Trying to get an appointment, especially when dealing with Tricare and the military health system, can be a daunting task. Trying to get an appointment that isn’t ten years down the road, at 4:30 in the morning, when pigs are flying with chimpanzees on their backs is even harder.
There is something you can do.
Actually, you have quite a bit of power. You just need to know your rights and when to use them.
Tricare is actually a very good insurance company. All three of the regions have steps in place to ensure that you are able to get the medical care you need as long as you know the steps to take.
So, I’ve decided I’m going to share some of the tricks of the trade over the course of the next couple of months.
Today, I’ve chosen appointments.
I act as an advocate on a regular basis trying to get patients the care they deserve. Often, I have found that it isn’t Tricare or the doctors that are keeping patients from being seen, but someone in between in the magical land of teleprompting numbers and ladies with nasal voices asking for sponsors social security numbers. So, the solution is quite simple.
If the middle man isn’t working, find some one who is.
When making an appointment, always call the appointment line first and explain your situation. Make sure you let them know the symptoms and the priority that should be given to your issue.
Be honest. Seriously, if you’ve had a bum knee for three months and are just getting around to calling, the appointment isn’t going to be listed as urgent.
However, if you just PCSed and you are 37 weeks pregnant and usually deliver at 36 weeks, priority is of the utmost importance.
If you have tried to call and aren’t getting a timely appointment, it’s time to call in the reserves. Every post, base, naval station, fort, and barracks that has an MTF (Medical Treatment Facility) has a Tricare Patient Representative. They should be prominently listed on the MTF’s website with a name and contact number.
Call that number, making sure you have the sponsor’s social security number and your personal information ready, and tell the Patient Representative about your issue.
Be polite, but let them know that you need to get an appointment in a timely manner and that you are aware that your Patient Bill of Rights entitles you to a referral to an outside source if an appointment at the MTF isn’t available promptly. Allow them 24 hours to resolve the situation.
If you aren’t satisfied at that level, all military locality websites will have consumer feedback forums (for the Army, it’s called ICE and is located at the bottom of each website’s home page). Go to the health section and file a complaint, leaving your information and requesting to be contacted. If you post a complaint anonymously, don’t expect to hear anything back. It is best to leave your information so the issue can be resolved.
Don’t worry about whether filing a complaint or calling the Patient Representative will affect your sponsor’s career. Those facilities are put in place for you to use, so use them. The military needs to know where they are not keeping up and these programs have been put in place to protect you and your ability to receive quality healthcare.
In a last resort, get in touch with me here. I’ll get you where you need to go…
Over and out.
12 Comments
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I wish I would read that about two months ago. I had a real issue making an appointment for my son. I called the day he bang his knee. he had a really bad bump with nasty bruise. my appointment was set for 3 weeks later. so I waited and as time went on my sons knees did get better but the idea is why so long to be seen. once I got the appointment the doctor had told me if i ever NEED to be seen again to request to talk to a nurse and go to urgent care. never again will I let the ladies with nasal voices asking for sponsors social security numbers make health decisions for me.
i did let the doctor know i was very upset about it. I did get a call later from some representative asking how was my last appointment making experience. I sure did let them know my experience.
Kathy,
I’m glad you took the time to talk to a representative to let them know about your negative experience getting an appointment. It was also a good move to let your docotr know about your frustrations. You did as well as you could, with the knowledge you were given and hopefully, your next experience will be better.
Chelle
The very first time I ever tried to make an appointment I was told there just wasn’t any room at any time. I simply wasn’t allowed to make one. So we went to the ER and after 8 hours was finally seen. I’m thankful for the insurance and I keep hearing how good it is…but I’ve yet to experience that good side.
Becca,
That’s a very common reproach for the schedulers to use. That’s why you need to make sure to call your on-post patient representative and let them know that your needs are not being met.
There is always an appointment open. Doctors leave room for unscheduled visits in their schedules because they know that things will come up. It is imperative to push the issue until you are able to speak with someone willing to listen to you.
Chelle
I totally have had the same situation as Becca. I was told that there will not be any appointments for the next 48 hours. What the heck? Seriously, this has to stop!!
After 15 years being the spouse of active duty I’ve seen many different scenarios, and many different PCM’s. Of all of those, most have been good experiences…
The base where we are stationed now, however, is a place where the retirees outnumber active duty outrageously. Here, it is nearly impossible for a dependent to get an appointment at the MTF, because retirees take up nearly all of the appointments. And forget about getting a prescrition filled at the MTF pharmacy…you walk in and there are a zillion retirees sitting waiting, butting in line in front of you etc… My number one question about this is…Why do retirees not have their own clinics so that active duty people and their families can recieve first priority?
Don’t get me wrong, I appreciate the retirees and the sacrifices they have made for us in their service…I have many aquaintences and friends who are retired from active service, and even they say that they need their own treatment facility. What gives??
I’m not retired, but retirees have to pay a premium for Tricare Prime and as a dependent you get free medical care. In a sense don’t you think they deserve just as much? Okay, so let look at the big picture. Medical care not including military health care eats up 14% of our Gross Domestic Product. Don’t you think that financing a war is expensive? We don’t have the funds even to move military personnel like we used to, our economy is down the drains. Where do you propose we get funding to have a separate MTF for retirees? I think once you provide that answer you can propose it to Congress. As long as people who do not take care of their health through keeping themselves fit, watching what they eat, being safe by using safety equipment and expect doctors to provide all of it, our health care system will continue down the path of eating up our economy. People who make appointments with their PCMs should ask themselves, would I be willing to pay for this service. If the answer is yes, go ahead and make that appointment. Okay, so my daughter plays softball so she gets banged up all the time. If I had her see her PCM everytime she complained of pain, we would be contributing to our deteriorating health care system. People are often narrow minded and only see their problem and don’t see that there’s people with serious health issues where a doctor is really needed. They’re treating more people who comes back from deployments hurt with complex issues, yet allocation of providers are much less than what it used to be. Of course you should be talking to a provider that can decide the urgency of the condition and not to a receptionist.
I have to agree with the comments by Peaches. I also have to agree that there is the good, bad and ugly parts of Tricare. I finally found a PCM after a year of searching and being on a provider’s waiting list for new patients for a year. After a couple of months of finally having my new PCM, she ran some tests and discovered something in my liver. I’m in the midst of more tests right now to find out what the problem is. Then I get a phone call a couple of weeks ago from my doctor’s office stating that they are no longer accepting Tricare patients and so I would need to find another doctor. This is before I have received a diagnosis. Needless to say, I was completely shocked. I did read some months ago that Tricare has not been fully reimbursing medical providers, and so some medical providers are choosing to no longer be with Tricare. As Peaches states, more and more beneficiaries are being added to Tricare’s rolls and unforunately they can’t be everything to everyone. At the same time, there needs to be a minimum level of quality medical care, and as an active duty military spouse I can say that it certainly has not been consistent. From my experience and has already been stated previously here it can vary considerably by geographic area.
Beneficiaries need to take into account the honest level of priority of their medical issue. I was on an online forum recently and heard two vastly different experiences- one spouse that was going on and on complaining that her clearly cosmetic procedure was denied by Tricare, while another spouse spoke about the cancer treatment that her son was receiving.
I am not judging anyone, however, it’s clear that any health insurance program does not have unlimited funding. Appointments should be based on medical priority, and one would think there already is such a priority scale in place.
As far as benefits for retirees and active duty and active duty dependents are concerned, Congress is aware of this and many other medical cost issues. Just recently (Aug. 08) there was Congressional testimony stating that the Tricare fees for retirees have not changed for quite some years, and clearly not kept pace with economic changes. One of the findings of their study was that younger military retirees are much more financially able to pay a greater amount for medical care than older military retirees, but both groups of beneficiaries pay the same amount currently. There’s discussion that changes be made so that retirees pay into their medical care based on their income, rather than a set figure for all retirees (including older retirees who are not able to generate as great of an income as when they were younger)
Concerning priority of retirees vs. active duty vs. active duty dependents, etc., I think that is a very very difficult discussion that civilian and military policy makers have been making and will continue to make.
Rather than focusing on which group should receive priority treatment I think we should focus on providing as fair a system as we can with the resources available to us. This would mean cutting down on the all that government waste that you hear about every day. There is so much savings that can be made that can then in turn be applied towards a health care system that can serve everyone at a reasonable level.
I have dealt with trying to get an appointment on post here and at previous posts so I know the frustration!!!!!! This is the number one reason we do not deal with going to the doctors on post!!! We get quick appointments, and wonderful care! The downside to this is that if you are tricare prime you can only pick from certain doctors in your area. Thankfully we have been blessed with good doctors here in town!
Thank you so much for this!! My son needs an echo and was not given an appointment for one until two months from now!! I am calling the Tricare Representative today!! Thanks Chelle.
They do need an overhaul of the system. My proposal would be:
1. Appointment line for routine checkups or following chronic illness. That way it does not really matter (much) if one has to wait a few weeks.
2. An urgent-care clinic. They would see people with minor injury and illness. Minor as in neither life-threatening nor chronic, aside from acute flare-ups that don’t need a trip to the ER. A bit like the active duty personnel’s “sick call” but would be all day.
3. Emergency Room. Life-or-limb-threatening injury or illness.