TRICARE “Access Improvements” May Limit Access – Here’s How You Can Help

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Just when we thought TRICARE reform couldn’t get any more disappointing and confusing…another policy detail will leave military families scratching their heads. This time, the letdown comes with potential changes to urgent care access.

Under the current Urgent Care Pilot Program, TRICARE Prime will cover up to two (2) urgent care visits a year without a referral from a primary care provider. The Pilot was a step in the right direction in giving military families access to medical care when they can’t get an appointment at their Military Treatment Facility (MTF) or when traveling.

Under the new policy military families with TRICARE Prime may still be allowed to access urgent care without a referral, however, the actual number of approved urgent care visits for each person will change from year to year. According to the official language – which can be found here – the number of urgent care visits without a referral will vary from “zero to unlimited”; to be determined by the Director of the Defense Health Agency (DHA) each year.

In the FY17 National Defense Authorization Act (NDAA) Congress authorized referral free urgent care without restriction – one of the only definite wins for military families in Congress’ TRICARE reform effort. We’re disappointed the Department of Defense (DoD) chose not to interpret the provision the same way. Instead they chose to impose a limit on the number of referral free urgent care visits; potentially eliminating referral free urgent care altogether.

When military kids are sick, parents want them to be seen by their PCM whenever possible. However, if families can’t get an appointment at their MTF, we believe they should have access to civilian urgent care to avoid unnecessary trips to the ER. The Urgent Care Pilot was a good start, but some families were confused by the limit of two urgent care visits per year. This wasn’t helped by inconsistent communication across the Military Health System. Months after the Urgent Care Pilot started, we spotted the old policy on several web pages and scrolling across an electronic message board at a military clinic.

If the number of allowed urgent care visits without a referral changes each year, it will surely create even more confusion for military families, in addition to significant communication challenges for TRICARE. Instead of reform, this new urgent care policy takes TRICARE backward. To say we’re disappointed is an understatement.

Between now and November 28, 2017, the DoD will be accepting comments and can be viewed publically after the deadline. We highly encourage you to submit your comments here on how this change will impact your family. We also encourage you to share your comments with us below or on our Facebook Page and we’ll be sure to use your comments when we draft our own written statement.

Whether you submit your comments directly to the DoD or through us, we encourage you to be part of the advocacy process. Your voice matters, because Together We’re Stronger.

Posted November 6, 2017


From: Mary Green on: November 8, 2017
As a retired military family we made the decision to cut our loses and pay to have Blue Cross after my husband fell from a ladder and literally broke his arm in half, and it was such a hassle to find a provider that accepted tricare. I am astounded at how badly our military families are treated, and how many promises have been Broken! Take away the referral policy, and allow everyone to pick a specialist and Provider!
From: Suzanne on: November 8, 2017
Please oh please don't take away the 2 free urgent care appointments! They can be lifesavers and prevent the spread of infection, at least in the case of our family. I was so happy to be able to use one of my son's free urgent care appointments the other day. When I called to see if I could get an appointment I was told there were no appointments available for that day. I was told I could either try and go to the base urgent care or wait till Sunday and see if I could get an appointment for Monday. The last time we went to the base urgent care we waited over 3 hours to be seen and another 2 hours to get taken care of-for a total of 5 hours; all to get 3 stitches for a finger my child sliced open. This seems to be an ongoing theme here at the MTF where we are at. Come to find out my son had a highly infectious skin infection that in the time we would have waited to be seen on base, he could have spread to untold people. What would be even better would be appropriately staffing the MTF or transferring people out to the civilian side so that they may receive care in a timely manner. But since that isn't likely to happen I will take our 2 urgent care visits.
From: Tina on: November 7, 2017
Access to urgent care is a life saver. There are many examples face time with a doctor has identified life threatening illnesses and mitigated suffering. Heartburn or heart attack, the flu or something more, ear ache or ear drum rupture, broken bone or bad sprain, infected or not... It always seems to happen after hours. Additionally, it is way more expensive to send urgent matters through the ER. Keep referral-less urgent care available.
From: Doreen on: November 7, 2017
Ok I know this isn't necessarily an Urgent Care issue but I guess at this rate it could turn into one. Here is my complaint, .. We've had Tricare Prime with a civilian PCP in the same area for 10 years. We've been referred to specialist from Dermatology to Podiatry, same day minor procedures to overnight stay surgeries and have always been referred to a civilian specialist nearest to our home. Now I have to have minor surgery and all of a sudden Tricare wants me to go to the MTF. Tricare refuse to allow me to go to the specialty group that I have been going to for a decade. Giving me the line that the MTF has right of first refusal. Seriously, so my choice has been stripped from me, forcing me to take a full day off from work and drive an hour to the MTF, when there's a specialist less than 10 minutes from my home. Both the Tricare and the MTF rep's were rude and basically with glee told me that I don't have to make the appointment at the MTF, but if I don't use the MTF I will have to pay out of pocket for the services. It's bad enough our prescriptions cost have gone through the roof, but now I get to remain in significant pain on pain medication. Guess this is just an example of Tricare doing their part with the epidemic. Completely disgusting... TRICARE & HUMANA you SUCK.
From: R on: November 7, 2017
Our assigned MTF is incredibly overworked and understaffed. I've observed PCM's being rushed to keep up with the patient quotas, or the 15-minute time frame for patients. Rushing appointments results in mistakes and subpar care. Same day appointments are also not usually possible. Using urgent care is a needed option for most families because of this issue. Either help appropriately staff MTFs or let patients determine the best way possible to be seen when needed.
From: Theresa on: November 7, 2017
My kids always seem to get sick on holiday weekends when the MTF is closed. The last time I called tricare for a referral for urgent care and was on the phone for 50 minutes - not very practical when you have a sick child. Urgent care should not need referrals!
From: Ashley on: November 6, 2017
I live dar from base so I have to see an off base provider. These providers are very limited and have lots if patients. It can take me 2 months to get an appointment. It takes a little to get a referral because they are do swamped. They can’t see me right away if I am ill or if my child is ill. I never really had to use urgent care until last year during my high risk pregnancy that eventually didn’t work out. I needed those visits to urgent care when I couldn’t get a referral right away.
From: Jennie on: November 6, 2017
My family and I have had the same great PCM since my husband's retirement 5 years ago. I sincerely hope we can keep going to the provider who knows me and my family. The few providers in my area do not take Tricare due to poor reimbursement!
From: Susanne on: November 6, 2017
My husband retired one year ago, it’s been a nightmare trying to figure out Tricare prime to say the least. My husband got a job and we had to move State, we now have a two hour drive one way to our Doctor because that’s the closest we could get with Tricare Prime, we have been lucky so far not needing urgent care or the ER, BUT who’s to say we won’t need that tomorrow or in six months? Then what? But ok I’ll just drive my self the four hours it takes to the Doctor and home again throwing up or in pain or what ever it might be, because that’s safe having sick people driving the interstate!!!
From: Elizabeth on: November 6, 2017
The closest MTF is not accepting new patients. My families PCM is over 20 miles away. So what? You want me to move? When I retired 5 years ago, I had a doctor I liked. A doctor only 2 miles away from my home. I was PROMISED by Tricare nothing was going to change BEFORE buying my home but it did change, just 6 months after moving in. Stop messing with my Healthcare. It's no wonder why GOOD doctors don't want to accept Tricare. It's HORRIBLE!
From: Marlene on: November 6, 2017
I believe that military families should have more than 2 urgent care visits without a referral. I always, always call the nurse line to get a referral before going to urgent care, but I feel that at times the nurses can't really give a reliable diagnosis and instead of giving a referral tell you to treat your child at home. They ask the parent for symptoms that we try are best to provide, but we aren't health care physicians who can tell if something else is wrong with our children. In efforts to help the military families I say we should be able to have more visits to urgent care without a referral in order to successfully get ourselves and our children treated properly. Please consider increasing the limit for military families. Access to our on base PCMs aren't always available, as it is very hard to get an appointment last minute.
From: Valerie on: November 6, 2017
I’m Tricare Prime and have been for many years, my 3 children grew up seeing military doctors, but back then it was Champus. I’ve never had to use the UCC and the ER only twice in 11 years as I’ve been lucky with my doctors and MTF’s. I use to work in CAMO (Central Appointing Management Office) for the JBSA community. I saw many spouses of active duty-both AF & AR- schedule appointments with their child’s PCM only to not show for it or cancel 5 minutes before the appointment time. There is no repercussions for them doing either of these. But by allowing them to abuse the system like that they are wasting the military’s money in addition to keeping another child from being seen. Unfortunately 99% of them don’t care and it ranges from the lower enlisted all the way up to officer spouses. Or you have the ones that know the child needs to be seen and purposely calls for an appointment late in the day knowing that there won’t be one because they don’t want to have to drive to the MTF and go to the UCC around the corner to them or so they don’t have to take off work. I even had some call for an urgent slot with the PCM for a sports physical then when they can’t get in fast enough expect that they can go to an UCC and expect Tricare to cover. I know that every area my not be the way it is like it is here at JBSA but until something is done to prevent spouses from no showing or from canceling at the last minute to where the appointment slot is wasted...then there is going to be problems. Years ago when my boys were little, if I did either of those my sponsors CO was notified and if it wasn’t corrected then he would answer for it. From what I understand now, nothing is done. On the civilian sector if you no show then you are billed a fee for not showing, also for not canceling so many hours before- so they can still use the appointment slot. In addition, if you no show 3 times you are no longer seen at that clinic. I’ve worked at clinics that have done this. It makes them responsible for their actions. But in today’s world along with the younger generation- none of us are responsible for what we do because we blame it on someone else, say we didn’t know, cry out that it’s unfair, straight out lie about it, or claim the other party is being racist. How about the individuals that make decisions actually take care of our troops and their families like it should be, but make sure that they are responsible for their actions, after all they are adults and not children...Right????
From: Mary on: November 6, 2017
Here's my comment: Congress and DoD - YOU SUCK! Tricare & Humana Military: You also suck! How brave of you to take away almost ALL heath care from Retirees who have little to no recourse!! I pray that what you have done to all of us comes back to all of you TENFOLD!!!
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