TriCare - Help needed to protect our benefits for WLS

Thanks so much for the response! 

I have printed off the info from the websites you presented and will take that info with me.

Again, thank you!!!

 Hi 
I have been reading for a while since my daughter is having surgery on 12-5-11.
I joined to give you my take on Tricare. We have Tricare Prime but there is also Tricare standard that reqires you to pay more out of pocket but is less restrictive with referals and other rules.
First of all it is not free.  We pay a monthly fee as well as copays for Dr. Visits and medication.
My husband is  a 30 year veteran who was in Vietnam, the Gulf war, in Yugoslavia as well as Irak.
We uprooted every 2 to 3 years and had to go where we were sent.
Also when he joined up he was promised free health care for life.
So to say it is all taxpayer money is wrong.  How many million Dollars do other insurances pay out for 
WLS ? 
I agree that purely cosmetic procedures should be limited, but sometimes these procedures a medically neccessary.  Some of them are performed at military hospitals on a space available basis.
Since most military Doctors are paid a salary according to their rank there is no extra surgeons fee to be paid if done at a military hospital, and some Military hospitals are also teaching Hospitals.
Also once you reach Social Security age you have to pay for medicare the same as everybody else.
And every military member pays taxes on their income just as everybody else.
So really there is not that much diffrence than if you have private health insurance , but the insurance TriCare provides could almost be descibed as a benefit that was earned. 
Long separations from Family, less earning than the civilian counterparts, a commitment of at least 20 years.    

Sorry this is so long but I hope i could explain a little how it all works for us retirees that have Tricare.

 Please don't apologize for length of response.  Your answer was great and is providing me with the necessary insight needed to make the points necessary.

Thank you...

Tricare standard paid for my RNY. However it took 8 months to get approval from them. My husband paid taxes his entire 21 years in the Navy, he continues to pay taxes out of his retirement. How do people get that Tricare is FREE?  Why do people think that military families do not pay taxes??  They pay federal taxes just like everyone else and state, social security and medicaid.  So we can pay for all the other government programs with our military pay but those who aren't in the military won't fund us?  WTF is that???

 

My out of pocket expenses for approval totaled about 1500 dollars (co pays, psyche eval, testings ect)  Tricare Standard is not a free service. My husband earned it by dedicating 21 years of his life to the military, losing 90 percent of his hearing, by having aches and pains and an increased risk of cancer due to the asbestos exposure that he faced daily in the engine rooms on those ships. He is disabled physically from his service to this country.  How dare anyone insinuate that we get anything for free?  Tricare prime requires a fee to enroll in as well as copays and out of pocket expenses.  We have a 3000 annual out of pocket expense and we hit that by september.  Again, how is it free?

My WLS was paid for by Tricare, just like BCBS paid for my lapband, however, I can bet Tricare paid less than BCBS did to the hospital, doctors and everyone else that I saw. 

Post surgery I had high cholesterol (Lipitor) and borderline diabetic (resolved with lapband but was coming back), a bad back (pain management with Tramadol) and who knows what else would have been prescribed.

I take nothing for pain, for cholesterol and I'm not on insulin (thank god). 

What happened to this country that people suddenly want to take away from the men and women who dedicate their lives to serving and protecting them?  

I read the article that came out in the Washington news group and it was disgusting, they should be ashamed of themselves.  The painted military wives as fat lazy slobs who were looking for an easy fix.  I can assure you that I have worked my entire life, from the time I was 10 years old and washing dishes in my families restaurant, I may be obese, but that doesn't make me undeserving. 

Next thing you know is that people will start protesting the treatment of mental disorders to those in the military as well.  Sorry no PTSD treatment for you.

I hope and pray that they do not twist your words and paint the military families in the same light as the other article it did and I wish you the best of luck

 

 

 

Mary,

Thank you from the bottom of my heart for your heartfelt response.

It is my understanding that the reason for the interview is to countermand the one that was done in Washington.  The individual who contacted me felt that military families got a raw deal and it is her intent to set the record straight.

Thanks for wishing me luck as I am sorta nervous.  I always fear I'm going to get tongue tied...

I have Tricare also, they do now require a 6 month supervised diet, medically supervised, and a whole sheet of hoops and tests to do first, I've been trying to get this done since feb of this year. It's not as easy as some think, and I am STILL waiting for the date. If I'm lucky I can have it done before the end of the year.

I dont know why you have all these hoops.  I got my referral after Feb.   I saw my PCM in March, got the referal, went to the hospital seminar in May, had my psych Eval in June, and had my first surgery in July.  I dont understand how it can be different from one person to the next.   Maybe you are seeing a civilian surgeon?  At the MTFs they are pretty quick and tricare just requires a psych eval for the surgery after qualifying.  

1.  It sounds like the military is receiving health care for doing nothing.  It was always my understanding that many companies provide health insurance for its employees.  The military is doing the same through Tricare.  Many people agreed to serve in the military because of the health care benefit.
   The military and their family have more than paid for "free" health care.  My husband has fought in 2 wars.   He has been deployed half of the 16 years we have been married.  He has missed countless birthdays,  anniversaries, and holidays because he was away with the military.  Even when he is home he works long hours.  It is not uncommon for him to work 12-14 hour days. (I shouldn't have to add he doesn't get paid overtime.)  There have been some days where he goes to work at 4 am am and comes home after 11 pm.  We move every 2-4 years.  Each time the children have to find new friends and new schools.They have to struggle at each new school as the curriculum is often different.  They also have to work twice as hard to get in gifted and talented programs, sport teams, and other organizations.  Each time we lose thousands of dollars on the move.  The military does give us money, but it never covers all the expenses.  Because of the current housing situation, many military families are stuck with upside down loans for homes.  We currently own a house at our previous duty station that is worth $50,000 less than what we paid for it.  We are renting it out, but that doesn't cover the entire payment.  With Realtor fees we are loosing $400.00 a month.  We have no choice to move.  If we had stayed in one place we would not be in this situation.  
     Tricare may be free, but it is certainly not great health care.  We don't have the choice of who we go to.  Many times we have young Dr.s without much experience.  I can not begin to tell you the mistakes that have been made through the years.  
    As the wife of a marine I don't sit at home and watch tv all day at tax payer expense.  I am both mother and father most of the time.  My husband knows he can go to war and not worry about his family.  Most commanders know that if the soldier is distracted with family problems they can not concentrate on doing their jobs.  Lives are lost that way.  That is why they have programs in place to help the military family.

2. Tricare approval was not easy for me.  I had to do 6 months of a supervised diet and many tests.  The diet and all nutritional support was out of my pocket.  This includes the dietitian with my surgeon.

3.I am no longer taking cholesterol medication or meds for my high blood pressure.  I also no longer have sleep apnea. 
    

Hi Day Dream,

Thanks so much for the response.  Your response, especially, hit home with me as you mentioned things I had forgotten.

I do so love my military sisters!!!

Thank you!!!

I got my bill in from the hospital (finally today)

The hospital billed Tricare $26,276.64 for my surgery.  Tricare paid $8185.78 for my surgery

The insurance adjustment (write off) is -17.648.66

Patient responsibility is $442.20 (yes see, I have to pay part of it)

Break down

med surge 2 bed 2020

pharmacy 2067.34

Iv solution  281.35

drugs other 20.25

med sur supplies 1894.00

Sterile supply 81.00

supply implants 995.00

labs 114.50

labs/chemistry 506.00

labs/immunology 48.00

labs/hemotology 118.00

Pathol/hytol 400.00

Xray 723.00

OR Service  $13,790.00

Anethesia Materials 2260.00

Inhalation Srvs 195.00

Pulmonary function 13.00

Recovery room 750.00

Total patient services 26276.64

 

I know that BCBS paid 18000.00 for my lapband and that was AFTER adjustment.  So I would love to see the comparison for RNY and other insurances.

also, my anethesia bill has not come in yet, that one is separate from the hospital bill

PS - Happy Veteran's Day tomorrow to all the military families/wives/children and supporters of our troops.