Tricare Prime Insurance

Doctors in NNY accept Tricare

WASHINGTON — Some members of the military continue to be turned away by doctors who refuse to accept the Defense Department's Tricare health insurance program, a government study found.

Health care providers continue to be scared off by relatively low reimbursement rates that are tied to Medicare, the U.S. Government Accountability Office reported.

Around Fort Drum, however, about 95 percent of providers accept Tricare patients, said Denise K. Young, director of the Fort Drum Regional Health Planning Organization. That rate, she said, is so good it is "pretty much unheard of across the country and may have as much to do with patriotism around the 10th Mountain Division as anything else."

At issue are the Tricare Standard and Extra programs, which are mainly for nonactivated military beneficiaries who can seek care from nonmilitary doctors. Active military members are required to enroll in Tricare Prime, a managed care program.

"Providers' concern about Tricare's reimbursement rates — which are generally set at Medicare rates — has been a long-standing issue and has more recently been cited as the primary reason civilian providers will not accept Tricare Standard and Extra beneficiaries as patients," the GAO reported.

In its report, the GAO —the investigative arm of Congress —said participation by doctors varies by state and is of particular concern in mental health, which has seen a spike in demand since the wars in Iraq and Afghanistan.

The GAO also reported that the Defense Department has received 13 requests for increases in reimbursement rates since 2003, including one in Watertown. In that case, in 2003, the department turned down an application for higher rates for midwife nurses, saying the paperwork was not complete.

The low reimbursement rate tied to Medicare is a long-standing issue, exacerbated by increase in demand for mental health care, although the report noted that access to mental health care is an issue across the general population.

Officials at the Pentagon's Tricare Management Activity have been working since 2010 to gain a clear sense of how available civilian medical providers are to Tricare beneficiaries; no system was in place to monitor how Tricare Standard and Extra beneficiaries were doing at finding civilian doctors. The GAO credited the department with making good progress but noted that the system is still in its infancy.

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I am 5 foot 3 and I weigh 228 pounds. I have been overweight most all my life (all of my adult life). I have attempted so many weight loss diets, pills, programs and even a gym and my success has been short lived with any of the them. I have been contimplating on looking in a different direction and considering Lapband or Gastric Bypass. My husband is active duty in the army and we have Tricare Prime for health insurance. I have not called Tricare to question if they support weight loss surgery as of yet. I thought I would first see if anyone out here is cyber space has been through what I am contimplating. If there are any military wives out there who have successfully had Tricare Prime pay for their weight loss surgery, or maybe you know someone who has… I would love to hear your stories, ideas and suggestions on how I could possibily get the ball rolling in this matter. FYI- we are currently stationed at Fort Hood in Texas if that makes any difference. Thanks so much.

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