Why You May Have to Pay for the ER


Among the many changes proposed by the Defense Department to Tricare is making you pay to pay between $30 and $70 (depending on rank) to use the emergency room if what you're there for is ruled a "non-emergency."

This seemed like a pretty good idea to me. We know military families frequent emergency rooms for minor yet urgent issues like ear infections and children with extremely high temperatures. If Tricare and the services are going to do the work to make sure military families don't have to use an emergency room to get care for that stuff, then why shouldn't the ones who choose to use it for that pay?

Here's the problem: there is no indication that they are going to make those changes. Instead, they would likely just start charging a fee and leave everything else the same. Additionally, there is no current ruling on who will define what is a "non-emergency" or how that standard will be decided. One spouse's "emergency" could be another's day-in-the-life.

I am personally guilty of emergency room "abuse." My kid had a raging ear infection over one weekend and needed treatment. The closest Urgent Care my Tricare regional contractor would let me use was 90 minutes away (even though I live at a large Army base and about 45 minutes outside a major city). So we went to the emergency room because we didn't have a choice. Then there was the time I had mastitis. My OB was on a cruise and with no urgent care options to get the simple antibiotic prescription I needed, I had to take up space in the emergency room.

But my little problems are nothing compared to the military health care users who have major health problems and are seen at military treatment facilities (MTFs). While some clinics at some MTFs are fantastic (I'm looking at you Screaming Eagle Medical Home at Fort Campbell, Ky.!) and do have same or next day appointments available, others may not have an opening for weeks. And if you or your child is sick right now, an appointment in two weeks just isn't going to cut it.

And even though Tricare says the standard for care is that the MTF give you an urgent care referral if there are no appointments available, many bases (such as Bolling Air Force Base, Maryland, according to the National Military Family Association) have policies against doing so. That Tricare nurse advice line that can help you get an urgent care appointment is only really helpful if, when you need it, they actually do help you.

That's why military family advocates, such as the National Military Family Association (NMFA), are actively opposing the ER misuse fee idea.

"When military families call the Military Treatment Facility (MTF) to make an appointment for a sick child, too many are told there are no appointments available. Or that they can’t get a referral to an urgent care in the community," they said in a blog post opposing the few proposal. "And too many are left with the Emergency Room as their only option for treatment of acute medical problems, like ear infections and strep throat – conditions that aren’t emergencies, but must be treated promptly."

Sick military families, NMFA says, deserve to be given prompt treatment for acute (even non-emergency) problems. They are asking military families who think the emergency room misuse fee proposal is a bad idea to sign a petition that they plan to give to lawmakers.

Maybe you're feeling optimistic -- or haven't experienced the problems accessing care that so many other MTF users complain about. If that's you, don't sign the petition. But for those who continue to fight an uphill care battle, heading over to this petition effort may be a step in the right direction.

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