to choose between hospice and treatment. You cannot have both services operating concurrently.