Families Forced to Give Up Civilian Health Care

Health care

More than 27,000 Army and Navy Tricare Prime users who see civilian primary care providers are involuntarily being moved to doctors within a military treatment facility.

The mandatory reassignment was launched on Army installations in September of last year. It is progressing on a rolling basis to 11 Army posts and three Navy bases, Army and Navy officials said.

Troops and their families are notified by mail with about 60-90 days notice that they will receive a new primary care provider, Army officials said. The letters give users the name of the new provider and information on how to appeal if they believe their condition requires outside help.

Army officials said the program is currently impacting 15,420 beneficiaries who live within a 30-minute drive of the Army medical facilities at Fort Bragg, N.C.; Fort Meade, Md.; Fort Knox, Ky.; Fort Sam Houston, Texas; Fort Sill, Okla.; Joint Base Lewis-McChord, Wash.; Fort Carson, Colo.; Fort Bliss, Texas; Fort Riley, Kan.; Fort Leonard Wood, Mo.; and Fort Rucker, Ala.

Navy officials did not identify their impacted medical facilities.

Army health officials said the reassignments are designed to fill empty spots at the military treatment facilities (MTFs). As the drawdown continues, the capacity at the centers increases because Army doctors are spending more time stateside and less time deployed. In 2013, 17 percent of primary care appointments at Army MTFs went unfilled, officials said.

Rather than farm Tricare Prime enrolled Army families out to in-network civilian doctors, known as Managed Care Support Contractors (MCSC), the Pentagon wants to pull them back in. Officials said 72 percent of Tricare Prime beneficiaries near an MTF are enrolled on post.

"The involuntary recapture campaigns are intended to ensure we use existing capacity in our MTFs," said Marie Tolleson, an Army health spokesperson. "The government is purchasing the care twice where we have unused capacity in an MTF and enrollment in the MCSC network."

Navy officials identified the move as a cost-cutting measure. In 2013, 9 percent of available appointments at Navy MTFs went unused each month, according to the Navy. Over 80 percent of the eligible Tricare Prime users are currently enrolled at Navy MTFs.

"By using the fixed assets of MTFs closer to their capacity, we will also reduce expenditures we would normally incur in our Tricare network," said Paul Ross, a Navy Medicine spokesman. "The best use of government resources is to use the fixed facilities' capacity and not have to pay again for the Tricare network resource if it can be provided at an MTF."

Users at most of the installations executing mandatory reassignments have likely already started receiving letters. But because the recapture plans for Fort Knox, Fort Meade, Fort Sam Houston, Fort Sill and Fort Rucker were approved only this month, users there may not have been notified yet.

Army officials expect their re-enrollment process to be completed by November, while Navy officials said they expect to be done by January 2015.

More Army MTFs will be added as local commanders request the program, Army officials said. Tricare officials said they have worked with the Army, Navy and Air Force to identify locations that could increase MTF enrollment.

"The services have identified areas where they can increase MTF enrollment -- an objective which enhances readiness, sustains the clinical skills of providers and, by better using the fixed assets of MTFs, also reduces costs," said Kevin Dwyer, a Tricare spokesman.

Air Force MTFs are not currently using a mandatory recapture program. Air Force officials said in 2013 that 18 percent of Air Force appointments were not initially booked, but all but 1.6 percent of them were filled through walk-ins. Officials said 77 percent of Tricare Prime beneficiaries near Air Force MTFs are currently enrolled on base.

Many of the Tricare Prime users who are part of the changes are currently seen off base because the Army and Navy sent them there. If the military treatment facility was at capacity when a family arrived at their new duty station, they were given the option to be seen in by an in-network civilian doctor. Others were permitted to be seen off base after filing an appeal to the MTF commander.

Tricare Prime enrollees pay no out-of-pocket costs for care, but must use a doctor at a military treatment facility if one is available or receive a waiver. Users on Tricare Standard, however, are permitted to pick a civilian doctor, but pay a co-pay for care.

Tricare Standard users are not impacted by the recapture. Users may be able to avoid changing primary care managers by switching over to Tricare Standard. Those who switch are required to stay on Standard for at least one year before moving back to Prime.

Beneficiaries who have been automatically moved are allowed to appeal based on "medical necessity," officials said.  But approving the waiver is up to the local MTF commander and based on "local capabilities," they said.

While only the 14 posts and bases are currently making reassignments automatic, others are inviting users back onto base through media campaigns. Blanchfield Army Community Hospital at Fort Campbell is letting users know that it has room to grow.

Still, Army families who currently use those facilities complain about appointment call center wait times and a lack of available appointments. At Fort Campbell, users regularly complain on the "Fort Campbell Wives" Facebook page about the inability to secure a same-day appointment for a sick child.

Officials with the National Military Family Association said their only concern about the recapture is that it will hurt the ability of military families to get care.

But some of those who have been switched to MTFs are not happy with the care and said they would be switching to Standard to stay away.

"I'd rather have to pay for civilian care using [Tricare] Standard than have my children, or myself, seen on post," said one Fort Bragg Army wife who asked that her name not be used. Her family was part of the automatic recapture in late January after being seen off post for four years.

She received a waiver to be seen off post thanks to a medical condition, but her two children did not. After months of headaches over referrals through Womack Army Medical Center for care for her children, she has given up.

"I dropped them down to Standard and kept them off post," she said.

Cristal Griffin, a Joint Base Lewis-McChord Army spouse, said she was notified of the change via mail in May after seeing a civilian doctor there since 2009. She said the change makes her worry about continuity of care, but that she's trying to look on the bright side -- she'll no longer be buying medication at an off post pharmacy.

"It sucks to me, because [our doctor] knows us so well ... so now I'm going to start all over," she said. "The good thing is that I won't have to pay for meds. I'm trying to take it positive."

-- Amy Bushatz can be reached at Amy.Bushatz@monster.com.

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