Readers of Tom Philpott's Military Update column sound off.

Patients, Providers Differ on TRICARE Commute Rule

I'm okay with this new DoD policy aimed at cleaning up TRICARE Prime enrollment at military treatment facilities. I'm a recently retired Air Force nurse who has worked with TRICARE at three bases [Keesler in Mississippi, Nellis in Nevada, Altus in Oklahoma] and with two TRICARE support contractors.

I know I wanted a primary care manager who was closer to my home than the Navy base 30 minutes away. In two of the clinics I worked in, we had patients driving two to four hours, or more, for both routine and urgent health care. Especially concerning were some patients who needed urgent care and yet they passed multiple facilities en route to the base for a clinic appointment.

At smaller bases, it may be appropriate to limit enrollment to active duty and family members needing family practice and pediatric care. The issue then is whether providers get to see the more complex patient cases that help more junior providers grow.

I am more upset about the upcoming third generation TRICARE contract changes that likely won't allow retirees to enroll in TRICARE Prime if they live more than 40 miles from a military treatment facility. I plan to move near Charlotte, N.C., and will not be able to use Prime under the new contracts. I had encouraged use of Prime to so many patients, even those who lived outside MTF catchment areas. But now, after 12 years pushing Prime, I will fall out of eligibility, increasing my costs.

I want to continue with Prime, and believe many retirees are in the same situation.

JEANETTE HOPE
Major, USAF-Ret.
Lake Villa, Ill.

I appreciated the article on TRICARE Prime policy enforcement of distance rules. I believe this is the start of an incremental plan to move people into the more expensive TRICARE Standard option.

Because recent attempts to raise our premiums have failed, this is a way to accomplish some cost reductions for TRICARE overall.

There should be a distance waivers granted to anyone who has had access to Prime at their present address. No one should have to move.

PATRICIA LEWIS
Hanford, Calif.

This action by decision makers with TRICARE Prime is pure B.S. and shows they think only about costs, not quality of care. It's all about saving money by forcing eligible beneficiaries to make tough decisions.

MICHAEL R. RUNELS
Major, USAF-Ret.
Via e-mail

Your article makes TRICARE Standard look like a bad option for Mrs. Debbie Tilch. I disagree.

TRICARE Prime, an HMO, has an enrollment fee [of $460 a year] for retiree families. TRICARE Standard has no enrollment fee and a $300 family deductible. Standard users also have the freedom to choose their doctors without referrals from a primary care provider.

Smart folks find a TRICARE supplemental insurance company that pays what TRICARE does not pay. If you have an account with Pentagon Federal Credit Union, for example, you can sign on with A&SI in Rockville, Md. My A&SI policy even pays the TRICARE $300 deductible!

I reach my $3000 cap just about every year, in May or June. After that TRICARE pays 100 percent for all outpatient visits to include my prescription drugs.

I think the Tilch family would have been far better off with TRICARE Standard and supplemental insurance, instead of moving closer to the MTF at Twentynine Palms, Calif.

It's a great medical insurance program that many folks do not explore, because all they have ever known is Prime. It's fear the unknown.

TERRY HUNTER
Yorktown, Va.

This is not a fair decision by TRICARE. If you know you live outside the 100-mile "fence," you also know you will have to drive that distance. If you're a retired military member, you know and accept that the drive will be a long one and are to make these decisions on your own.

TRICARE interference is unwarranted.

W.R. WHITNEY
Via e-mail

My spouse is sorely disappointed as she was considering moving to Sequim, Wash., which is way outside of the new proposed limits.

GARY GRAVES
Chief Warrant 3, USA-Ret.

I am currently on TRICARE Prime because of the lower cost, but I live outside of the designated area. I am working with my local health care facility to get one of their physicians TRICARE Prime certified so we do not have to drive 50 miles to the nearest Prime doctor.

It is not fair to say that because we do not live near a base that we do not deserve TRICARE Prime. My husband was in the military for 26 years. I "served" most of that time, going where he went, taking care of the household and children so he could do his job.

My husband can obtain his care from a veterans' hospital only 30 miles from our home. I cannot. The idea of cutting me off or making me pay more for medical care infuriates me after all we have done for our country.

FRAN VANDRE
Jefferson, Wis.

Could TRICARE's decision to enforce the waiver rule for commutes longer than 30-minutes to primary care managers have anything to do with travel benefits afforded patients as outlined in the following fact sheet link.

An interesting question for the Tilch family would be: How much were they paid for travel expenses during these 19 hospital stays for their son and for other doctor visits and medical tests over the past year?

JEFF BREWER
Colorado Springs, Colo.

We did ask. Debbie Tilch said her family asked TRICARE only once in recent years to reimburse them for medical travel expenses.

"We felt it was easier to pay out of our pocket because sometimes it was a hassle" to file the paperwork. "So my husband and I opted to not apply for travel," Debbie said. "We were just happy having our TRICARE Prime." – Tom Philpott

Letters may be edited for clarity or length. Write to Military Forum, P.O. Box 231111, Centreville, VA 20120-1111, send e-mail to militaryforum@aol.com or visit www.militaryupdate.com.